Government success in partnership: the USDA-ARS area-wide ecologically based invasive annual grass management program

USDA-ARS?s Scientific Manuscript database

As new research is conducted and new methods for solving problems are developed, the USDAARS has a program that allocates substantial funding to ensure these improved strategies and techniques are adopted by those who can benefit from them. These programs are called Area-wide demonstrations. A partn...

ETV REPORT AND STATEMENT, ABB INC. BIOTEMP VETABLE OIL - BASED INSULATING DIELECTRIC FLUID

EPA Science Inventory

THE USEPA has created the ETV program to facilitate the deployment of innovative of improved environmental technologies through performance verification and information dissemination. The goal of the ETV Program is to further environmental protection by substantially acceleratin...

School Library Media Programs and the National Program for Library and Information Services. Related Paper No. 7.

ERIC Educational Resources Information Center

Franckowiak, Bernard M.

The nature of the instructional process, with emphasis on student involvement in the use of materials, makes it essential that excellent school library media programs be provided at the school building level. The National Program for Library and Information Services could provide substantial improvement in the provision of information services to…

HerzMobil Tirol network: rationale for and design of a collaborative heart failure disease management program in Austria.

PubMed

Von der Heidt, Andreas; Ammenwerth, Elske; Bauer, Karl; Fetz, Bettina; Fluckinger, Thomas; Gassner, Andrea; Grander, Willhelm; Gritsch, Walter; Haffner, Immaculata; Henle-Talirz, Gudrun; Hoschek, Stefan; Huter, Stephan; Kastner, Peter; Krestan, Susanne; Kufner, Peter; Modre-Osprian, Robert; Noebl, Josef; Radi, Momen; Raffeiner, Clemens; Welte, Stefan; Wiseman, Andreas; Poelzl, Gerhard

2014-11-01

Heart failure (HF) is approaching epidemic proportions worldwide and is the leading cause of hospitalization in the elderly population. High rates of readmission contribute substantially to excessive health care costs and highlight the fragmented nature of care available to HF patients. Disease management programs (DMPs) have been implemented to improve health outcomes, patient satisfaction, and quality of life, and to reduce health care costs. Telemonitoring systems appear to be effective in the vulnerable phase after discharge from hospital to prevent early readmissions. DMPs that emphasize comprehensive patient education and guideline-adjusted therapy have shown great promise to result in beneficial long-term effects. It can be speculated that combining core elements of the aforementioned programs may substantially improve long-term cost-effectiveness of patient management.We introduce a collaborative post-discharge HF disease management program (HerzMobil Tirol network) that incorporates physician-controlled telemonitoring and nurse-led care in a multidisciplinary network approach.

Getting It Right: Designing Principal Preparation Programs That Meet District Needs for Improving Low-Performing Schools. A Technical Report on Innovative Principal Preparation Models

ERIC Educational Resources Information Center

Fry-Ahearn, Betty; Collins, David

2016-01-01

A grant from the School Leadership Program sponsored by the U.S. Department of Education during 2008-14 provided the opportunities and resources for SREB to bring together its cutting-edge knowledge base, field experience, and substantial bank of publications and training materials in the closely related fields of school improvement and school…

Lean and Efficient Software: Whole-Program Optimization of Executables

DTIC Science & Technology

2015-09-30

libraries. Many levels of library interfaces—where some libraries are dynamically linked and some are provided in binary form only—significantly limit...software at build time. The opportunity: Our objective in this project is to substantially improve the performance, size, and robustness of binary ...executables by using static and dynamic binary program analysis techniques to perform whole-program optimization directly on compiled programs

Go Figure! Using Quantitative Measures to Enhance Program and Student Success

ERIC Educational Resources Information Center

Frost, Leanne H.; Braun, Gwendolyn K.

2006-01-01

Using quantitative assessment, Montana State University-Billings substantially improved and expanded its developmental education program and learning center during the past five years. Student-centered questions drove the research efforts. By gathering, analyzing and sharing hard data, the department identified unmet student needs, discovered…

Improving cold chain systems: Challenges and solutions.

PubMed

Ashok, Ashvin; Brison, Michael; LeTallec, Yann

2017-04-19

While a number of new vaccines have been rolled out across the developing world (with more vaccines in the pipeline), cold chain systems are struggling to efficiently support national immunization programs in ensuring the availability of safe and potent vaccines. This article reflects on the Clinton Health Access Initiative, Inc. (CHAI) experience working since 2010 with national immunization programs and partners to improve vaccines cold chains in 10 countries-Ethiopia, Nigeria, Kenya, Malawi, Tanzania, Uganda, Cameroon, Mozambique, Lesotho and India - to identify the root causes and solutions for three common issues limiting cold chain performance. Key recommendations include: Collectively, the solutions detailed in this article chart a path to substantially improving the performance of the cold chain. Combined with an enabling global and in-country environment, it is possible to eliminate cold chain issues as a substantial barrier to effective and full immunization coverage over the next few years. Copyright © 2017. Published by Elsevier Ltd.

Job-Embedded Professional Learning Essential to Improving Teaching and Learning in Early Education

ERIC Educational Resources Information Center

Pacchiano, Debra; Klein, Rebecca; Hawley, Marsha Shigeyo

2016-01-01

Improving classroom teaching improves children's learning outcomes. In pursuit of those goals, the early education field has made substantial investments aimed at increasing the quality of classroom environments and teacher-child interactions. Yet, in publicly funded programs across the country, the quality of instruction remains low and…

RSA Monitoring Redesign Initiative Informational Booklet #2

ERIC Educational Resources Information Center

US Department of Education, 2005

2005-01-01

The U.S. Department of Education's Rehabilitation Services Administration (RSA) is undertaking a major initiative to substantially redesign its program monitoring and improvement system. The overriding goal is to improve vocational rehabilitation (VR) services and employment outcomes for individuals with disabilities through the development of a…

Preschool and Prosperity. Policy Paper No. 2014-017

ERIC Educational Resources Information Center

Bartik, Timothy J.

2014-01-01

Substantial research shows that high-quality early childhood education programs have a large economic payoff. This payoff is increased earnings for former child participants, increased earnings for parents, and increased earnings for all workers when average worker skills improve. A program package of universal pre-K, combined with child care and…

44 CFR 61.8 - Applicability of risk premium rates.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE... flood insurance made available for: (a) Any structure, the construction or substantial improvement of...

44 CFR 61.8 - Applicability of risk premium rates.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE... flood insurance made available for: (a) Any structure, the construction or substantial improvement of...

44 CFR 61.8 - Applicability of risk premium rates.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE... flood insurance made available for: (a) Any structure, the construction or substantial improvement of...

Economic and Nutritional Analyses Offer Substantial Synergies for Understanding Human Nutrition1

PubMed Central

Alderman, Harold; Behrman, Jere R.; Hoddinott, John

2007-01-01

There is growing recognition that interventions designed to improve human nutritional status have, in addition to their intrinsic value, instrumental value in terms of economic outcomes. In many cases, productivity gains alone provide sufficient economic returns to justify investments using benefit and cost criteria. The often-held belief that nutrition programs are welfare interventions that divert resources that could be better used in other ways to raise national incomes is incorrect. Many investments in nutrition are in fact very good economic investments. This recognition has developed out of work that integrates insights from nutrition and economics. Further exploration of this interface is the focus of this article, which seeks: 1) to outline recent contributions that integrate research results from both economics and nutrition, particularly in the context of poor countries; and 2) to describe some areas in which enhanced collaboration is likely to have substantial payoffs in terms of both improved knowledge and more informed policy choices. Collaborative cross-disciplinary research on the topics described here is likely to have substantial payoffs, not only in terms of our understanding of nutritional and economic issues, but also in the improved design of programs and policies that seek to benefit nutritional-related outcomes. PMID:17311936

Economic and nutritional analyses offer substantial synergies for understanding human nutrition.

PubMed

Alderman, Harold; Behrman, Jere R; Hoddinott, John

2007-03-01

There is growing recognition that interventions designed to improve human nutritional status have, in addition to their intrinsic value, instrumental value in terms of economic outcomes. In many cases, productivity gains alone provide sufficient economic returns to justify investments using benefit and cost criteria. The often-held belief that nutrition programs are welfare interventions that divert resources that could be better used in other ways to raise national incomes is incorrect. Many investments in nutrition are in fact very good economic investments. This recognition has developed out of work that integrates insights from nutrition and economics. Further exploration of this interface is the focus of this article, which seeks: 1) to outline recent contributions that integrate research results from both economics and nutrition, particularly in the context of poor countries; and 2) to describe some areas in which enhanced collaboration is likely to have substantial payoffs in terms of both improved knowledge and more informed policy choices. Collaborative cross-disciplinary research on the topics described here is likely to have substantial payoffs, not only in terms of our understanding of nutritional and economic issues, but also in the improved design of programs and policies that seek to benefit nutritional-related outcomes.

Standardized Patient Training Programs: an Efficient Solution to the Call for Quality Improvement in Oncologist Communication Skills.

PubMed

Ju, Melody; Berman, Abigail T; Vapiwala, Neha

2015-09-01

Several key medical and oncologic professional societies have endorsed the importance of physician communication as a quality improvement metric. Despite this clear message, there remain substantial barriers to communication skills training (CST) in oncologic specialties. Herein, we describe the major barriers to communications training and propose standardized patient (SP) programs as efficient and strategic starting points and as expansion opportunities for new and existing CSTs.

Implementation of Turnaround Strategies in Chronically Low-Performing Schools

ERIC Educational Resources Information Center

Turnbull, Brenda J.; Arcaira, Erikson R.

2012-01-01

There is some evidence to indicate that chronically low-performing schools, whether improving student performance or not, often report pursuing substantially similar policies, programs, and practices. However, while chronically low-performing schools may pursue similar school improvement strategies, there is some evidence that the level and…

Improvements and applications of COBRA-TF for stand-alone and coupled LWR safety analyses

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

Avramova, M.; Cuervo, D.; Ivanov, K.

2006-07-01

The advanced thermal-hydraulic subchannel code COBRA-TF has been recently improved and applied for stand-alone and coupled LWR core calculations at the Pennsylvania State Univ. in cooperation with AREVA NP GmbH (Germany)) and the Technical Univ. of Madrid. To enable COBRA-TF for academic and industrial applications including safety margins evaluations and LWR core design analyses, the code programming, numerics, and basic models were revised and substantially improved. The code has undergone through an extensive validation, verification, and qualification program. (authors)

One-Shot Deal? Students' Perceptions of Assessment and Course Placement in California's Community Colleges

ERIC Educational Resources Information Center

Venezia, Andrea; Bracco, Kathy Reeves; Nodine, Thad

2010-01-01

There is substantial work being done--in California and nationwide--to develop college readiness standards; expand concurrent enrollment programs; communicate clearly about the key cognitive strategies necessary for postsecondary success (e.g., analytical thinking); improve student supports; and implement other approaches to improve students'…

DOSESCREEN: a computer program to aid dose placement

Treesearch

Kimberly C. Smith; Jacqueline L. Robertson

1984-01-01

Careful selection of an experimental design for a bioassay substantially improves the precision of effective dose (ED) estimates. Design considerations typically include determination of sample size, dose selection, and allocation of subjects to doses. DOSESCREEN is a computer program written to help investigators select an efficient design for the estimation of an...

Instruction in Renal Physiology on a Minicomputer-Based Educational System.

ERIC Educational Resources Information Center

Wells, C. H.; And Others

A prototypical minicomputer-based educational system was designed at the University of Texas Medical Branch to determine if it is possible to evolve complex educational programs which are effective and also flexible and of low cost. Freshman medical students using the minicomputer program substantially improved their problem-solving abilities in…

Can disease management reduce health care costs by improving quality?

PubMed

Fireman, Bruce; Bartlett, Joan; Selby, Joe

2004-01-01

Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

U.S. Immunization program adult immunization activities and resources.

PubMed

Woods, LaDora O; Bridges, Carolyn B; Graitcer, Samuel B; Lamont, Brock

2016-04-02

Adults are recommended to receive vaccines based on their age, medical conditions, prior vaccinations, occupation and lifestyle. However, adult immunization coverage is low in the United States and lags substantially below Healthy People 2020 goals. To assess activities and resources designated for adult immunization programs by state and local health department immunization programs in the United States, we analyzed 2012 and 2013 data from the Centers for Disease Control and Prevention's (CDC) Program Annual Reports and Progress Assessments (PAPA) survey of CDC-funded immunization programs. Fifty-six of 64 funded US immunization programs' responses were included in the analysis. Eighty-two percent of (n = 46) programs reported having a designated adult immunization coordinator in 2012 and 73% (n = 41) in 2013. Of the 46 coordinators reported in 2012, 30% (n = 14) spent more than 50% of their time on adult immunization activities, and only 24% (n = 10) of the 41 adult coordinators in 2013 spent more than 50% of their time on adult immunization activities. In 2012, 23% (n = 13) of the 56 programs had a separate immunization coalition for adults and 68% (n = 38) included adult issues in their overall immunization program coalition. In 2013, 25% (n = 14) had a separate adult immunization coalition while 57% (n = 32) incorporated adult immunizations into their overall immunization program coalition. The results indicate substantial variation across the US in public health infrastructure to support adult immunizations. Continued assessment of adult immunization resources and activities will be important in improving adult immunization coverage levels though program support. With many programs having limited resources dedicated to improving adult immunization rates in the in US, efforts by the health departments to collaborate with providers and other partners in their jurisdictions to increase awareness, increase the use of proven strategies to improve vaccination of adults, and implement the Standards for Adult Immunization Practice may lead to improved adult immunization coverage and fewer illnesses, hospitalizations and deaths from vaccine preventable diseases.

U.S. Immunization program adult immunization activities and resources

PubMed Central

Woods, LaDora O.; Bridges, Carolyn B.; Graitcer, Samuel B.; Lamont, Brock

2016-01-01

ABSTRACT Adults are recommended to receive vaccines based on their age, medical conditions, prior vaccinations, occupation and lifestyle. However, adult immunization coverage is low in the United States and lags substantially below Healthy People 2020 goals. To assess activities and resources designated for adult immunization programs by state and local health department immunization programs in the United States, we analyzed 2012 and 2013 data from the Centers for Disease Control and Prevention's (CDC) Program Annual Reports and Progress Assessments (PAPA) survey of CDC-funded immunization programs. Fifty-six of 64 funded US immunization programs' responses were included in the analysis. Eighty-two percent of (n = 46) programs reported having a designated adult immunization coordinator in 2012 and 73% (n = 41) in 2013. Of the 46 coordinators reported in 2012, 30% (n = 14) spent more than 50% of their time on adult immunization activities, and only 24% (n = 10) of the 41 adult coordinators in 2013 spent more than 50% of their time on adult immunization activities. In 2012, 23% (n = 13) of the 56 programs had a separate immunization coalition for adults and 68% (n = 38) included adult issues in their overall immunization program coalition. In 2013, 25% (n = 14) had a separate adult immunization coalition while 57% (n = 32) incorporated adult immunizations into their overall immunization program coalition. The results indicate substantial variation across the US in public health infrastructure to support adult immunizations. Continued assessment of adult immunization resources and activities will be important in improving adult immunization coverage levels though program support. With many programs having limited resources dedicated to improving adult immunization rates in the in US, efforts by the health departments to collaborate with providers and other partners in their jurisdictions to increase awareness, increase the use of proven strategies to improve vaccination of adults, and implement the Standards for Adult Immunization Practice may lead to improved adult immunization coverage and fewer illnesses, hospitalizations and deaths from vaccine preventable diseases. PMID:26577532

Iterative refinement of structure-based sequence alignments by Seed Extension

PubMed Central

Kim, Changhoon; Tai, Chin-Hsien; Lee, Byungkook

2009-01-01

Background Accurate sequence alignment is required in many bioinformatics applications but, when sequence similarity is low, it is difficult to obtain accurate alignments based on sequence similarity alone. The accuracy improves when the structures are available, but current structure-based sequence alignment procedures still mis-align substantial numbers of residues. In order to correct such errors, we previously explored the possibility of replacing the residue-based dynamic programming algorithm in structure alignment procedures with the Seed Extension algorithm, which does not use a gap penalty. Here, we describe a new procedure called RSE (Refinement with Seed Extension) that iteratively refines a structure-based sequence alignment. Results RSE uses SE (Seed Extension) in its core, which is an algorithm that we reported recently for obtaining a sequence alignment from two superimposed structures. The RSE procedure was evaluated by comparing the correctly aligned fractions of residues before and after the refinement of the structure-based sequence alignments produced by popular programs. CE, DaliLite, FAST, LOCK2, MATRAS, MATT, TM-align, SHEBA and VAST were included in this analysis and the NCBI's CDD root node set was used as the reference alignments. RSE improved the average accuracy of sequence alignments for all programs tested when no shift error was allowed. The amount of improvement varied depending on the program. The average improvements were small for DaliLite and MATRAS but about 5% for CE and VAST. More substantial improvements have been seen in many individual cases. The additional computation times required for the refinements were negligible compared to the times taken by the structure alignment programs. Conclusion RSE is a computationally inexpensive way of improving the accuracy of a structure-based sequence alignment. It can be used as a standalone procedure following a regular structure-based sequence alignment or to replace the traditional iterative refinement procedures based on residue-level dynamic programming algorithm in many structure alignment programs. PMID:19589133

Using the Madeline Hunter Direct Instruction Model to Improve Outcomes Assessments in Marketing Programs

ERIC Educational Resources Information Center

Steward, Michelle D.; Martin, Gregory S.; Burns, Alvin C.; Bush, Ronald F.

2010-01-01

This study introduces marketing educators to the Madeline Hunter Direct Instruction Model (HDIM) as an approach to significantly and substantially improve student learning through course-embedded assessment. The effectiveness of the method is illustrated in three different marketing courses taught by three different marketing professors. The…

78 FR 23320 - Self-Regulatory Organizations; BATS Y-Exchange, Inc.; Notice of Designation of a Longer Period...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-18

... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-69369; File No. SR-BYX-2013-008] Self... Member Organization To Attest That ``Substantially All'' Orders Submitted to The Retail Price Improvement...,'' rather than all, orders submitted to the Retail Price Improvement Program qualify as ``Retail Orders...

Establishing a Research Agenda for American Indian and Alaska Native Head Start Programs

ERIC Educational Resources Information Center

Marks, Ellen L.; Graham, Elliott T.

2004-01-01

Since it began in 1965, Head Start has been the cornerstone of the nation's services for low-income children and their families. A substantial research base has been attached to Head Start, providing information about the program's overall accomplishments and directions about ways to improve services for young children. American Indian and Alaska…

A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

PubMed

Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

2013-11-01

Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Strategies for Energy Efficient Resource Management of Hybrid Programming Models

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

Li, Dong; Supinski, Bronis de; Schulz, Martin

2013-01-01

Many scientific applications are programmed using hybrid programming models that use both message-passing and shared-memory, due to the increasing prevalence of large-scale systems with multicore, multisocket nodes. Previous work has shown that energy efficiency can be improved using software-controlled execution schemes that consider both the programming model and the power-aware execution capabilities of the system. However, such approaches have focused on identifying optimal resource utilization for one programming model, either shared-memory or message-passing, in isolation. The potential solution space, thus the challenge, increases substantially when optimizing hybrid models since the possible resource configurations increase exponentially. Nonetheless, with the accelerating adoptionmore » of hybrid programming models, we increasingly need improved energy efficiency in hybrid parallel applications on large-scale systems. In this work, we present new software-controlled execution schemes that consider the effects of dynamic concurrency throttling (DCT) and dynamic voltage and frequency scaling (DVFS) in the context of hybrid programming models. Specifically, we present predictive models and novel algorithms based on statistical analysis that anticipate application power and time requirements under different concurrency and frequency configurations. We apply our models and methods to the NPB MZ benchmarks and selected applications from the ASC Sequoia codes. Overall, we achieve substantial energy savings (8.74% on average and up to 13.8%) with some performance gain (up to 7.5%) or negligible performance loss.« less

Review of "Promising Start: An Empirical Analysis of How EdChoice Vouchers Affect Ohio Public Schools"

ERIC Educational Resources Information Center

Lubienski, Christopher

2008-01-01

A Friedman Foundation report attempts to find empirical support for the contention that competition from private schools, through voucher programs, improves the effectiveness of public schools. In the first year of Ohio's new EdChoice voucher program, the report claims to have found substantial academic gains at public schools exposed to the…

Outcome and impact of Master of Public Health programs across six countries: education for change

PubMed Central

2014-01-01

Background The human resources for health crisis has highlighted the need for high-level public health education to add specific capacities to the workforce. Recently, it was questioned whether Master of Public Health (MPH) training prepared graduates with competencies relevant to low- and middle-income countries (LMICs). This study aims to examine the influence of the MPH programs geared towards LMICs offered in Vietnam, China, South Africa, Mexico, Sudan, and the Netherlands on graduates’ careers, application of acquired competencies, performance at the workplace, and their professional contribution to society. Methods A self-administered questionnaire was sent to graduates from six MPH programs. Frequency distributions of the answers were calculated, and a bivariate analysis and logistic regression of certain variables was performed. Results The response rate was 37.5%. Graduates reported change in leadership (69%), in technical position (69%), acquiring new responsibilities (80%), and increased remuneration (63%); they asserted that MPH programs contributed significantly to this. Graduates’ attribution of their application of 7 key competencies ‘substantially to the MPH program’ ranged from 33% to 48%. Of the 26 impact variables, graduates attributed the effect they had on their workplace substantially to the MPH program; the highest rated variable ranged from 31% to 73% and the lowest ranged from 9% to 43%. Of the 10 impact variables on society, graduates attributed the effect they had on society substantially to the MPH program; for the highest rated variable (13% to 71%); for the lowest rated variable (4% to 42%). Candidates’ attribution of their application of acquired competencies as well as their impact at the workplace varied significantly according to institution of study and educational background. Conclusions This study concludes that these MPH programs contribute to improving graduates’ careers and to building leadership in public health. The MPH programs contribute to graduates’ application of competencies. MPH programs contribute substantially towards impact variables on the workplace, such as development of research proposals and reporting on population health needs, and less substantially to their impact on society, such as contributing equitable access to quality services. Differences reported between MPH programs merit further study. The results can be used for curriculum reform. PMID:25099707

76 FR 76905 - Extension of Comment Period for Proposed Rulemaking on Substantially Underserved Trust Areas (SUTA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-09

... and community development. By financing improvements to rural electric, water and waste, and telecom..., water and waste, and telecom and broadband programs. The proposed rule invited the public to submit...

Educating More Engineers

ERIC Educational Resources Information Center

Environmental Science and Technology, 1973

1973-01-01

Indicates that there will be a substantially increased demand for environmental engineers during the next few years, especially in the areas of water pollution control and sanitary engineering. Educators see the need for additional engineering graduates and for improved environmental training programs in schools. (JR)

The Government Performance and Results Act: 1997 Governmentwide Implementation Will be Uneven

DOT National Transportation Integrated Search

1997-06-01

A consensus that the nation's persistent federal deficit must be addressed and that the effectiveness of federal programs must improve substantially has spurred widespread efforts in the executive branch and Congress to dramatically change the way th...

An Investigation of Teaching and Learning Programs in Pharmacy Education

PubMed Central

Baia, Patricia

2016-01-01

Objective. To investigate published, peer-reviewed literature on pharmacy teaching and learning development programs and to synthesize existing data, examine reported efficacy and identify future areas for research. Methods. Medline and ERIC databases were searched for studies on teaching development programs published between 2001 and 2015. Results. Nineteen publications were included, representing 21 programs. Twenty programs were resident teaching programs, one program described faculty development. The majority of programs spanned one year and delivered instruction on teaching methodologies and assessment measures. All except one program included experiential components. Thirteen publications presented outcomes data; most measured satisfaction and self-perceived improvement. Conclusion. Published literature on teacher development in pharmacy is focused more on training residents than on developing faculty members. Although programs are considered important and highly valued by program directors and participants, little data substantiates that these programs improve teaching. Future research could focus on measurement of program outcomes and documentation of teaching development for existing faculty members. PMID:27293226

An Investigation of Teaching and Learning Programs in Pharmacy Education.

PubMed

Strang, Aimee F; Baia, Patricia

2016-05-25

Objective. To investigate published, peer-reviewed literature on pharmacy teaching and learning development programs and to synthesize existing data, examine reported efficacy and identify future areas for research. Methods. Medline and ERIC databases were searched for studies on teaching development programs published between 2001 and 2015. Results. Nineteen publications were included, representing 21 programs. Twenty programs were resident teaching programs, one program described faculty development. The majority of programs spanned one year and delivered instruction on teaching methodologies and assessment measures. All except one program included experiential components. Thirteen publications presented outcomes data; most measured satisfaction and self-perceived improvement. Conclusion. Published literature on teacher development in pharmacy is focused more on training residents than on developing faculty members. Although programs are considered important and highly valued by program directors and participants, little data substantiates that these programs improve teaching. Future research could focus on measurement of program outcomes and documentation of teaching development for existing faculty members.

Planning and scheduling for success

NASA Technical Reports Server (NTRS)

Manzanera, Ignacio

1994-01-01

Planning and scheduling programs are excellent management tools when properly introduced to the project management team and regularly maintained. Communications, creativity, flexibility and accuracy are substantially improved by following a simple set of rules. A planning and scheduling program will work for you if you believe in it, make others in your project team realize its benefits, and make it an extension of your project cost control philosophy.

Programmatic Research to Develop and Disseminate Improved Instructional Technology for Handicapped Children. Project MORE Quarterly Progress Report, September 1 to December 1, 1972.

ERIC Educational Resources Information Center

Schiefelbusch, Richard L.; Lent, James R.

During the past reporting period the curriculum development staff of Project MORE (Mediated Operational Research for Education) has made substantial progress in attaining its program objectives. Design and development phases have proceeded on schedule. Four programs are currently in the field-testing stage, and four others are under development.…

Learning what matters for patients: qualitative evaluation of a health promotion program for those with serious mental illness

PubMed Central

Shiner, Brian; Whitley, Rob; Van Citters, Aricca D.; Pratt, Sarah I.; Bartels, Stephen J.

2008-01-01

Sedentary lifestyle, poor dietary behaviors and metabolic alterations associated with psychiatric medications contribute to poor health and high rates of obesity among individuals with serious mental illness (SMI). Interventions that increase engagement in physical exercise, dietary modifications, lifestyle changes and preventive health care can provide health benefits across the lifespan. These interventions have led to substantial physical improvements in some persons with SMI, while others have not improved or have experienced worsening physical health. We set out to identify characteristics of a health promotion program that persons with SMI associated with physical health improvements. Interviews were conducted with eight participants from the In SHAPE health-promotion program who lost at least 10 pounds or diminished their waist circumference by at least 10 cm. Interviews aimed to determine which aspects of the program were perceived to be most helpful in promoting physical health improvement. Among successful participants, three themes emerged, highlighting the importance of: (i) individualized interventions promoting engagement in the program; (ii) relationships with health-promotion program employees and (iii) self-confidence resulting from program participation. Health-promotion programs that target these areas may have better success in achieving health benefits for persons with SMI. PMID:18552363

Improving the Selection, Classification, and Utilization of Army Enlisted Personnel: Final Report on Project A

DTIC Science & Technology

1991-08-01

being used in both current and long-range research programs that are expected to make the Army more effective in matching the requirements for first- and... make substantial improvements to the existing selection and classifi- cation system. xi IMPROVING THE SELECTION, CLASSIFICATION, AND UTILIZATION OF...basis for new methods of allocating personnel, and making near-real-time decisions on the best match between characteristics of an individual enlistee

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

Simpson, L.

ITN Energy Systems, Inc., and Global Solar Energy, Inc., with the assistance of NREL's PV Manufacturing R&D program, have continued the advancement of CIGS production technology through the development of trajectory-oriented predictive/control models, fault-tolerance control, control-platform development, in-situ sensors, and process improvements. Modeling activities to date include the development of physics-based and empirical models for CIGS and sputter-deposition processing, implementation of model-based control, and application of predictive models to the construction of new evaporation sources and for control. Model-based control is enabled through implementation of reduced or empirical models into a control platform. Reliability improvement activities include implementation of preventivemore » maintenance schedules; detection of failed sensors/equipment and reconfiguration to continue processing; and systematic development of fault prevention and reconfiguration strategies for the full range of CIGS PV production deposition processes. In-situ sensor development activities have resulted in improved control and indicated the potential for enhanced process status monitoring and control of the deposition processes. Substantial process improvements have been made, including significant improvement in CIGS uniformity, thickness control, efficiency, yield, and throughput. In large measure, these gains have been driven by process optimization, which, in turn, have been enabled by control and reliability improvements due to this PV Manufacturing R&D program. This has resulted in substantial improvements of flexible CIGS PV module performance and efficiency.« less

Is Health of the Aging Improved by Conditional Cash Transfer Programs? Evidence From Mexico

PubMed Central

Behrman, Jere R.

2013-01-01

Conditional cash transfer (CCT) programs link public transfers to human capital investment in the hopes of alleviating current poverty and reducing its intergenerational transmission. Whereas nearly all studies of their effects have focused on youth, CCT programs may also have an impact on aging adults by increasing household resources or inducing changes in allocations of time of household members, which may be of substantial interest, particularly given the rapid aging of most populations. This article contributes to this underresearched area by examining health and work impacts on the aging for the best-known and most influential of these programs, the Mexican PROGRESA/Oportunidades program. For a number of health indicators, the program appears to significantly improve health, with larger effects for recipients with a greater time receiving benefits from the program. Most of these health effects are concentrated on women. PMID:23494570

Medicare+Choice: what lies ahead?

PubMed

Layne, R Jeffrey

2002-03-01

Health plans have continued to exit the Medicare+Choice program in recent years, despite efforts of Congress and the Centers for Medicare and Medicaid Services (CMS) to reform the program. Congress and CMS therefore stand poised to make additional, substantial reforms to the program. CMS has proposed to consolidate its oversight of the program, extend the due date for Medicare+Choice plans to file their adjusted community rate proposals, revise risk-adjustment processes, streamline the marketing review process, enhance quality-improvement requirements, institute results based performance assessment audits, coordinate policy changes to coincide with contracting cycles, expand its fall advertising campaign for the program, provide better employer-based Medicare options for beneficiaries, and take steps to minimize beneficiary costs. Congressional leaders have proposed various legislative remedies to improve the program, including creation of an entirely new pricing structure for the program based on a competitive bidding process.

Attitudes of Pulmonary and Critical Care Training Program Directors toward Quality Improvement Education.

PubMed

Kahn, Jeremy M; Feemster, Laura C; Fruci, Carolyn M; Hyzy, Robert C; Savant, Adrienne P; Siner, Jonathan M; Weiss, Curtis H; Patel, Bela

2015-04-01

Quality improvement (QI) is a required component of fellowship training in pulmonary, critical care, and sleep medicine. However, little is known about how training programs approach QI education. We sought to understand the perceptions of pulmonary, critical care, and sleep medicine training program directors toward QI education. We developed and fielded an internet survey of pulmonary, critical care, and sleep medicine training program directors during 2013. Survey domains included program characteristics, the extent of trainee and faculty involvement in QI, attitudes toward QI education, and barriers to successful QI education in their programs. A total of 75 program directors completed the survey (response rate = 45.2%). Respondents represented both adult (n = 43, 57.3%) and pediatric (n = 32, 42.7%) programs. Although the majority of directors (n = 60, 80.0%) reported substantial fellow involvement in QI, only 19 (26.0%) reported having a formal QI education curriculum. QI education was primarily based around faculty mentoring (n = 46, 61.3%) and lectures (n = 38, 50.7%). Most directors agreed it is an important part of fellowship training (n = 63, 84.0%). However, fewer reported fellows were well integrated into ongoing QI activities (n = 45, 60.0%) or graduating fellows were capable of carrying out independent QI (n = 28, 50.7%). Key barriers to effective QI education included lack of qualified faculty, lack of interest among fellows, and lack of time. Training program directors in pulmonary, critical care, and sleep medicine value QI education but face substantial challenges to integrating it into fellowship training.

Risk Managers’ Descriptions of Programs to Support Second Victims after Adverse Events

PubMed Central

White, Andrew A.; Brock, Doug; McCotter, Patricia I.; Hofeldt, Ron; Edrees, Hanan H.; Wu, Albert W.; Shannon, Sarah; Gallagher, Thomas H.

2015-01-01

Guidelines call for healthcare organizations to provide emotional support for clinicians involved in adverse events, but little is known about these organizations seek to meet this need. We surveyed U.S. members of ASHRM about the presence, features, and perceived efficacy of their organization’s provider support program. The majority reported that their organization had a support program, but features varied widely and there are substantial opportunities to improve services. Provider support programs should enhance referral mechanisms and peer support, critically appraise the role of Employee Assistance Programs, and demonstrate their value to institutional leaders. PMID:25891288

Weekend sun protection and sunburn in Australia trends (1987-2002) and association with SunSmart television advertising.

PubMed

Dobbinson, Suzanne J; Wakefield, Melanie A; Jamsen, Kris M; Herd, Natalie L; Spittal, Matthew J; Lipscomb, John E; Hill, David J

2008-02-01

The Australian state of Victoria has run a population-based skin cancer prevention program called SunSmart since 1988, incorporating substantial public education efforts and environmental change strategies. Trends over 15 years in behavioral risk factors for skin cancer were examined in a population exposed to the SunSmart program. Whether outcomes were associated with extent of SunSmart television advertising was then assessed. In nine cross-sectional surveys from 1987 to 2002, 11,589 adults were interviewed by telephone about their sun exposure and sun protection during outdoor activities on summer weekends. Analyses completed in 2007 adjusted for ambient temperature and ultraviolet radiation. Sun protection and sunburn show substantial general improvement over time, but have stalled in recent years. Use of hats and sunscreens significantly increased over time and peaked during the mid to late 1990s, compared with the pre-SunSmart baseline. The mean proportion of unprotected skin was reduced and was lowest in the summer of 1997-1998. Summer sunburn incidence declined over time and was 9.1% in 2002, almost half baseline (OR=0.53; 95% CI=0.39-0.73). Higher exposure to SunSmart advertising in the 4 weeks before the interview increased: (1) preference for no tan, (2) hat and sunscreen use, and (3) proportion of body surface protected from the sun. The general improvement in sun-protective behaviors over time highlight that a population's sun-protective behaviors are amenable to change. Population-based prevention programs incorporating substantial television advertising campaigns into the mix of strategies may be highly effective in improving a population's sun-protective behaviors.

Findings From the National Machine Guarding Program: A Small Business Intervention: Lockout/Tagout.

PubMed

Parker, David L; Yamin, Samuel C; Xi, Min; Brosseau, Lisa M; Gordon, Robert; Most, Ivan G; Stanley, Rodney

2016-01-01

Failure to implement lockout/tagout (LOTO) procedures adversely affects the rate of work-related fatalities and serious traumatic injury and is one of the most frequently cited Occupational Safety and Health Administration standards. This study assesses the impact of a nationwide intervention to improve LOTO in small metal fabrication businesses. Insurance safety consultants conducted a standardized and validated evaluation of LOTO programs and procedures. Businesses received a baseline evaluation, two intervention visits, and a 12-month follow-up evaluation. The intervention was completed by 160 businesses. The mean LOTO procedure score improved from 8% to 33% (P < 0.0001), the mean program score went from 55% to 76% (P < 0.0001), and the presence of lockable disconnects went from 88% to 92% (P < 0.0001). This nationwide intervention showed substantial improvements in LOTO. It provides a framework for assessing and improving LOTO.

High-End Climate Science: Development of Modeling and Related Computing Capabilities

DTIC Science & Technology

2000-12-01

toward strengthening research on key scientific issues. The Program has supported research that has led to substantial increases in knowledge , improved...provides overall direction and executive oversight of the USGCRP. Within this framework, agencies manage and coordinate Federally supported scientific...critical for the U.S. Global Change Research Program. Such models can be used to look backward to test the consistency of our knowledge of Earth system

SU-F-E-12: Elective International Rotations in Medical Physics Residency Programs

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

Brown, D; Mundt, A; Einck, J

Purpose: The purpose of this educational program is to motivate talented, intelligent individuals to become stakeholders in the global effort to improve access to radiotherapy. Methods: The need to improve global access to radiotherapy has been clearly established and several organizations are making substantial progress in securing funding and developing plans to achieve this worthwhile goal. The incorporation of elective international rotations in residency programs may provide one possible mechanism to promote and support this future investment. We recently incorporated an elective 1-month international rotation into our CAMPEP accredited Medical Physics residency program, with our first rotation taking place inmore » Vietnam. A unique aspect of this rotation was that it was scheduled collaboratively with our Radiation Oncology residency program such that Radiation Oncology and Medical Physics residents traveled to the same clinic at the same time. Results: We believe the international rotation substantially enhances the educational experience, providing additional benefits to residents by increasing cross-disciplinary learning and offering a shared learning experience. The combined international rotation may also increase benefit to the host institution by modeling positive multidisciplinary working relationships between Radiation Oncologists and Medical Physicists. Our first resident returned with several ideas designed to improve radiotherapy in resource-limited settings – one of which is currently being pursued in collaboration with a vendor. Conclusion: The elective international rotation provides a unique learning experience that has the potential to motivate residents to become stakeholders in the global effort to improve access to radiotherapy. What better way to prepare the next generation of Medical Physicists to meet the challenges of improving global access to radiotherapy than to provide them with training experiences that motivate them to be socially conscious and equip them with the clinical and problem solving skills required to deliver effective treatments in resource limited settings?.« less

The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.

PubMed

Ouslander, Joseph G; Bonner, Alice; Herndon, Laurie; Shutes, Jill

2014-03-01

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and accountable care organizations, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust quality assurance performance improvement program, which is being rolled out by the federal government over the next year. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Cognitive-Behavioral Therapy for Bulimia: An Initial Outcome Study.

ERIC Educational Resources Information Center

Ordman, Arnold M.; Kirschenbaum, Daniel S.

1985-01-01

Examined the efficacy of a cognitive-behavioral therapy for bulimia. Assigned 20 bulimic women to full- or brief-intervention therapy programs. Results indicated that full-intervention clients, relative to brief-intervention clients, substantially reduced the frequency of their bingeing-vomiting; improved their psychological adjustment; and…

General aviation accidents : the United States Air Force Aero Club solution

DOT National Transportation Integrated Search

1998-08-01

Aviation if an intrisically safe mode of travel. In 1994, the United States Air Force system of Aero Clubs put forth substantial effort to put a program in place (Fly Smart) to improve flying safety in it aircraft. This study compares the accident ra...

Student Financial Aid Delivery System.

ERIC Educational Resources Information Center

O'Neal, John R.; Carpenter, Catharine A.

1983-01-01

Ohio University's use of computer programing for the need analysis and internal accounting functions in financial aid is described. A substantial improvement of services resulted, with 6,000-10,000 students and the offices of financial aid, bursar, registration, student records, housing, admissions, and controller assisted in the process. Costs…

Assessing School Turnaround: Evidence from Ohio

ERIC Educational Resources Information Center

Player, Daniel; Katz, Veronica

2016-01-01

Policy makers have struggled to find successful approaches to address concentrated, persistent low school achievement. While NCLB and the School Improvement Grant (SIG) program have devoted significant time and attention to turnaround, very little empirical evidence substantiates whether and how these efforts work. This study employs a comparative…

Accuracy of Surgery Clerkship Performance Raters.

ERIC Educational Resources Information Center

Littlefield, John H.; And Others

1991-01-01

Interrater reliability in numerical ratings of clerkship performance (n=1,482 students) in five surgery programs was studied. Raters were classified as accurate or moderately or significantly stringent or lenient. Results indicate that increasing the proportion of accurate raters would substantially improve the precision of class rankings. (MSE)

A pilot study of orthopaedic resident self-assessment using a milestones’ survey just prior to milestones implementation

PubMed Central

Bradley, Kendall E.

2016-01-01

Objectives To pilot test if Orthopaedic Surgery residents could self-assess their performance using newly created milestones, as defined by the Accreditation Council on Graduate Medical Education.  Methods In June 2012, an email was sent to Program Directors and administrative coordinators of the154 accredited Orthopaedic Surgery Programs, asking them to send their residents a link to an online survey. The survey was adapted from the Orthopaedic Surgery Milestone Project. Completed surveys were aggregated in an anonymous, confidential database. SAS 9.3 was used to perform the analyses. Results Responses from 71 residents were analyzed. First and second year residents indicated through self-assessment that they had substantially achieved Level 1 and Level 2 milestones. Third year residents reported they had substantially achieved 30/41, and fourth year residents, all Level 3 milestones. Fifth year, graduating residents, reported they had substantially achieved 17 Level 4 milestones, and were extremely close on another 15. No milestone was rated at Level 5, the maximum possible.  Earlier in training, Patient Care and Medical Knowledge milestones were rated lower than the milestones reflecting the other four competencies of Practice Based Learning and Improvement, Systems Based Practice, Professionalism, and Interpersonal Communication. The gap was closed by the fourth year. Conclusions Residents were able to successfully self-assess using the 41 Orthopaedic Surgery milestones. Respondents’ rate improved proficiency over time. Graduating residents report they have substantially, or close to substantially, achieved all Level 4 milestones.  Milestone self-assessment may be a useful tool as one component of a program’s overall performance assessment strategy. PMID:26752012

State “Technical Assistance Programs” for nursing home quality improvement: variations and potential implications

PubMed Central

Li, Yue; Spector, Williams D.; Glance, Laurent G.; Mukamel, Dana B.

2013-01-01

Context To improve nursing home quality, many states developed “Technical Assistance Programs” that provide on-site consultation and training for nursing facility staff. Methods We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. Results As of 2010, 17 states have developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. Conclusion State “Technical Assistance Programs” for nursing homes varies in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives. PMID:23216345

Consumer Law Guide

DTIC Science & Technology

1994-06-01

Consumer Finance Act by making short-term advances to customers who write personal checks in return for substantially smaller amounts of on-the-spot case...practices lawsuit with H&R Block, Inc. forcing tax return company to advertise its "Rapid Refund" program is actually a loan program charging customers ...home equity loans/lines of credit/home improvement loans, etc.) 2. A consumer can have only 9M principal dwelling at a time (includes mobile homes

A Case Study of Change in the Teaching and Learning of Precalculus to Calculus 2: What We Are Doing with What We Have

ERIC Educational Resources Information Center

Apkarian, Naneh; Bowers, Janet; O'Sullivan, Michael E.; Rasmussen, Chris

2018-01-01

This article presents a case study that details the successes and lessons learned by faculty and administrators at San Diego State University (SDSU) who are in the process of implementing a substantial improvement to the Precalculus to Calculus 2 sequence. Improvement efforts have been informed by national studies of successful programs and center…

The technology application process as applied to a firefighter's breathing system

NASA Technical Reports Server (NTRS)

Mclaughlan, P. B.

1974-01-01

The FBS Program indicated that applications of advanced technology can result in an improved FBS that will satisfy the requirements defined by municipal fire departments. To accomplish this technology transfer, a substantial commitment of resources over an extended period of time has been required. This program has indicated that the ability of NASA in terms of program management such as requirement definition, system analysis, and industry coordination may play as important a role as specific sources of hardware technology. As a result of the FBS program, a sequence of milestones was passed that may have applications as generalized milestones and objectives for any technical application program.

Eating Better for Less: A National Discount Program for Healthy Food Purchases in South Africa

PubMed Central

An, Ruopeng; Patel, Deepak; Segal, Darren; Sturm, Roland

2012-01-01

Background Improving diet quality is a key health promotion strategy. The HealthyFood program provides up to a 25% discount on selected food items to about 260,000 households across South Africa. Objectives Examine whether reducing prices for healthy food purchases leads to changes in self-reported measures of food consumption and weight status. Methods Repeated surveys of about 350,000 HealthyFood participants and nonparticipants. Results Program participation is associated with more consumption of fruits/vegetables and wholegrain foods, and less consumption of high sugar/salt foods, fried foods, processed meats, and fast-food. There is no strong evidence that participation reduces obesity. Conclusions A substantial price intervention might be effective in improving diets. PMID:22943101

Teaching Children to Identify the Main Idea of Expository Texts.

ERIC Educational Resources Information Center

Williams, Joanna P.

1986-01-01

When 11-year-old learning disabled students who were two years behind in reading participated in an instructional program emphasizing comprehension of main ideas using basic categorization and classification skills, there was a significant and substantial improvement in reading comprehension and ability to write sentences containing the main idea…

Promoting Educator Effectiveness: The Effects of Two Key Strategies. NCEE 2018-4009

ERIC Educational Resources Information Center

Wayne, Andrew; Garet, Michael; Wellington, Alison; Chiang, Hanley

2018-01-01

Having a more effective teacher or principal can substantially improve students' academic outcomes. The Teacher Incentive Fund (TIF) program, established in 2006, provided competitive grants to help states and districts implement a multi-strategy approach to enhancing educator effectiveness. TIF grantees were required to measure educator…

34 CFR 200.42 - Corrective action.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Corrective action. 200.42 Section 200.42 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.42 Corrective action. (a) Definition. “Corrective action” means action by an LEA that— (1) Substantially and directly responds to— (i...

34 CFR 200.42 - Corrective action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Corrective action. 200.42 Section 200.42 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.42 Corrective action. (a) Definition. “Corrective action” means action by an LEA that— (1) Substantially and directly responds to— (i...

How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

PubMed

Cho, Yu Kyung

2016-07-01

In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

Aid to people with disabilities: Medicaid's growing role.

PubMed

Carbaugh, Alicia L; Elias, Risa; Rowland, Diane

2006-01-01

Medicaid is the nation's largest health care program providing assistance with health and long-term care services for millions of low-income Americans, including people with chronic illness and severe disabilities. This article traces the evolution of Medicaid's now-substantial role for people with disabilities; assesses Medicaid's contributions over the last four decades to improving health insurance coverage, access to care, and the delivery of care; and examines the program's future challenges as a source of assistance to children and adults with disabilities. Medicaid has shown that it is an important source of health insurance coverage for this population, people for whom private coverage is often unavailable or unaffordable, substantially expanding coverage and helping to reduce the disparities in access to care between the low-income population and the privately insured.

Improvements to the adaptive maneuvering logic program

NASA Technical Reports Server (NTRS)

Burgin, George H.

1986-01-01

The Adaptive Maneuvering Logic (AML) computer program simulates close-in, one-on-one air-to-air combat between two fighter aircraft. Three important improvements are described. First, the previously available versions of AML were examined for their suitability as a baseline program. The selected program was then revised to eliminate some programming bugs which were uncovered over the years. A listing of this baseline program is included. Second, the equations governing the motion of the aircraft were completely revised. This resulted in a model with substantially higher fidelity than the original equations of motion provided. It also completely eliminated the over-the-top problem, which occurred in the older versions when the AML-driven aircraft attempted a vertical or near vertical loop. Third, the requirements for a versatile generic, yet realistic, aircraft model were studied and implemented in the program. The report contains detailed tables which make the generic aircraft to be either a modern, high performance aircraft, an older high performance aircraft, or a previous generation jet fighter.

A program-management plan with critical-path definition for Combustion Augmentation with Thermionic Energy Conversion (CATEC)

NASA Technical Reports Server (NTRS)

Morris, J. F.; Merrill, O. S.; Reddy, H. K.

1981-01-01

Thermionic energy conversion (TEC) is discussed. In recent TEC-topping analyses, overall plant efficiency (OPE) and cost of electricity (COE) improved slightly with current capabilities and substantially with fully matured technologies. Enhanced credibility derives from proven hot-corrosion protection for TEC by silicon-carbide clads in fossil fuel combustion products. Combustion augmentation with TEC (CATEC) affords minimal cost and plant perturbation, but with smaller OPE and COE improvements than more conventional topping applications. Risk minimization as well as comparative simplicity and convenience, favor CATEC for early market penetration. A program-management plan is proposed. Inputs, characteristics, outputs and capabilities are discussed.

A program-management plan with critical-path definition for Combustion Augmentation with Thermionic Energy Conversion (CATEC)

NASA Astrophysics Data System (ADS)

Morris, J. F.; Merrill, O. S.; Reddy, H. K.

Thermionic energy conversion (TEC) is discussed. In recent TEC-topping analyses, overall plant efficiency (OPE) and cost of electricity (COE) improved slightly with current capabilities and substantially with fully matured technologies. Enhanced credibility derives from proven hot-corrosion protection for TEC by silicon-carbide clads in fossil fuel combustion products. Combustion augmentation with TEC (CATEC) affords minimal cost and plant perturbation, but with smaller OPE and COE improvements than more conventional topping applications. Risk minimization as well as comparative simplicity and convenience, favor CATEC for early market penetration. A program-management plan is proposed. Inputs, characteristics, outputs and capabilities are discussed.

Implementation of a worksite educational program focused on promoting healthy eating habits.

PubMed

Tanagra, Dimitra; Panidis, Dimitris; Tountas, Yannis; Remoudaki, Elina; Alexopoulos, Evangelos C

2013-01-01

To estimate the effectiveness of a short-term educational-counseling worksite program focused on lipid intake, by monitoring the possible change on nutrition knowledge and eating habits. an 8-week educational program based on the Health Belief Model was implemented in a honey packaging and sales company in Greece. 20 out of the 29 employees initially enrolled completed the program. Knowledge level and eating habits were evaluated prior and after the intervention by the "Nutrition Knowledge Questionnaire" and the "Food Habits Questionnaire". ANOVA, Spearman rho test and paired Wilcoxon test were employed in statistical analysis. Non smokers and those with higher educational level had healthier eating habits. Knowledge following the intervention was significantly improved concerning recommendations and basic food ingredients but as far as eating habits were concerned, scores were not improved significantly, while intake of fried food was increased. Short-term interventions may produce substantial improvement in knowledge but not necessarily modifications in unhealthy eating habits.

Cognitive intervention in unemployed individuals with reading and writing disabilities.

PubMed

Jensen, J; Lindgren, M; Andersson, K; Ingvar, D H; Levander, S

2000-01-01

Sixty native-born Swedish unemployed participants with reading and writing disabilities (R&WD) participated in a 20-week educational program aimed at improving reading and writing, verbal memory, self-confidence, and flexibility of perspectives. They were tested with a comprehensive battery (interviews, questionnaires, neuropsychological tests, and tests of academic achievement) before and after the intervention. Sixteen controls, matched for sex, age, education, and nonverbal IQ, participated in the pre- and posttest sessions but received only standard unemployment interventions. The educational program participants' performance in tests assessing spelling, decoding of letters, self-confidence, and flexibility improved significantly in comparison with the controls after the intervention. A significantly larger number of the participants had obtained work or started a regular education than expected. A substantial proportion of unemployed participants have R&WD and it appears that an intensive but fairly short educational program can improve their accessibility to the labor market and their motivation for study.

Solid polymer electrolyte (SPE) fuel cell technology program, phase 1/1A. [design and fabrication

NASA Technical Reports Server (NTRS)

1975-01-01

A solid polymer electrolyte fuel cell was studied for the purpose of improving the characteristics of the technology. Several facets were evaluated, namely: (1) reduced fuel cell costs; (2) reduced fuel cell weight; (3) improved fuel cell efficiency; and (4) increased systems compatibility. Demonstrated advances were incorporated into a full scale hardware design. A single cell unit was fabricated. A substantial degree of success was demonstrated.

Hypertension in Russia: Changes Observed After 4 Years of a Comprehensive Health System Improvement Program in the Yaroslavl Region.

PubMed

Mozheyko, Maria; Eregin, Sergey; Danilenko, Natalia; Vigdorchik, Alexey; Tobe, Sheldon W; Campbell, Norman; McLean, Donna; Baskakova, Zhanna; Klimovskaia, Ilnaz; Ramanathan, Krishnan; Hughes, David

2017-02-01

Rates of cardiovascular mortality and morbidity in Russia have been among the highest in Europe. A comprehensive health system improvement program targeting better diagnosis and control of hypertension was undertaken in the Yaroslavl Region of Russia. This initiative was a joint program between clinicians, the Department of Health and Pharmacy of the Yaroslavl Region, and Novartis Pharma LLC. From 2011 to 2014, the blood pressure control rate improved substantially (94% relative improvement), the percentage of patients with a systolic blood pressure ≥180 mm Hg decreased (from 10% to 5%), and there was a reduction in stroke incidence rate from 4.6 to 3.7 per 1000 population. During this same period, significant changes were made to the way hypertension was diagnosed and treated across all regional government polyclinics, and the use of antihypertensive therapies increased. © 2016 The Authors. The Journal of Clinical Hypertension Published by Wiley Periodicals, Inc.

A Revised Guide for Improving Teacher Education in Human Rights.

ERIC Educational Resources Information Center

Phi Delta Kappa, Bloomington, IN. Commission of Education, Human Rights, and Responsibilities.

This document serves as a guide for teacher education institutions and programs designed to prepare educators for meeting their responsibilities in the area of human rights and human relations. This second edition of the guide represents a substantial modification of the original guide, and includes many activities, experiences, and suggestions…

34 CFR 609.20 - What are the application requirements for a grant under this part?

Code of Federal Regulations, 2013 CFR

2013-07-01

... GRADUATE INSTITUTIONS PROGRAM How Does an Eligible Institution Apply for a Grant? § 609.20 What are the... funds and how those activities will improve graduate educational opportunities for Black and low-income... applicant is making a substantial contribution to the legal, medical, dental, veterinary or other graduate...

34 CFR 609.20 - What are the application requirements for a grant under this part?

Code of Federal Regulations, 2010 CFR

2010-07-01

... GRADUATE INSTITUTIONS PROGRAM How Does an Eligible Institution Apply for a Grant? § 609.20 What are the... funds and how those activities will improve graduate educational opportunities for Black and low-income... applicant is making a substantial contribution to the legal, medical, dental, veterinary or other graduate...

34 CFR 609.20 - What are the application requirements for a grant under this part?

Code of Federal Regulations, 2012 CFR

2012-07-01

... GRADUATE INSTITUTIONS PROGRAM How Does an Eligible Institution Apply for a Grant? § 609.20 What are the... funds and how those activities will improve graduate educational opportunities for Black and low-income... applicant is making a substantial contribution to the legal, medical, dental, veterinary or other graduate...

34 CFR 609.20 - What are the application requirements for a grant under this part?

Code of Federal Regulations, 2011 CFR

2011-07-01

... GRADUATE INSTITUTIONS PROGRAM How Does an Eligible Institution Apply for a Grant? § 609.20 What are the... funds and how those activities will improve graduate educational opportunities for Black and low-income... applicant is making a substantial contribution to the legal, medical, dental, veterinary or other graduate...

National Service Programs and Their Effects on Military Manpower and Civilian Youth Problems. Budget Issue Paper for Fiscal Year 1979.

DTIC Science & Technology

1978-01-01

advent of the All-Volunteer Force (AVF), military salaries have risen substantially; working conditions have improved; recruiting and advertising ...to be second-class citizens. 14/ Alienation among disavantaged youth—for example, black teenagers in urban ghettos—is particularly high. 13/ ACE

Essential Competencies for Interdisciplinary Graduate Training: Summary Report. GS-10F-0086K

ERIC Educational Resources Information Center

Gamse, Beth C.; Espinosa, Lorelle L.; Roy, Radha

2013-01-01

The Integrative Graduate Education and Research Traineeship (IGERT) program represents a substantial investment by the National Science Foundation (NSF) to improve the quality of graduate education, and ultimately, to increase the number of graduates better prepared to address our nation's 21st century scientific and technological needs. The…

78 FR 71555 - Medicare Program; Town Hall Meeting on FY 2015 Applications for New Medical Services and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-29

... FY 2015 new medical services and technologies applications meet the substantial clinical improvement... new medical services and technologies under Medicare. Effective for discharges beginning on or after... specifies that a medical service or technology will be considered ``new'' if it meets criteria established...

Revisiting Economies of Size in American Education: Are We Any Closer to a Consensus?

ERIC Educational Resources Information Center

Andrews, Matthew; Duncombe, William; Yinger, John

2002-01-01

Explores whether state policies encouraging the consolidation of rural school districts to improve efficiency through economies of scale are substantiated in the research literature. Reviews three decades of research on education economies of scale involving cost and production-function studies. Finds little program-evaluation research on school…

Performance Feedback Utility in a Small Organization: Effects on Organizational Outcomes and Managerial Decision Processes.

ERIC Educational Resources Information Center

Florin-Thuma, Beth C.; Boudreau, John W.

1987-01-01

Investigated the frequent but previously untested assertion that utility analysis can improve communication and decision making about human resource management programs by examining a performance feedback intervention in a small fast-food store. Results suggest substantial payoffs from performance feedback, though the store's owner-managers had…

Optimization of a bundle divertor for FED

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

Hively, L.M.; Rothe, K.E.; Minkoff, M.

1982-01-01

Optimal double-T bundle divertor configurations have been obtained for the Fusion Engineering Device (FED). On-axis ripple is minimized, while satisfying a series of engineering constraints. The ensuing non-linear optimization problem is solved via a sequence of quadratic programming subproblems, using the VMCON algorithm. The resulting divertor designs are substantially improved over previous configurations.

James-Stein Estimation. Program Statistics Research, Technical Report No. 89-86.

ERIC Educational Resources Information Center

Brandwein, Ann Cohen; Strawderman, William E.

This paper presents an expository development of James-Stein estimation with substantial emphasis on exact results for nonnormal location models. The themes of the paper are: (1) the improvement possible over the best invariant estimator via shrinkage estimation is not surprising but expected from a variety of perspectives; (2) the amount of…

Publication of the maps of Tenke and Manono (Zaire) from LANDSAT data

NASA Technical Reports Server (NTRS)

Yampania, M.

1981-01-01

The collection of cartographic data on Zaire up to the present time was based on aerial reconnaissance. This approach is very expensive if repetitive coverage is required in such a large country. The integration with the LANDSAT program among the data collection systems improves the mapping efforts substantially.

Benefits of Coaching on Test Scores Seen as Negligible.

ERIC Educational Resources Information Center

Report on Education Research, 1983

1983-01-01

THE FOLLOWING IS THE FULL TEXT OF THIS DOCUMENT: A new study by a pair of Harvard University researchers discounts earlier findings that coaching can substantially improve student performance on the Scholastic Aptitude Test (SAT). "There is simply insufficient evidence that large score increases are a result of a coaching program," write…

Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon.

PubMed

Wright, Bill J; Garcia-Alexander, Ginny; Weller, Margarette A; Baicker, Katherine

2017-05-01

Efforts to reduce the ranks of the uninsured hinge on take-up of available programs and subsidies, but take-up of even free insurance is often less than complete. The evidence of the effectiveness of policies aiming to increase take-up is limited. We used a randomized controlled design to evaluate the impact of improved communication and behaviorally informed "nudges" designed to increase Medicaid take-up among eligible populations. Fielding randomized interventions in two different study populations in Oregon, we found that even very low-cost interventions substantially increased enrollment. Effects were larger in a population whose members had already expressed interest in obtaining coverage, but the effects were more persistent in low-income populations whose members were already enrolled in other state assistance programs but had not expressed interest in health insurance. The effects were similar across different demographic groups. Our results suggest that improving the design of enrollment processes and using low-cost mass-outreach efforts have the potential to substantially increase insurance coverage of vulnerable populations. Project HOPE—The People-to-People Health Foundation, Inc.

The effect of a contingent monetary reward on probation referrals to a drug abuse program.

PubMed

Hunsaker, A C

1985-01-01

Faced with reductions in public funds and calls for greater accountability, substance abuse programs can possibly increase revenues through patient fees by increasing referrals from the criminal justice system. Accountability can be improved through the use of organizational behavior management techniques. This study demonstrates the utility of behavioral techniques to increase referrals and revenue in an outpatient drug abuse program. The rate of criminal justice referrals increased substantially when counselors were offered "commissions" based on patient fees. These results are discussed with respect to the practicality of behavioral techniques in the management of drug abuse programs and with regard to policy implications.

Risk managers' descriptions of programs to support second victims after adverse events.

PubMed

White, Andrew A; Brock, Douglas M; McCotter, Patricia I; Hofeldt, Ron; Edrees, Hanan H; Wu, Albert W; Shannon, Sarah; Gallagher, Thomas H

2015-01-01

Guidelines call for healthcare organizations to provide emotional support for clinicians involved in adverse events, but little is known about how these organizations seek to meet this need. We surveyed US members of the American Society for Healthcare Risk Management (ASHRM) about the presence, features, and perceived efficacy of their organization's provider support program. The majority reported that their organization had a support program, but features varied widely and there are substantial opportunities to improve services. Provider support programs should enhance referral mechanisms and peer support, critically appraise the role of employee assistance programs, and demonstrate their value to institutional leaders. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

Energy efficient engine pin fin and ceramic composite segmented liner combustor sector rig test report

NASA Technical Reports Server (NTRS)

Dubiel, D. J.; Lohmann, R. P.; Tanrikut, S.; Morris, P. M.

1986-01-01

Under the NASA-sponsored Energy Efficient Engine program, Pratt and Whitney has successfully completed a comprehensive test program using a 90-degree sector combustor rig that featured an advanced two-stage combustor with a succession of advanced segmented liners. Building on the successful characteristics of the first generation counter-parallel Finwall cooled segmented liner, design features of an improved performance metallic segmented liner were substantiated through representative high pressure and temperature testing in a combustor atmosphere. This second generation liner was substantially lighter and lower in cost than the predecessor configuration. The final test in this series provided an evaluation of ceramic composite liner segments in a representative combustor environment. It was demonstrated that the unique properties of ceramic composites, low density, high fracture toughness, and thermal fatigue resistance can be advantageously exploited in high temperature components. Overall, this Combustor Section Rig Test program has provided a firm basis for the design of advanced combustor liners.

Improving vocational rehabilitation services for injured workers in Washington State.

PubMed

Sears, Jeanne M; Wickizer, Thomas M; Schulman, Beryl A

2014-06-01

Workers who incur permanent impairments or have ongoing medical restrictions due to injuries or illnesses sustained at work may require support from vocational rehabilitation programs in order to return to work. Vocational rehabilitation programs implemented within workers' compensation settings are costly, and effective service delivery has proven challenging. The Vocational Improvement Project, a 5.5-year pilot program beginning in 2008, introduced major changes to the Washington State workers' compensation-based vocational rehabilitation program. In the evaluation of this pilot program, set within a large complex system characterized by competing stakeholder interests, we assessed effects on system efficiency and employment outcomes for injured workers. While descriptive in nature, this evaluation provided evidence that several of the intended outcomes were attained, including: (1) fewer repeat referrals, (2) fewer delays, (3) increased choice for workers, and (4) establishment of statewide partnerships to improve worker outcomes. There remains substantial room for further improvement. Retraining plan completion rates remain under 60% and only half of workers earned any wages within two years of completing their retraining plan. Ongoing communication with stakeholders was critical to the successful conduct and policy impact of this evaluation, which culminated in a 3-year extension of the pilot program through June 2016. Copyright © 2013 Elsevier Ltd. All rights reserved.

PowerGuard® manufacturing innovation and expansion

NASA Astrophysics Data System (ADS)

Dinwoodie, Thomas; Kleiner, Tim; O'Brien, Colleen; Quiroz, Maurice

1999-03-01

PowerLight Corporation, with support from the DOE's PVMaT program, has undertaken a comprehensive agenda to automate the manufacture of its PowerGuard PV roof tile system. The advanced manufacturing will lead to substantially reduced costs, quality improvements, and increased production capacity. Over the three years of the PVMaT contract, system costs are expected to fall 2.65/Wp, with annual production capability increasing from 5 to 16 MW. PowerLight is on schedule with meeting its objectives under this program.

Evidence-Based Medicine and State Health Care Coverage: The Washington Health Technology Assessment Program.

PubMed

Rothman, David J; Blackwood, Kristy L; Adair, Whitney; Rothman, Sheila M

2018-04-01

To evaluate the Washington State Health Technology Assessment Program (WHTAP). Washington State Health Technology Assessment Program proceedings in Seattle, Washington. We assessed the program through observation of its proceedings over a 5-year period, 2009-2014. We conducted detailed analyses of the documents it produced and reviewed relevant literature. Washington State Health Technology Assessment Program is unique compared to other state and federal programs. It has successfully applied evidence-based medicine to health care decision making, limited by the strength of available data. It claims cost savings, but they are not substantiated. Washington State Health Technology Assessment Program is a useful model for other states considering implementation of technology assessment programs. We provide key lessons for improving WHTAP's process. © Health Research and Educational Trust.

Telepractice for Pediatric Dysphagia: A Case Study

PubMed Central

Malandraki, Georgia A.; Roth, Melissa; Sheppard, Justine Joan

2014-01-01

A closed-ended intensive pediatric swallowing telepractice program was developed and piloted in one pediatric patient with Opitz BBB/G and Asperger’s Syndromes, oropharyngeal dysphagia and aerophagia. The present study is a case report. Outcome variables included behavioral, swallowing and quality of life variables, and were assessed at baseline and at the end of the four-week program. Selective variables were also assessed at a follow-up family interview four weeks post program completion. Over the four-week intervention period, the patient demonstrated substantial improvements in: oral acceptance of eating-related objects and a variety of foods (behavioral variable), timing of voluntary saliva swallows and aerophagia levels (swallowing variables) and quality of life. Follow-up interview analysis showed that most skills were retained or improved one-month post intervention. This intensive telepractice program proved to be feasible and effective for this pediatric patient with dysphagia. PMID:25945217

The Massachusetts HIV, hepatitis, addiction services integration (HHASI) experience: responding to the comprehensive needs of individuals with co-occurring risks and conditions.

PubMed

Hoffman, Heidi L; Castro-Donlan, Carolyn A; Johnson, Victoria M; Church, Daniel R

2004-01-01

Categorical funding mechanisms traditionally used to fund public health programs are a challenge to providers serving individuals with complex needs that often span multiple service areas. Integration--a formalized, collaborative process among service systems--responds to the challenge by decreasing fragmentation of care and improving coordination. In 2000, the Massachusetts Department of Public Health (MDPH) received a one-year planning grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to evaluate opportunities for integrating HIV/AIDS programs and substance abuse treatment programs. The project was later expanded to include viral hepatitis programming. Outcomes include the development of a strategic plan, joint procurement initiatives, and an ongoing commitment to sustain inter-bureau integration efforts, even in the face of substantial budget reductions. Integrated approaches can promote greater efficiency, improving communication and coordination among clients, providers, and government funding agencies.

Refinement and Preliminary Testing of an Imagery-Based Program to Improve Coping and Performance and Prevent Trauma among Urban Police Officers

PubMed Central

Arble, Eamonn; Lumley, Mark A.; Pole, Nnamdi; Blessman, James; Arnetz, Bengt B.

2016-01-01

Police officers are regularly exposed to traumatic critical incidents. The substantial mental, behavioral, and social costs of police trauma indicate a substantial need for prevention. We have refined and enhanced a previously tested Swedish program to the harsh conditions of U.S. inner cities. The program was designed to strengthen resilience during stressful encounters and teach methods of coping after exposure, thereby preventing the emergence of maladaptive symptoms and behaviors with adverse effects on professionalism. In an uncontrolled demonstration project, junior officers were trained by senior officers to engage in imaginal rehearsal of specific dangerous situations while incorporating optimal police tactics and healthy emotional reactions. A class of 32 officers in the police academy engaged in the program, and they and the trainers reported high satisfaction with it. After their first year of field work, 22 officers were reassessed. Compared to pre-training, these officers showed significant increases in the use of positive reframing and humor and significant reductions in anxiety and alcohol use over the year. Trauma symptoms did not increase. These results offer preliminary evidence for the feasibility and effectiveness of this trauma prevention program for new police officers. PMID:28439149

Refinement and Preliminary Testing of an Imagery-Based Program to Improve Coping and Performance and Prevent Trauma among Urban Police Officers.

PubMed

Arble, Eamonn; Lumley, Mark A; Pole, Nnamdi; Blessman, James; Arnetz, Bengt B

2017-03-01

Police officers are regularly exposed to traumatic critical incidents. The substantial mental, behavioral, and social costs of police trauma indicate a substantial need for prevention. We have refined and enhanced a previously tested Swedish program to the harsh conditions of U.S. inner cities. The program was designed to strengthen resilience during stressful encounters and teach methods of coping after exposure, thereby preventing the emergence of maladaptive symptoms and behaviors with adverse effects on professionalism. In an uncontrolled demonstration project, junior officers were trained by senior officers to engage in imaginal rehearsal of specific dangerous situations while incorporating optimal police tactics and healthy emotional reactions. A class of 32 officers in the police academy engaged in the program, and they and the trainers reported high satisfaction with it. After their first year of field work, 22 officers were reassessed. Compared to pre-training, these officers showed significant increases in the use of positive reframing and humor and significant reductions in anxiety and alcohol use over the year. Trauma symptoms did not increase. These results offer preliminary evidence for the feasibility and effectiveness of this trauma prevention program for new police officers.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis.

PubMed

Montroy, Joshua; Breau, Rodney H; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T; Fergusson, Dean A; Schramm, David

2016-01-01

The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72-0.91), deep (pRR 0.82; 95% CI0.64-1.05) and organ space (pRR 1.15; 95% CI 0.96-1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39-0.77; deep pRR 0.61, 95% CI 0.50-0.75, and organ space pRR 0.60, 95% CI 0.50-0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

PubMed Central

Montroy, Joshua; Breau, Rodney H.; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T.; Fergusson, Dean A.; Schramm, David

2016-01-01

Background The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. Study Design A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Results Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. Conclusions These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities. PMID:26812596

A full-scale fire program to evaluate new furnishings and textile materials developed by the National Aeronautics and Space Administration

NASA Technical Reports Server (NTRS)

Hillenbrand, L. J.; Wray, J. A.

1974-01-01

A program of experimental fires was carried out to establish the advantages offered by new materials for improved fire safety. Four full-scale bedrooms, differing only in the materials used to furnish them, were built and burned to provide comparative data on the fire hazards produced. Cost and availability differences were not considered. The visual evidence provided by TV and photographic coverage of the four experimental room fires showed clearly that the rooms responded very differently to a common ignition condition. Resistance to the ignition and spread of fire was substantially improved in the rooms furnished completely or partially with the new materials.

Tackling the child malnutrition problem: from what and why to how much and how.

PubMed

McLachlan, Milla

2006-12-01

There is strong economic evidence to invest in improving the economic status of young children, yet programs remain underresourced. Returns on investment in child nutrition in terms of improved health, better education outcomes and increased productivity are substantial, and cost estimates for effective programs are in the range of $2.8 to $5.3 billion. These amounts are modest when compared with total international development assistance or current spending on luxury goods in wealthy nations. New initiatives to redefine nutrition science and to apply innovative problem-solving technologies to the global nutrition problem suggest that steps are being taken to accelerate progress toward a malnutrition-free world.

A potential role of anti-poverty programs in health promotion

PubMed Central

Silverman, Kenneth; Holtyn, August F.; Jarvis, Brantley

2016-01-01

Poverty is one of the most pervasive risk factors underlying poor health, but is rarely targeted to improve health. Research on the effects of anti-poverty interventions on health has been limited, at least in part because funding for that research has been limited. Anti-poverty programs have been applied on a large scale, frequently by governments, but without systematic development and cumulative programmatic experimental studies. Anti-poverty programs that produce lasting effects on poverty have not been developed. Before evaluating the effect of anti-poverty programs on health, programs must be developed that can reduce poverty consistently. Anti-poverty programs require systematic development and cumulative programmatic scientific evaluation. Research on the therapeutic workplace could provide a model for that research and an adaptation of the therapeutic workplace could serve as a foundation of a comprehensive anti-poverty program. Once effective anti-poverty programs are developed, future research could determine if those programs improve health in addition to increasing income. The potential personal, health and economic benefits of effective anti-poverty programs could be substantial, and could justify the major efforts and expenses that would be required to support systematic research to develop such programs. PMID:27235603

A potential role of anti-poverty programs in health promotion.

PubMed

Silverman, Kenneth; Holtyn, August F; Jarvis, Brantley P

2016-11-01

Poverty is one of the most pervasive risk factors underlying poor health, but is rarely targeted to improve health. Research on the effects of anti-poverty interventions on health has been limited, at least in part because funding for that research has been limited. Anti-poverty programs have been applied on a large scale, frequently by governments, but without systematic development and cumulative programmatic experimental studies. Anti-poverty programs that produce lasting effects on poverty have not been developed. Before evaluating the effect of anti-poverty programs on health, programs must be developed that can reduce poverty consistently. Anti-poverty programs require systematic development and cumulative programmatic scientific evaluation. Research on the therapeutic workplace could provide a model for that research and an adaptation of the therapeutic workplace could serve as a foundation of a comprehensive anti-poverty program. Once effective anti-poverty programs are developed, future research could determine if those programs improve health in addition to increasing income. The potential personal, health and economic benefits of effective anti-poverty programs could be substantial, and could justify the major efforts and expenses that would be required to support systematic research to develop such programs. Copyright © 2016 Elsevier Inc. All rights reserved.

Eccentric-Overload Training in Team-Sport Functional Performance: Constant Bilateral Vertical Versus Variable Unilateral Multidirectional Movements.

PubMed

Gonzalo-Skok, Oliver; Tous-Fajardo, Julio; Valero-Campo, Carlos; Berzosa, César; Bataller, Ana Vanessa; Arjol-Serrano, José Luis; Moras, Gerard; Mendez-Villanueva, Alberto

2017-08-01

To analyze the effects of 2 different eccentric-overload training (EOT) programs, using a rotational conical pulley, on functional performance in team-sport players. A traditional movement paradigm (ie, squat) including several sets of 1 bilateral and vertical movement was compared with a novel paradigm including a different exercise in each set of unilateral and multi-directional movements. Forty-eight amateur or semiprofessional team-sport players were randomly assigned to an EOT program including either the same bilateral vertical (CBV, n = 24) movement (squat) or different unilateral multidirectional (VUMD, n = 24) movements. Training programs consisted of 6 sets of 1 exercise (CBV) or 1 set of 6 exercises (VUMD) × 6-10 repetitions with 3 min of passive recovery between sets and exercises, biweekly for 8 wk. Functional-performance assessment included several change-of-direction (COD) tests, a 25-m linear-sprint test, unilateral multidirectional jumping tests (ie, lateral, horizontal, and vertical), and a bilateral vertical-jump test. Within-group analysis showed substantial improvements in all tests in both groups, with VUMD showing more robust adaptations in pooled COD tests and lateral/horizontal jumping, whereas the opposite occurred in CBV respecting linear sprinting and vertical jumping. Between-groups analyses showed substantially better results in lateral jumps (ES = 0.21), left-leg horizontal jump (ES = 0.35), and 10-m COD with right leg (ES = 0.42) in VUMD than in CBV. In contrast, left-leg countermovement jump (ES = 0.26) was possibly better in CBV than in VUMD. Eight weeks of EOT induced substantial improvements in functional-performance tests, although the force-vector application may play a key role to develop different and specific functional adaptations.

Public High School Principals' Perceptions of Academic Reform. Center for Education Statistics Bulletin.

ERIC Educational Resources Information Center

Center for Education Statistics (ED/OERI), Washington, DC.

A survey of public high school principals asked which policies, programs, and practices designed to improve learning were currently in operation at their schools, and whether these policies were instituted or substantially strengthened in the past 5 years. These policies reflect the school-level recommendations for education reform made in "A…

Essential Competencies for Interdisciplinary Graduate Training in IGERT: Final Report. GS-10F-0086K

ERIC Educational Resources Information Center

Gamse, Beth C.; Espinosa, Lorelle L.; Roy, Radha

2013-01-01

The Integrative Graduate Education and Research Traineeship (IGERT) program represents a substantial investment by the National Science Foundation (NSF) to improve the quality of graduate education, and ultimately, to increase the number of graduates better prepared to address the nation's 21st century scientific and technological needs. The…

If We Teach Them, They Can Learn: Young Students Views of Nature of Science during an Informal Science Education Program

ERIC Educational Resources Information Center

Quigley, Cassie; Pongsanon, Khemmawadee; Akerson, Valarie L.

2011-01-01

There have been substantial reform efforts in science education to improve students' understandings of science and its processes and provide continual support for students becoming scientifically literate (AAAS, "Benchmarks for science literacy," Oxford University Press, New York, 1993; NRC, National Academy Press, Washington, DC, 1996; NSTA,…

Multimodal exercise training in multiple sclerosis: A randomized controlled trial in persons with substantial mobility disability.

PubMed

Sandroff, Brian M; Bollaert, Rachel E; Pilutti, Lara A; Peterson, Melissa L; Baynard, Tracy; Fernhall, Bo; McAuley, Edward; Motl, Robert W

2017-10-01

Mobility disability is a common, debilitating feature of multiple sclerosis (MS). Exercise training has been identified as an approach to improve MS-related mobility disability. However, exercise randomized controlled trials (RCTs) on mobility in MS have generally not selectively targeted those with the onset of irreversible mobility disability. The current multi-site RCT compared the efficacy of 6-months of supervised, multimodal exercise training with an active control condition for improving mobility, gait, physical fitness, and cognitive outcomes in persons with substantial MS-related mobility disability. 83 participants with substantial MS-related mobility disability underwent initial mobility, gait, fitness, and cognitive processing speed assessments and were randomly assigned to 6-months of supervised multimodal (progressive aerobic, resistance, and balance) exercise training (intervention condition) or stretching-and-toning activities (control condition). Participants completed the same outcome assessments halfway through and immediately following the 6-month study period. There were statistically significant improvements in six-minute walk performance (F(2158)=3.12, p=0.05, η p 2 =0.04), peak power output (F(2150)=8.16, p<0.01, η p 2 =0.10), and Paced Auditory Serial Addition Test performance (F(2162)=4.67, p=0.01, η p 2 =0.05), but not gait outcomes, for those who underwent the intervention compared with those who underwent the control condition. This RCT provides novel, preliminary evidence that multimodal exercise training may improve endurance walking performance and cognitive processing speed, perhaps based on improvements in cardiorespiratory capacity, in persons with MS with substantial mobility disability. This is critical for informing the development of multi-site exercise rehabilitation programs in larger samples of persons with MS-related mobility disability. Copyright © 2017 Elsevier Inc. All rights reserved.

Fault Tree Analysis.

PubMed

McElroy, Lisa M; Khorzad, Rebeca; Rowe, Theresa A; Abecassis, Zachary A; Apley, Daniel W; Barnard, Cynthia; Holl, Jane L

The purpose of this study was to use fault tree analysis to evaluate the adequacy of quality reporting programs in identifying root causes of postoperative bloodstream infection (BSI). A systematic review of the literature was used to construct a fault tree to evaluate 3 postoperative BSI reporting programs: National Surgical Quality Improvement Program (NSQIP), Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (JC). The literature review revealed 699 eligible publications, 90 of which were used to create the fault tree containing 105 faults. A total of 14 identified faults are currently mandated for reporting to NSQIP, 5 to CMS, and 3 to JC; 2 or more programs require 4 identified faults. The fault tree identifies numerous contributing faults to postoperative BSI and reveals substantial variation in the requirements and ability of national quality data reporting programs to capture these potential faults. Efforts to prevent postoperative BSI require more comprehensive data collection to identify the root causes and develop high-reliability improvement strategies.

Demand Side Management: An approach to peak load smoothing

NASA Astrophysics Data System (ADS)

Gupta, Prachi

A preliminary national-level analysis was conducted to determine whether Demand Side Management (DSM) programs introduced by electric utilities since 1992 have made any progress towards their stated goal of reducing peak load demand. Estimates implied that DSM has a very small effect on peak load reduction and there is substantial regional and end-user variability. A limited scholarly literature on DSM also provides evidence in support of a positive effect of demand response programs. Yet, none of these studies examine the question of how DSM affects peak load at the micro-level by influencing end-users' response to prices. After nearly three decades of experience with DSM, controversy remains over how effective these programs have been. This dissertation considers regional analyses that explore both demand-side solutions and supply-side interventions. On the demand side, models are estimated to provide in-depth evidence of end-user consumption patterns for each North American Electric Reliability Corporation (NERC) region, helping to identify sectors in regions that have made a substantial contribution to peak load reduction. The empirical evidence supports the initial hypothesis that there is substantial regional and end-user variability of reductions in peak demand. These results are quite robust in rapidly-urbanizing regions, where air conditioning and lighting load is substantially higher, and regions where the summer peak is more pronounced than the winter peak. It is also evident from the regional experiences that active government involvement, as shaped by state regulations in the last few years, has been successful in promoting DSM programs, and perhaps for the same reason we witness an uptick in peak load reductions in the years 2008 and 2009. On the supply side, we estimate the effectiveness of DSM programs by analyzing the growth of capacity margin with the introduction of DSM programs. The results indicate that DSM has been successful in offsetting the need for additional production capacity by the means of demand response measures, but the success is limited to only a few regions. The rate of progress in the future will depend on a wide range of improved technologies and a continuous government monitoring for successful adoption of demand response programs to manage growing energy demand.

Development of advanced magnetic resonance sensor for industrial applications. Final report

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

De Los Santos, A.

1997-06-01

Southwest Research Institute (SwRI) and various subcontractors, in a cooperative agreement with the DOE, have developed and tested an advanced magnetic resonance (MR) sensor for several industrial applications and made various market surveys. The original goal of the program was to develop an advanced moisture sensor to allow more precise and rapid control of drying processes so that energy and/or product would not be wasted. Over the course of the program, it was shown that energy savings were achievable but in many processes the return in investment did not justify the cost of a magnetic resonance sensor. However, in manymore » processes, particularly chemical, petrochemical, paper and others, the return in investment can be very high as to easily justify the cost of a magnetic resonance sensor. In these industries, substantial improvements in product yield, quality, and efficiency in production can cause substantial energy savings and reductions in product wastage with substantial environmental effects. The initial applications selected for this program included measurement of corn gluten at three different points and corn germ at one point in an American Maize corn processing plant. During the initial phases (I and II) of this program, SwRI developed a prototype advanced moisture sensor utilizing NMR technology capable of accurately and reliably measuring moisture in industrial applications and tested the sensor in the laboratory under conditions simulating on-line products in the corn wet milling industry. The objective of Phase III was to test the prototype sensor in the plant environment to determine robustness, reliability and long term stability. Meeting these objectives would permit extended field testing to improve the statistical database used to calibrate the sensor and subject the sensor to true variations in operating conditions encountered in the process rather than those which could only be simulated in the laboratory.« less

Avoided electricity subsidy payments can finance substantial appliance efficiency incentive programs: Case study of Mexico

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

Leventis, Greg; Gopal, Anand; Rue du Can, Stephane de la

Numerous countries use taxpayer funds to subsidize residential electricity for a variety of socioeconomic objectives. These subsidies lower the value of energy efficiency to the consumer while raising it for the government. Further, while it would be especially helpful to have stringent Minimum Energy Performance Standards (MEPS) for appliances and buildings in this environment, they are hard to strengthen without imposing a cost on ratepayers. In this secondbest world, where the presence of subsidies limits the government’s ability to strengthen standards, we find that avoided subsidies are a readily available source of financing for energy efficiency incentive programs. Here, wemore » introduce the LBNL Energy Efficiency Revenue Analysis (LEERA) model to estimate the appliance efficiency improvements that can be achieved in Mexico by the revenue neutral financing of incentive programs from avoided subsidy payments. LEERA uses the detailed techno-economic analysis developed by LBNL for the Super-efficient Equipment and Appliance Deployment (SEAD) Initiative to calculate the incremental costs of appliance efficiency improvements. We analyze Mexico’s tariff structures and the long-run marginal cost of supply to calculate the marginal savings for the government from appliance efficiency. We find that avoided subsidy payments alone can finance incentive programs that cover the full incremental cost of refrigerators that are 27% more efficient and TVs that are 32% more efficient than baseline models. We find less substantial market transformation potential for room ACs primarily because AC energy savings occur at less subsidized tariffs.« less

NASTRAN internal improvements for 1992 release

NASA Technical Reports Server (NTRS)

Chan, Gordon C.

1992-01-01

The 1992 NASTRAN release incorporates a number of improvements transparent to users. The NASTRAN executable was made smaller by 70 pct. for the RISC base Unix machines by linking NASTRAN into a single program, freeing some 33 megabytes of system disc space that can be used by NASTRAN for solving larger problems. Some basic matrix operations, such as forward-backward substitution (FBS), multiply-add (MPYAD), matrix transpose, and fast eigensolution extraction routine (FEER), have been made more efficient by including new methods, new logic, new I/O techniques, and, in some cases, new subroutines. Some of the improvements provide ground work ready for system vectorization. These are finite element basic operations, and are used repeatedly in a finite element program such as NASTRAN. Any improvements on these basic operations can be translated into substantial cost and cpu time savings. NASTRAN is also discussed in various computer platforms.

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

Mexico: perspectives in school health.

PubMed

Allensworth, D M; Greene, A G

1990-09-01

The school health program in Mexico, directed by the Office of School Hygiene (la Unidad de Higiene Escolar), is in a state of flux. The program will change substantially if an initiative between the national offices of health and education is enacted. The initiative would establish a national commission to be replicated at state, county, and district levels. Commissions would oversee integration of the health services component, social participation, and research into the school health program which currently only focuses on health instruction and a healthy school environment. The initiative would restore and improve a former model that incorporated health services as a part of the school health program. The history of the school health program, which can trace its roots to 1861 and President Benito Juarez, is provided.

Atmospheric Ionizing Radiation and Human Exposure

NASA Technical Reports Server (NTRS)

Wilson, John W.; Mertens, Christopher J.; Goldhagen, Paul; Friedberg, W.; DeAngelis, G.; Clem, J. M.; Copeland, K.; Bidasaria, H. B.

2005-01-01

Atmospheric ionizing radiation is of interest, apart from its main concern of aircraft exposures, because it is a principal source of human exposure to radiations with high linear energy transfer (LET). The ionizing radiations of the lower atmosphere near the Earth s surface tend to be dominated by the terrestrial radioisotopes. especially along the coastal plain and interior low lands, and have only minor contributions from neutrons (11 percent). The world average is substantially larger but the high altitude cities especially have substantial contributions from neutrons (25 to 45 percent). Understanding the world distribution of neutron exposures requires an improved understanding of the latitudinal, longitudinal, altitude and spectral distribution that depends on local terrain and time. These issues are being investigated in a combined experimental and theoretical program. This paper will give an overview of human exposures and describe the development of improved environmental models.

Atmospheric Ionizing Radiation and Human Exposure

NASA Technical Reports Server (NTRS)

Wilson, J. W.; Goldhagen, P.; Friedberg, W.; DeAngelis, G.; Clem, J. M.; Copeland, K.; Bidasaria, H. B.

2004-01-01

Atmospheric ionizing radiation is of interest, apart from its main concern of aircraft exposures, because it is a principal source of human exposure to radiations with high linear energy transfer (LET). The ionizing radiations of the lower atmosphere near the Earth s surface tend to be dominated by the terrestrial radioisotopes especially along the coastal plain and interior low lands and have only minor contributions from neutrons (11 percent). The world average is substantially larger but the high altitude cities especially have substantial contributions from neutrons (25 to 45 percent). Understanding the world distribution of neutron exposures requires an improved understanding of the latitudinal, longitudinal, altitude and spectral distribution that depends on local terrain and time. These issues are being investigated in a combined experimental and theoretical program. This paper will give an overview of human exposures and describe the development of improved environmental models.

Technology for small spacecraft

NASA Technical Reports Server (NTRS)

1994-01-01

This report gives the results of a study by the National Research Council's Panel on Small Spacecraft Technology that reviewed NASA's technology development program for small spacecraft and assessed technology within the U.S. government and industry that is applicable to small spacecraft. The panel found that there is a considerable body of advanced technology currently available for application by NASA and the small spacecraft industry that could provide substantial improvement in capability and cost over those technologies used for current NASA small spacecraft. These technologies are the result of developments by commercial companies, Department of Defense agencies, and to a lesser degree NASA. The panel also found that additional technologies are being developed by these same entities that could provide additional substantial improvement if development is successfully completed. Recommendations for future technology development efforts by NASA across a broad technological spectrum are made.

Impact of a Pilot Videogame-Based Physical Activity Program on Walking Speed in Adults with Schizophrenia.

PubMed

Leutwyler, H; Hubbard, E; Cooper, B A; Dowling, G

2017-11-10

The purpose of this report is to describe the impact of a videogame-based physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA) on walking speed in adults with schizophrenia. In this randomized controlled trial, 28 participants played either an active videogame for 30 min (intervention group) or played a sedentary videogame for 30 min (control group), once a week for 6 weeks. Walking speed was measured objectively with the Short Physical Performance Battery at enrollment and at the end of the 6-week program. The intervention group (n = 13) showed an average improvement in walking speed of 0.08 m/s and the control group (n = 15) showed an average improvement in walking speed of 0.03 m/s. Although the change in walking speed was not statistically significant, the intervention group had between a small and substantial clinically meaningful change. The results suggest a videogame based physical activity program provides clinically meaningful improvement in walking speed, an important indicator of health status.

Engage: The Science Speaker Series - A novel approach to improving science outreach and communication

NASA Astrophysics Data System (ADS)

Mitchell, R.; Hilton, E.; Rosenfield, P.

2011-12-01

Communicating the results and significance of basic research to the general public is of critical importance. Federal funding and university budgets are under substantial pressure, and taxpayer support of basic research is critical. Public outreach by ecologists is an important vehicle for increasing support and understanding of science in an era of anthropogenic global change. At present, very few programs or courses exist to allow young scientists the opportunity to hone and practice their public outreach skills. Although the need for science outreach and communication is recognized, graduate programs often fail to provide any training in making science accessible. Engage: The Science Speaker Series represents a unique, graduate student-led effort to improve public outreach skills. Founded in 2009, Engage was created by three science graduate students at the University of Washington. The students developed a novel, interdisciplinary curriculum to investigate why science outreach often fails, to improve graduate student communication skills, and to help students create a dynamic, public-friendly talk. The course incorporates elements of story-telling, improvisational arts, and development of analogy, all with a focus on clarity, brevity and accessibility. This course was offered to graduate students and post-doctoral researchers from a wide variety of sciences in the autumn of 2010. Students who participated in the Engage course were then given the opportunity to participate in Engage: The Science Speaker Series. This free, public-friendly speaker series is hosted on the University of Washington campus and has had substantial public attendance and participation. The growing success of Engage illustrates the need for such programs throughout graduate level science curricula. We present the impetus for the development of the program, elements of the curriculum covered in the Engage course, the importance of an interdisciplinary approach, and discuss strategies for implementing similar programs at research institutions nationally.

Engage: The Science Speaker Series - A novel approach to improving science outreach and communication

NASA Astrophysics Data System (ADS)

Mitchell, R.; Hilton, E.; Rosenfield, P.

2012-12-01

Communicating the results and significance of basic research to the general public is of critical importance. Federal funding and university budgets are under substantial pressure, and taxpayer support of basic research is critical. Public outreach by ecologists is an important vehicle for increasing support and understanding of science in an era of anthropogenic global change. At present, very few programs or courses exist to allow young scientists the opportunity to hone and practice their public outreach skills. Although the need for science outreach and communication is recognized, graduate programs often fail to provide any training in making science accessible. Engage: The Science Speaker Series represents a unique, graduate student-led effort to improve public outreach skills. Founded in 2009, Engage was created by three science graduate students at the University of Washington. The students developed a novel, interdisciplinary curriculum to investigate why science outreach often fails, to improve graduate student communication skills, and to help students create a dynamic, public-friendly talk. The course incorporates elements of story-telling, improvisational arts, and development of analogy, all with a focus on clarity, brevity and accessibility. This course was offered to graduate students and post-doctoral researchers from a wide variety of sciences in the autumn of 2010 and 2011, and will be retaught in 2012. Students who participated in the Engage course were then given the opportunity to participate in Engage: The Science Speaker Series. This free, public-friendly speaker series has been hosted at the University of Washington campus and Seattle Town Hall, and has had substantial public attendance and participation. The growing success of Engage illustrates the need for such programs throughout graduate level science curricula. We present the impetus for the development of the program, elements of the curriculum covered in the Engage course, the importance of an interdisciplinary approach, and discuss strategies for implementing similar programs at research institutions nationally.

The American College of Surgeons National Surgical Quality Improvement Program: achieving better and safer surgery.

PubMed

Ko, Clifford Y; Hall, Bruce L; Hart, Amy J; Cohen, Mark E; Hoyt, David B

2015-05-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), in operation since late 2004, evaluates surgical quality and safety by feeding back valid, timely, risk-adjusted outcomes, which providers use to improve care. A number of components have been developed and refined in the more than a decade since ACS NSQIP's initiation. These items can be grouped into areas of data collection, case sampling, risk adjustment, feedback reporting, the expansion into procedure-targeted sampling, development of improvement collaboratives, and the development of improvement tools. Although ACS NSQIP was originally designed as a hospital-based program, it now also allows for surgeon-specific reporting that can be used by individual surgeons as a feedback tool to improve their performance. There are more than 600 ACS NSQIP hospitals in 49 of the 50 states of the United States and in 13 other countries. Virtually all surgical (sub)specialties are touched by ACS NSQIP, which contains several million patient records and more than 100 statistically risk-adjusted models. In studies that have used ACS NSQIP clinical data, demonstrable improvement has been reported in local hospitals, in regional collaboratives, and across the program overall. Concomitantly, substantial cost savings for individual hospitals, as well as at regional and national levels, have been reported. ACS NSQIP has not only demonstrated how and why the use of accurate clinical data is crucial, but also how the program, through its risk-adjusted feedback, improvement tools, and hospital collaboratives, helps hospitals and providers to achieve safer surgery and better patient care.

On-Line Thermal Barrier Coating Monitoring for Real-Time Failure Protection and Life Maximization

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

Dennis H. LeMieux

2005-04-01

Under the sponsorship of the U. S. Department of Energy's National Energy Laboratory, Siemens Westinghouse Power Corporation proposes a four year program titled, ''On-Line Thermal Barrier Coating (TBC) Monitor for Real-Time Failure Protection and Life Maximization'', to develop, build and install the first generation of an on-line TBC monitoring system for use on land-based advanced gas turbines (AGT). Federal deregulation in electric power generation has accelerated power plant owner's demand for improved reliability availability maintainability (RAM) of the land-based advanced gas turbines. As a result, firing temperatures have been increased substantially in the advanced turbine engines, and the TBCs havemore » been developed for maximum protection and life of all critical engine components operating at these higher temperatures. Losing TBC protection can therefore accelerate the degradation of substrate components materials and eventually lead to a premature failure of critical component and costly unscheduled power outages. This program seeks to substantially improve the operating life of high cost gas turbine components using TBC; thereby, lowering the cost of maintenance leading to lower cost of electricity. Siemens Westinghouse Power Corporation has teamed with Indigo Systems, a supplier of state-of-the-art infrared camera systems, and Wayne State University, a leading research organization in the field of infrared non-destructive examination (NDE), to complete the program.« less

ON-LINE THERMAL BARRIER COATING MONITORING FOR REAL-TIME FAILURE PROTECTION AND LIFE MAXIMIZATION

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

Dennis H. LeMieux

2003-10-01

Under the sponsorship of the U. S. Department of Energy's National Energy Laboratory, Siemens Westinghouse Power Corporation proposes a four year program titled, ''On-Line Thermal Barrier Coating (TBC) Monitor for Real-Time Failure Protection and Life Maximization,'' to develop, build and install the first generation of an on-line TBC monitoring system for use on land-based advanced gas turbines (AGT). Federal deregulation in electric power generation has accelerated power plant owner's demand for improved reliability, availability, and maintainability (RAM) of the land-based advanced gas turbines. As a result, firing temperatures have been increased substantially in the advanced turbine engines, and the TBCsmore » have been developed for maximum protection and life of all critical engine components operating at these higher temperatures. Losing TBC protection can, therefore, accelerate the degradation of substrate component materials and eventually lead to a premature failure of critical components and costly unscheduled power outages. This program seeks to substantially improve the operating life of high cost gas turbine components using TBC; thereby, lowering the cost of maintenance leading to lower cost of electricity. Siemens Westinghouse Power Corporation has teamed with Indigo Systems, a supplier of state-of-the-art infrared camera systems, and Wayne State University, a leading research organization in the field of infrared non-destructive examination (NDE), to complete the program.« less

ON-LINE THERMAL BARRIER COATING MONITORING FOR REAL-TIME FAILURE PROTECTION AND LIFE MAXIMIZATION

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

Dennis H. LeMieux

2003-07-01

Under the sponsorship of the U. S. Department of Energy's National Energy Laboratory, Siemens Westinghouse Power Corporation proposes a four year program titled, ''On-Line Thermal Barrier Coating (TBC) Monitor for Real-Time Failure Protection and Life Maximization,'' to develop, build and install the first generation of an on-line TBC monitoring system for use on land-based advanced gas turbines (AGT). Federal deregulation in electric power generation has accelerated power plant owner's demand for improved reliability, availability, and maintainability (RAM) of the land-based advanced gas turbines. As a result, firing temperatures have been increased substantially in the advanced turbine engines, and the TBCsmore » have been developed for maximum protection and life of all critical engine components operating at these higher temperatures. Losing TBC protection can, therefore, accelerate the degradation of substrate component materials and eventually lead to a premature failure of critical components and costly unscheduled power outages. This program seeks to substantially improve the operating life of high cost gas turbine components using TBC; thereby, lowering the cost of maintenance leading to lower cost of electricity. Siemens Westinghouse Power Corporation has teamed with Indigo Systems, a supplier of state-of-the-art infrared camera systems, and Wayne State University, a leading research organization in the field of infrared non-destructive examination (NDE), to complete the program.« less

On-Line Thermal Barrier Coating Monitoring for Real-Time Failure Protection and Life Maximization

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

Dennis H. LeMieux

2005-10-01

Under the sponsorship of the U. S. Department of Energy's National Energy Laboratory, Siemens Power Generation, Inc proposed a four year program titled, ''On-Line Thermal Barrier Coating (TBC) Monitor for Real-Time Failure Protection and Life Maximization'', to develop, build and install the first generation of an on-line TBC monitoring system for use on land-based advanced gas turbines (AGT). Federal deregulation in electric power generation has accelerated power plant owner's demand for improved reliability availability maintainability (RAM) of the land-based advanced gas turbines. As a result, firing temperatures have been increased substantially in the advanced turbine engines, and the TBCs havemore » been developed for maximum protection and life of all critical engine components operating at these higher temperatures. Losing TBC protection can therefore accelerate the degradation of substrate components materials and eventually lead to a premature failure of critical component and costly unscheduled power outages. This program seeks to substantially improve the operating life of high cost gas turbine components using TBC; thereby, lowering the cost of maintenance leading to lower cost of electricity. Siemens Power Generation, Inc. has teamed with Indigo Systems, a supplier of state-of-the-art infrared camera systems, and Wayne State University, a leading research organization in the field of infrared non-destructive examination (NDE), to complete the program.« less

Design and implementation of a patient navigation system in rural Nepal: Improving patient experience in resource-constrained settings.

PubMed

Raut, Anant; Thapa, Poshan; Citrin, David; Schwarz, Ryan; Gauchan, Bikash; Bista, Deepak; Tamrakar, Bibhu; Halliday, Scott; Maru, Duncan; Schwarz, Dan

2015-12-01

Patient navigation programs have shown to be effective across multiple settings in guiding patients through the care delivery process. Limited experience and literature exist, however, for such programs in rural and resource-constrained environments. Patients living in such settings frequently have low health literacy and substantially lower social status than their providers. They typically have limited experiences interfacing with formalized healthcare systems, and, when they do, their experience can be unpleasant and confusing. At a district hospital in rural far-western Nepal, we designed and implemented a patient navigation system that aimed to improve patients' subjective care experience. First, we hired and trained a team of patient navigators who we recruited from the local area. Their responsibility is exclusively to demonstrate compassion and to guide patients through their care process. Second, we designed visual cues throughout our hospital complex to assist in navigating patients through the buildings. Third, we incorporated the patient navigators within the management and communications systems of the hospital care team, and established standard operating procedures. We describe here our experiences and challenges in designing and implementing a patient navigator program. Such patient-centered systems may be relevant at other facilities in Nepal and globally where patient health literacy is low, patients come from backgrounds of substantial marginalization and disempowerment, and patient experience with healthcare facilities is limited. Copyright © 2015 Elsevier Inc. All rights reserved.

Eating better for less: a national discount program for healthy food purchases in South Africa.

PubMed

An, Ruopeng; Patel, Deepak; Segal, Darren; Sturm, Roland

2013-01-01

To examine whether reducing prices for healthy food purchases leads to changes in self-reported measures of food consumption and weight status. Repeated surveys of about 350,000 HealthyFood participants and nonparticipants. Program participation is associated with more consumption of fruits/vegetables and whole-grain foods and less consumption of high sugar/salt foods, fried foods, processed meats, and fast food. There is no strong evidence that participation reduces obesity. A substantial price intervention might be effective in improving diets.

State Capacity to Support School Turnaround. NCEE Evaluation Brief. NCEE 2015-4012

ERIC Educational Resources Information Center

Tanenbaum, Courtney; Boyle, Andrea; Graczewski, Cheryl; James-Burdumy, Susanne; Dragoset, Lisa; Hallgren, Kristin

2015-01-01

One objective of the U.S. Department of Education's (ED) School Improvement Grants (SIG) and Race to the Top (RTT) program is to help states enhance their capacity to support the turnaround of low-performing schools. This capacity may be important, given how difficult it is to produce substantial and sustained achievement gains in low-performing…

Automated Analysis of Vital Signs to Identify Patients with Substantial Bleeding before Hospital Arrival: A Feasibility Study

DTIC Science & Technology

2015-05-01

Dziekan G, Bahl R, Mathai M, Merialdi M, Berry W, Gawande AA: Designing the WHO Safe Childbirth Checklist program to improve quality of care at... childbirth . Int J Gynaecol Obstet 122(2):164Y168, 2013. 35. Arriaga AF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, Hepner DL, Boorman DJ, Pozner

Evaluation of the VA's Pilot Program in Institutional Reorganization toward Primary and Ambulatory Care: Part I, Changes in the Process and Outcomes of Care.

ERIC Educational Resources Information Center

Rubenstein, Lisa V.; And Others

1996-01-01

A study evaluated the impact of the reorganization of the academic Sepulveda (California) Veterans' Administration medical center toward primary and ambulatory care. Surveys of several thousand patients were linked to computerized utilization and mortality data and related to the center's strategic plan and goals. Substantial improvement in…

School Turnarounds: Evidence from the 2009 Stimulus. Program on Education Policy and Governance Working Papers Series. PEPG 12-04

ERIC Educational Resources Information Center

Dee, Thomas S.

2012-01-01

The American Recovery and Reinvestment Act of 2009 (ARRA) targeted substantial School Improvement Grants (SIGs) to the nation's "persistently lowest achieving" public schools (i.e., up to $2 million per school annually over 3 years) but required schools accepting these awards to implement a federally prescribed school-reform model.…

JT90 Ceramic Outer Air Seal System Refinement Program, Phase 2

NASA Technical Reports Server (NTRS)

Shiembob, L. T.

1982-01-01

The sprayed ceramic gas turbine outer air seal system was tested in two JT9D engines to substantiate the abradability and durability of the seals. Of particular significance was that one of the tests, a 150 hour 1000 cycle endurance program at nominal JT9D operating conditions, was completed with minimal effect on the seals and received Federal Aviation Administration cognizance with respect to potential field service use by the airlines. The other engine test completed 1825 endurance cycles at severe operating conditions and no burn through or other serious defects in the structural integrity of a seal segment was observed. These test results combined with other Pratt and Whitney Aircraft engine tests substantiate the potential of the ceramic outer air seal system to attain the durability goal of 50000 hour engine operating capability. Both engine tests subjected the seals to intentional blade rubs and demonstrated good abradability with volume wear ratios greater than 100, far exceeding the design goal of 10. The improved volume wear ratio will allow the turbine tip clearance to be reduced, thereby resulting in an estimated thrust specific fuel consumption improvement of 0.3 percent.

Results of the Medicare Health Support disease-management pilot program.

PubMed

McCall, Nancy; Cromwell, Jerry

2011-11-03

In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries. The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures. In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.

Improving oversight of the graduate medical education enterprise: one institution's strategies and tools.

PubMed

Afrin, Lawrence B; Arana, George W; Medio, Franklin J; Ybarra, Angela F N; Clarke, Harry S

2006-05-01

Accreditation organizations, financial stakeholders, legal systems, and regulatory agencies have increased the need for accountability in educational processes and curricular outcomes of graduate medical education. This demand for greater programmatic monitoring has placed pressure on institutions with graduate medical education (GME) programs to develop greater oversight of these programs. Meeting these challenges requires development of new GME management strategies and tools for institutional GME administrators to scrutinize programs, while still allowing these programs the autonomy to develop and implement educational methods to meet their unique training needs. At the Medical University of South Carolina (MUSC), senior administrators in the college of medicine felt electronic information management was a critical strategy for success and thus proceeded to carefully select an electronic residency management system (ERMS) to provide functionality for both individual programs and the GME enterprise as a whole. Initial plans in 2002 for a phased deployment had to be changed to a much more rapid deployment due to regulatory issues. Extensive communication and cooperation among MUSC's GME leaders resulted in a successful deployment in 2003. Evaluation completion rates have substantially improved, duty hours are carefully monitored, patient safety has improved through more careful oversight of residents' procedural privileges, regulators have been pleased, and central GME administrative visibility of program performance has dramatically improved. The system is now being expanded to MUSC's medical school and other health professions colleges. The authors discuss lessons learned and opportunities and challenges ahead, which include improving tracking of development of procedural competency, establishing and monitoring program performance standards, and integrating the ERMS with GME reimbursement systems.

Identifying specific beliefs to target to improve restaurant employees' intentions for performing three important food safety behaviors.

PubMed

Pilling, Valerie K; Brannon, Laura A; Shanklin, Carol W; Howells, Amber D; Roberts, Kevin R

2008-06-01

Current national food safety training programs appear ineffective at improving food safety practices in foodservice operations, given the substantial number of Americans affected by foodborne illnesses after eating in restaurants each year. The Theory of Planned Behavior (TpB) was used to identify important beliefs that may be targeted to improve foodservice employees' intentions for three food safety behaviors that have the most substantial affect on public health: hand washing, using thermometers, and proper handling of food contact surfaces. In a cross-sectional design, foodservice employees (n=190) across three midwestern states completed a survey assessing TpB components and knowledge for the three food safety behaviors. Multiple regression analyses were performed on the TpB components for each behavior. Independent-samples t tests identified TpB beliefs that discriminated between participants who absolutely intend to perform the behaviors and those with lower intention. Employees' attitudes were the one consistent predictor of intentions for performing all three behaviors. However, a unique combination of important predictors existed for each separate behavior. Interventions for improving employees' behavioral intentions for food safety should focus on TpB components that predict intentions for each behavior and should bring all employees' beliefs in line with those of the employees who already intend to perform the food safety behaviors. Registered dietitians; dietetic technicians, registered; and foodservice managers can use these results to enhance training sessions and motivational programs to improve employees' food safety behaviors. Results also assist these professionals in recognizing their responsibility for enforcing and providing adequate resources for proper food safety behaviors.

Implementing Learning Assistants and Tutorials in the Laboratory Environment

NASA Astrophysics Data System (ADS)

Stewart, John; Henderson, Rachel; Miller, Paul

2016-03-01

This talk describes the results of a novel implementation of a Learning Assistant (LA) program where the LAs facilitated the presentation of the Tutorials in Introductory Physics as part of an otherwise traditional laboratory. LAs received both general training in the teaching of science and specific training in the presentation of the Tutorials. The LAs acted as the lead laboratory instructor for one hour each lab. The program required very little interaction from the lecturer. The program showed a substantial increase in learning gains on the Force and Motion Conceptual Inventory in the first semester course, but weaker improvement of learning gains on the Conceptual Survey of Electricity and Magnetism in the second semester course. Multiple linear regression showed that gender, student ability, and whether the student was on-sequence were significant regressors. The instructor was a substantial random effect (SD = 0 . 10), but the teaching assistant (SD = 0 . 00) and learning assistant (SD = 0 . 01) were much weaker random effects on the normalized gain. The instructor standing (tenure-track, teaching faculty, or adjunct) was a weakly significant regressor (p < 0 . 05).

Advanced concepts in biomass production and pretreatment. Annual report, April 1986-March 1987

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

Hiler, E.A.; Miller, F.R.; Dominy, R.E.

1987-04-01

The objective of the research is to develop an integrated system for methane production utilizing terrestrial biomass as the feedstock. The report provides specifics of research activities in the Texas A and M biomass program sponsored by Gas Research Institute and co-funded by Texas Agricultural Experiment Station. Researchers in the program include plant geneticists, plant physiologists, chemists, agronomists, ruminant physiologists, agricultural engineers, biochemical engineers, and agricultural economists. Major research emphases are genetic manipulation, physiology and production systems, harvesting, storage, processing and conversion systems, inhibitors, and economic and system analyses. During the past year, increasing emphasis was placed on the biologicalmore » pretreatment aspects of the program because of the critical importance of the area to the improved efficiency of the overall system. In the breeding, tissue culture, and production programs, continued substantial progress was made in identifying and characterizing sorghums that will produce high biomass yields and have improved lodging resistance and high uniformity. Economic and systems analyses provided important information regarding optimal overall systems.« less

A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland.

PubMed

Croyden, Debbie L; Vidgen, Helen A; Esdaile, Emma; Hernandez, Emely; Magarey, Anthea; Moores, Carly J; Daniels, Lynne

2018-03-13

PEACH™QLD translated the PEACH™ Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage. The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges. Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH™ Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and provision of services privately. Comparisons between pilot versus state-wide waves showed comparable prevalence of families not attending any sessions (25% vs 28%) but improved number of sessions attended (median = 5 vs 7) and completion rates (43% vs 56%). Translating programs developed in the research context to enable implementation at scale is complex and presents substantial challenges. Planning must ensure there is flexibility to accommodate and proactively manage the system changes that are inevitable over time. ACTRN12617000315314 . This trial was registered retrospectively on 28 February, 2017.

Academic plastic surgery: faculty recruitment and retention.

PubMed

Chen, Jenny T; Girotto, John A; Kitzmiller, W John; Lawrence, W Thomas; Verheyden, Charles N; Vedder, Nicholas B; Coleman, John J; Bentz, Michael L

2014-03-01

A critical element of a thriving academic plastic surgery program is the quality of faculty. A decline in recruitment and retention of faculty has been attributed to the many challenges of academic medicine. Given the substantial resources required to develop faculty, academic plastic surgery has a vested interest in improving the process of faculty recruitment and retention. The American Council of Academic Plastic Surgeons Issues Committee and the American Society of Plastic Surgeons/Plastic Surgery Foundation Academic Affairs Council surveyed the 83 existing programs in academic plastic surgery in February of 2012. The survey addressed the faculty-related issues in academic plastic surgery programs over the past decade. Recruitment and retention strategies were evaluated. This study was designed to elucidate trends, and define best strategies, on a national level. Academic plastic surgery programs have added substantially more full-time faculty over the past decade. Recruitment efforts are multifaceted and can include guaranteed salary support, moving expenses, nurse practitioner/physician's assistant hires, protected time for research, seed funds to start research programs, and more. Retention efforts can include increased compensation, designation of a leadership appointment, protected academic time, and call dilution. Significant change and growth of academic plastic surgery has occurred in the past decade. Effective faculty recruitment and retention are critical to a successful academic center. Funding sources in addition to physician professional fees (institutional program support, grants, contracts, endowment, and so on) are crucial to sustain the academic missions.

Benefits of a Pharmacology Antimalarial Reference Standard and Proficiency Testing Program Provided by the Worldwide Antimalarial Resistance Network (WWARN)

PubMed Central

Lourens, Chris; Lindegardh, Niklas; Barnes, Karen I.; Guerin, Philippe J.; Sibley, Carol H.; White, Nicholas J.

2014-01-01

Comprehensive assessment of antimalarial drug resistance should include measurements of antimalarial blood or plasma concentrations in clinical trials and in individual assessments of treatment failure so that true resistance can be differentiated from inadequate drug exposure. Pharmacometric modeling is necessary to assess pharmacokinetic-pharmacodynamic relationships in different populations to optimize dosing. To accomplish both effectively and to allow comparison of data from different laboratories, it is essential that drug concentration measurement is accurate. Proficiency testing (PT) of laboratory procedures is necessary for verification of assay results. Within the Worldwide Antimalarial Resistance Network (WWARN), the goal of the quality assurance/quality control (QA/QC) program is to facilitate and sustain high-quality antimalarial assays. The QA/QC program consists of an international PT program for pharmacology laboratories and a reference material (RM) program for the provision of antimalarial drug standards, metabolites, and internal standards for laboratory use. The RM program currently distributes accurately weighed quantities of antimalarial drug standards, metabolites, and internal standards to 44 pharmacology, in vitro, and drug quality testing laboratories. The pharmacology PT program has sent samples to eight laboratories in four rounds of testing. WWARN technical experts have provided advice for correcting identified problems to improve performance of subsequent analysis and ultimately improved the quality of data. Many participants have demonstrated substantial improvements over subsequent rounds of PT. The WWARN QA/QC program has improved the quality and value of antimalarial drug measurement in laboratories globally. It is a model that has potential to be applied to strengthening laboratories more widely and improving the therapeutics of other infectious diseases. PMID:24777099

77 FR 55120 - Federal Housing Administration (FHA): Section 232 Healthcare Facility Insurance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

...In 2010 through 2011, HUD commenced and completed the process of revising regulations applicable to, and closing documents used in, FHA insurance of multifamily rental projects, to reflect current policy and practices in the multifamily mortgage market. This final rule results from a similar process that was initiated in 2011 for revising and updating the regulations governing, and the transactional documents used in, the program for insurance of healthcare facilities under section 232 of the National Housing Act (Section 232 program). HUD's Section 232 program insures mortgage loans to facilitate the construction, substantial rehabilitation, purchase, and refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities. This rule revises the Section 232 program regulations to reflect current policy and practices, and improve accountability and strengthen risk management in the Section 232 program.

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign.

PubMed

Ellsbury, Dan L; Clark, Reese H; Ursprung, Robert; Handler, Darren L; Dodd, Elizabeth D; Spitzer, Alan R

2016-04-01

Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the "100,000 Babies Campaign." Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record-based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks' gestation) improved. Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record-based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes. Copyright © 2016 by the American Academy of Pediatrics.

Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select

PubMed Central

Akanni, Olufolake (Odufuwa); Smith, Matthew Lee; Ory, Marcia G.

2017-01-01

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits. PMID:28531094

Impact of Safety Training and Interventions on Training-Transfer: Targeting Migrant Construction Workers.

PubMed

Hussain, Rahat; Pedro, Akeem; Lee, Do Yeop; Pham, Hai Chien; Park, Chan Sik

2018-05-01

Despite substantial efforts to improve construction safety training, the accident rate of migrant workers is still high. One of the primary factors contributing to the inefficacy of training includes information delivery gaps during training sessions (knowledge-transfer). In addition, there is insufficient evidence that these training programs alone are effective enough to enable migrant workers to transfer their skills to jobsite (training-transfer). This research attempts to identify and evaluate additional interventions to improve the transfer of acquired knowledge to workplace. For this purpose, this study presents the first known experimental effort to assess the effect of interventions on migrant work groups in a multinational construction project in Qatar. Data analysis reveals that the adoption of training programs with the inclusion of interventions significantly improves training-transfer. Construction safety experts can leverage the findings of this study to enhance training-transfer by increasing worker's safety performance and hazard identification ability.

The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

PubMed

Murman, D L

2001-01-01

This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.

Tree breeding for pest resistance for the next 50 years: the search for cross resistance?

Treesearch

Alvin D. Yanchuk

2012-01-01

Research activities aimed at developing resistance to pests (insect, pathogens, mammals) in forest trees can be documented back over 5 decades. While a substantial body of research has been published on resistances in forest trees, not much of this work has made its way into applied tree improvement programs. There are several reasons for this, e.g.: (i) a new...

Psychological Sciences Division 1979 Programs.

DTIC Science & Technology

1979-11-01

the potential for substantially improving the ONR effectiveness of Navy undersea manipulator sys- tems. Computer aided controls can be used to Report...OPERATOR VIEWING AND CONTROL OF the operator enters control orders) to determine UNDERSEA VEHICLE AND WORK SYS- ihe structure and mode of command inputs...efforts focus upon a class of control-display ele- Current Navy submersible work systems, such as ments common to general purpose undersea work CURV

Between the Fears and Hopes for a Different Future for the Nation-States: Scholarship Programs in Saudi Arabia and United Arab Emirates from a Public Policy Standpoint

ERIC Educational Resources Information Center

Hilal, Kholoud T.

2013-01-01

As Bereday (1964) once said, comparative education research, in its most rudimentary form, begins with juxtaposition. When juxtaposing contemporary trends concerning higher education in Saudi Arabia and the United Arab Emirates--both of which currently provide substantial support to improve their higher education systems--differences abound in…

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.

PubMed

Coker, Kendell L; Stefanovics, Elina; Rosenheck, Robert

2016-01-01

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population. (c) 2016 APA, all rights reserved).

New deal for military space programs

NASA Astrophysics Data System (ADS)

Paecht, A.

1995-01-01

Military space programs will see a new incentive in telecommunications or optical and radar observation. In the intermediate term, electromagnetic surveillance or the detection of ballistic missile firings will have to be developed to meet our country's security needs. National organizations in the space field (CNES, DGA, ONERA) must be corrected. The improvement in French-German relations, currently being negotiated between the governments and private enterprises, will allow the emergence of a European space industry and of a joint and autonomous observation system. Financing of all the space programs-70 billion francs in 20 years will be possible only at the cost of a substantial savings effort in all areas, and of a heightened civilian-military synergy.

A constructive Indian country response to the evidence-based program mandate.

PubMed

Walker, R Dale; Bigelow, Douglas A

2011-01-01

Over the last 20 years governmental mandates for preferentially funding evidence-based "model" practices and programs has become doctrine in some legislative bodies, federal agencies, and state agencies. It was assumed that what works in small sample, controlled settings would work in all community settings, substantially improving safety, effectiveness, and value-for-money. The evidence-based "model" programs mandate has imposed immutable "core components," fidelity testing, alien programming and program developers, loss of familiar programs, and resource capacity requirements upon tribes, while infringing upon their tribal sovereignty and consultation rights. Tribal response in one state (Oregon) went through three phases: shock and rejection; proposing an alternative approach using criteria of cultural appropriateness, aspiring to evaluability; and adopting logic modeling. The state heard and accepted the argument that the tribal way of knowing is different and valid. Currently, a state-authorized tribal logic model and a review panel process are used to approve tribal best practices for state funding. This constructive response to the evidence-based program mandate elevates tribal practices in the funding and regulatory world, facilitates continuing quality improvement and evaluation, while ensuring that practices and programs remain based on local community context and culture. This article provides details of a model that could well serve tribes facing evidence-based model program mandates throughout the country.

ElderSmile: A Comprehensive Approach to Improving Oral Health for Seniors

PubMed Central

Northridge, Mary E.; De La Cruz, Leydis D.; Vaughan, Roger D.; O'Neil-Dunne, Jarlath; Lamster, Ira B.

2009-01-01

Societal changes, including the aging of the US population and the lack of routine dental service coverage under Medicare, have left many seniors unable to afford any dental care whatsoever, let alone the most advanced treatments.1 In 2004, the Columbia University College of Dental Medicine and its partners instituted the ElderSmile program in the largely impoverished communities of Harlem and Washington Heights/Inwood in New York City. The long-term goal of this program is to improve access to and delivery of oral health care for seniors; the short-term goal is to establish and operate a network of prevention centers surrounding a limited number of treatment centers. Preliminary results indicate substantial unmet dental needs in this largely Hispanic and Black elderly population. PMID:19276459

Comparison of bioimpedance analysis scan, hemoglobin and urea reduction ratio in hemodialysis patients following and not following monitoring program for improving quality of life

NASA Astrophysics Data System (ADS)

Muzasti, R. A.; Lubis, H. R.

2018-03-01

Hemodialysis (HD) is the renal replacement therapy in end-stage renal disease (ESRD), at least 2-3 times a week, impacting substantial changes in daily life. Therefore a monitoring program is needed to improve the quality of life (QoL) of HD patients. Indicators in monitoring QoL include phase angle (PhA), muscle and fat mass, and body fluid composition through Bio Scan impedance analysis (BIA) Scan, hemoglobin level, and urea reduction ratio (URR). An analytic study with the cross-sectional design was performed in 168 patients at Klinik Spesialis Ginjal Hipertensi (KSGH) Rasyida, Medan to compare BIA Scan profiles, hemoglobin levels, and URR in HD patients who follow and do not follow the monitoring program for improving QoL {Program Pemantauan Peningkatan Kualitas Hidup (P3KH)}. Each variable was analyzed by independent T-test, it is significant if p <0.05. This study showed that there were differences in BMI (p = 0.006), fat mass (p = 0.010), extracellular water / intracellular water (ECW / ICW) (p = 0.046), and haemoglobin p = 0.001). Although it was better in the program group, statistically there was no difference of PhA (p = 0.136), muscle mass (p = 0.842), and URR (p = 0.232).

The Canadian clinician-scientist training program must be reinstated.

PubMed

Twa, David D W; Squair, Jordan W; Skinnider, Michael A; Ji, Jennifer X

2015-11-03

Clinical investigators within the Canadian and international communities were shocked when the Canadian Institutes of Health Research (CIHR) announced that their funding for the MD/PhD program would be terminated after the 2015-2016 academic year. The program has trained Canadian clinician-scientists for more than two decades. The cancellation of the program is at odds with the CIHR's mandate, which stresses the translation of new knowledge into improved health for Canadians, as well as with a series of internal reports that have recommended expanding the program. Although substantial evidence supports the analogous Medical Scientist Training Program in the United States, no parallel analysis of the MD/PhD program has been performed in Canada. Here, we highlight the long-term consequences of the program's cancellation in the context of increased emphasis on translational research. We argue that alternative funding sources cannot ensure continuous support for students in clinician-scientist training programs and that platform funding of the MD/PhD program is necessary to ensure leadership in translational research.

How much can we gain from improved efficiency? An examination of performance of national HIV/AIDS programs and its determinants in low- and middle-income countries

PubMed Central

2012-01-01

Background The economic downturn exacerbates the inadequacy of resources for combating the worldwide HIV/AIDS pandemic and amplifies the need to improve the efficiency of HIV/AIDS programs. Methods We used data envelopment analysis (DEA) to evaluate efficiency of national HIV/AIDS programs in transforming funding into services and implemented a Tobit model to identify determinants of the efficiency in 68 low- and middle-income countries. We considered the change from the lowest quartile to the average value of a variable a "notable" increase. Results Overall, the average efficiency in implementing HIV/AIDS programs was moderate (49.8%). Program efficiency varied enormously among countries with means by quartile of efficiency of 13.0%, 36.4%, 54.4% and 96.5%. A country's governance, financing mechanisms, and economic and demographic characteristics influence the program efficiency. For example, if countries achieved a notable increase in "voice and accountability" (e.g., greater participation of civil society in policy making), the efficiency of their HIV/AIDS programs would increase by 40.8%. For countries in the lowest quartile of per capita gross national income (GNI), a notable increase in per capita GNI would increase the efficiency of AIDS programs by 45.0%. Conclusions There may be substantial opportunity for improving the efficiency of AIDS services, by providing more services with existing resources. Actions beyond the health sector could be important factors affecting HIV/AIDS service delivery. PMID:22443135

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the "On the Move" group exercise program in community-dwelling older adults.

PubMed

Brach, Jennifer S; Perera, Subashan; Gilmore, Sandra; VanSwearingen, Jessie M; Brodine, Deborah; Wert, David; Nadkarni, Neelesh K; Ricci, Edmund

2016-09-01

Group exercise programs for older adults often exclude the timing and coordination of movement. Stakeholder involvement in the research process is strongly encouraged and improves the relevance and adoption of findings. We describe stakeholder involvement in the design of a clinical trial of a group-based exercise program that incorporates timing and coordination of movement into the exercises. The study was a cluster randomized, single-blind intervention trial to compare the effects on function, disability and mobility of a standard group exercise program and the "On the Move" group exercise program in older adults residing in independent living facilities and senior apartment buildings, and attending community centers. Exercise classes were twice weekly for 12weeks delivered by study exercise leaders and facility activity staff personnel. The primary outcomes function, disability and mobility were assessed at baseline and post-intervention. Function and disability were assessed using the Late Life Function and Disability Instrument, and mobility using the Six-Minute Walk Test and gait speed. Patient and provider stakeholders had significant input into the study aims, design, sample, intervention, outcomes and operational considerations. A community-based exercise program to improve walking can be developed to address both investigator identified missing components in current exercise to improve walking and stakeholder defined needs and interest for the activity program. Involvement of stakeholders substantially improves the relevance of research questions, increases the transparency of research activities and may accelerate the adoption of research into practice. Copyright © 2016 Elsevier Inc. All rights reserved.

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “On the Move” group exercise program in community-dwelling older adults

PubMed Central

Brach, Jennifer S.; Perera, Subashan; Gilmore, Sandra; VanSwearingen, Jessie M.; Brodine, Deborah; Wert, David; Nadkarni, Neelesh K.; Ricci, Edmund

2016-01-01

Background Group exercise programs for older adults often exclude the timing and coordination of movement. Stakeholder involvement in the research process is strongly encouraged and improves the relevance and adoption of findings. We describe stakeholder involvement in the design of a clinical trial of a group-based exercise program that incorporates timing and coordination of movement into the exercises. Methods The study was a cluster randomized, single-blind intervention trial to compare the effects on function, disability and mobility of a standard group exercise program and the “On the Move” group exercise program in older adults residing in independent living facilities and senior apartment buildings, and attending community centers. Exercise classes were twice weekly for 12 weeks delivered by study exercise leaders and facility activity staff personnel. Outcomes The primary outcomes function, disability and mobility were assessed at baseline and post-intervention. Function and disability were assessed using the Late Life Function and Disability Instrument, and mobility using the Six-Minute Walk Test and gait speed. Stakeholders Patient and provider stakeholders had significant input into the study aims, design, sample, intervention, outcomes and operational considerations. Summary A community-based exercise program to improve walking can be developed to address both investigator identified missing components in current exercise to improve walking and stakeholder defined needs and interest for the activity program. Involvement of stakeholders substantially improves the relevance of research questions, increases the transparency of research activities and may accelerate the adoption of research into practice. PMID:27521806

A randomized controlled trial of a new behavioral home-based nutrition education program, "Eat Well with CF," in adults with cystic fibrosis.

PubMed

Watson, Helen; Bilton, Diana; Truby, Helen

2008-05-01

Cystic fibrosis (CF) remains the most common genetically inherited disease in the white population and its prognosis is affected by nutritional status. Adults with the disease are now surviving longer and new strategies are required to ensure that they maintain optimal nutrition. This article reports preliminary data from a randomized controlled trial of a 10-week home-based behavioral nutrition intervention, "Eat Well with CF." Outcome measures of weight change over 6 and 12 months and changes in CF-specific nutrition knowledge score, self-efficacy score, reported dietary fat intake and health-related quality-of-life score were compared between the intervention group (n=34) and a standard care control group (n=34). The hypotheses to be tested were that adults with CF completing "Eat Well with CF" would have an improved nutritional status, improvement in specific nutrition knowledge, and an improvement in self-efficacy regarding their ability to cope with a special diet, compared to those receiving standard care. There were substantial improvements in the intervention group's specific CF nutrition knowledge score, self-efficacy score, and reported fat intake compared to control, but no substantial change in body mass index or health-related quality of life over time. Home-based nutrition education incorporating behavioral strategies can be an effective way to support adults with CF, enabling improvement in self-management skills in relation to diet and pancreatic enzyme replacement therapy. This study revealed gaps in basic nutrition knowledge and skills, inadequate knowledge of diet-disease links and pancreatic enzyme replacement therapy. These need to be identified when subjects progress from pediatric to adult care, and programs such as "Eat Well with CF" are a useful adjunct for registered dietitians trying to manage this diverse but growing population.

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

PubMed

Coffey, Diane

2014-08-01

The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

The effect of Early Head Start on child welfare system involvement: A first look at longitudinal child maltreatment outcomes☆

PubMed Central

Green, Beth L.; Ayoub, Catherine; Bartlett, Jessica Dym; Von Ende, Adam; Furrer, Carrie; Chazan-Cohen, Rachel; Vallotton, Claire; Klevens, Joanne

2015-01-01

The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse. PMID:26744550

Small Hydropower in the United States

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

Hadjerioua, Boualem; Johnson, Kurt

Small hydropower, defined in this report as hydropower with a generating capacity of up to 10 MW typically built using existing dams, pipelines, and canals has substantial opportunity for growth. Existing small hydropower comprises about 75% of the current US hydropower fleet in terms of number of plants. The economic feasibility of developing new small hydropower projects has substantially improved recently, making small hydropower the type of new hydropower development most likely to occur. In 2013, Congress unanimously approved changes to simplify federal permitting requirements for small hydropower, lowering costs and reducing the amount of time required to receive federalmore » approvals. In 2014, Congress funded a new federal incentive payment program for hydropower, currently worth approximately 1.5 cents/kWh. Federal and state grant and loan programs for small hydropower are becoming available. Pending changes in federal climate policy could benefit all renewable energy sources, including small hydropower. Notwithstanding remaining barriers, development of new small hydropower is expected to accelerate in response to recent policy changes.« less

Dating Violence Prevention Programming: Directions for Future Interventions

PubMed Central

Shorey, Ryan C.; Zucosky, Heather; Brasfield, Hope; Febres, Jeniimarie; Cornelius, Tara L.; Sage, Chelsea; Stuart, Gregory L.

2012-01-01

Dating violence among college students is a widespread and destructive problem. The field of dating violence has seen a substantial rise in research over the past several years, which has improved our understanding of factors that increase risk for perpetration. Unfortunately, there has been less attention paid to dating violence prevention programming, and existing programs have been marred with methodological weaknesses and a lack of demonstrated effectiveness in reducing aggression. In hopes of sparking new research on dating violence prevention programs, the current review examines possible new avenues for dating violence prevention programming among college students. We discuss clinical interventions that have shown to be effective in reducing a number of problematic behaviors, including motivational interventions, dialectical behavior therapy, mindfulness, and bystander interventions, and how they could be applied to dating violence prevention. We also discuss methodological issues to consider when implementing dating violence prevention programs. PMID:22773916

An Ethics Framework for Public Health

PubMed Central

Kass, Nancy E.

2001-01-01

More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed. To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community. PMID:11684600

Milestone-specific, Observed data points for evaluating levels of performance (MODEL) assessment strategy for anesthesiology residency programs.

PubMed

Nagy, Christopher J; Fitzgerald, Brian M; Kraus, Gregory P

2014-01-01

Anesthesiology residency programs will be expected to have Milestones-based evaluation systems in place by July 2014 as part of the Next Accreditation System. The San Antonio Uniformed Services Health Education Consortium (SAUSHEC) anesthesiology residency program developed and implemented a Milestones-based feedback and evaluation system a year ahead of schedule. It has been named the Milestone-specific, Observed Data points for Evaluating Levels of performance (MODEL) assessment strategy. The "MODEL Menu" and the "MODEL Blueprint" are tools that other anesthesiology residency programs can use in developing their own Milestones-based feedback and evaluation systems prior to ACGME-required implementation. Data from our early experience with the streamlined MODEL blueprint assessment strategy showed substantially improved faculty compliance with reporting requirements. The MODEL assessment strategy provides programs with a workable assessment method for residents, and important Milestones data points to programs for ACGME reporting.

Adaptations Associated With an After-School Strength and Conditioning Program in Middle-School-Aged Boys: A Quasi-Experimental Design.

PubMed

Thompson, Brennan J; Stock, Matt S; Mota, Jacob A; Drusch, Alexander S; DeFranco, Ryan N; Cook, Tyler R; Hamm, Matthew A

2017-10-01

High-intensity strength and conditioning programs aimed at improving youth performance are becoming increasingly prevalent. The purpose of this study was to investigate the effects of a 16-week after-school strength and conditioning program on performance and body composition in middle-school-aged boys. Subjects in the training group (n = 16, mean age = 11.8 years) performed 90 minutes of supervised plyometric and resistance training twice weekly for 16 weeks. A group of control subjects (n = 9, age = 12.1 years) maintained their current activity levels. Sprint speed, 5-10-5 proagility, jump height, isometric peak torque of the leg extensors and flexors, and dual energy x-ray absorptiometry-derived body composition were examined during pretesting and posttesting. Data were analyzed by performing independent samples t-tests on the absolute change scores between groups. The primary findings were that the training intervention elicited significant improvements in 20-m sprint times (p = 0.03; mean change for training group = -0.17 seconds) and body-fat percentage (p = 0.03; 2.5% absolute improvement), the latter of which was a function of reduced fat mass (p = 0.06; -0.84 kg). Between-group differences were not noted for agility, jump height, lean mass, or strength measures; however, effect sizes generally showed greater improvements for the training group. In contrast to findings in longitudinal studies performed in collegiate athletes, sprint speed may be particularly adaptable during adolescence. In addition to potentially improving sport performance, high-intensity plyometric and resistance training programs offer the added benefit of improved body composition. These programs appear less effective for agility and jump performance and do not elicit substantial improvements in muscle mass above maturation.

BEHAVIOR ANALYSTS IN THE WAR ON POVERTY: A REVIEW OF THE USE OF FINANCIAL INCENTIVES TO PROMOTE EDUCATION AND EMPLOYMENT

PubMed Central

Holtyn, August F.; Jarvis, Brantley P.; Silverman, Kenneth

2017-01-01

Poverty is a pervasive risk factor underlying poor health. Many interventions that have sought to reduce health disparities associated with poverty have focused on improving health-related behaviors of low-income adults. Poverty itself could be targeted to improve health, but this approach would require programs that can consistently move poor individuals out of poverty. Governments and other organizations in the United States have tested a diverse range of antipoverty programs, generally on a large scale and in conjunction with welfare reform initiatives. This paper reviews antipoverty programs that used financial incentives to promote education and employment among welfare recipients and other low-income adults. The incentive-based, antipoverty programs had small or no effects on the target behaviors; they were implemented on large scales from the outset, without systematic development and evaluation of their components; and they did not apply principles of operant conditioning that have been shown to determine the effectiveness of incentive or reinforcement interventions. By applying basic principles of operant conditioning, behavior analysts could help address poverty and improve health through development of effective antipoverty programs. This paper describes a potential framework for a behavior-analytic antipoverty program, with the goal of illustrating that behavior analysts could be uniquely suited to make substantial contributions to the war on poverty. PMID:28078664

Behavior analysts in the war on poverty: A review of the use of financial incentives to promote education and employment.

PubMed

Holtyn, August F; Jarvis, Brantley P; Silverman, Kenneth

2017-01-01

Poverty is a pervasive risk factor underlying poor health. Many interventions that have sought to reduce health disparities associated with poverty have focused on improving health-related behaviors of low-income adults. Poverty itself could be targeted to improve health, but this approach would require programs that can consistently move poor individuals out of poverty. Governments and other organizations in the United States have tested a diverse range of antipoverty programs, generally on a large scale and in conjunction with welfare reform initiatives. This paper reviews antipoverty programs that used financial incentives to promote education and employment among welfare recipients and other low-income adults. The incentive-based, antipoverty programs had small or no effects on the target behaviors; they were implemented on large scales from the outset, without systematic development and evaluation of their components; and they did not apply principles of operant conditioning that have been shown to determine the effectiveness of incentive or reinforcement interventions. By applying basic principles of operant conditioning, behavior analysts could help address poverty and improve health through development of effective antipoverty programs. This paper describes a potential framework for a behavior-analytic antipoverty program, with the goal of illustrating that behavior analysts could be uniquely suited to make substantial contributions to the war on poverty. © 2017 Society for the Experimental Analysis of Behavior.

Economic implications of cardiovascular disease management programs: moving beyond one-off experiments.

PubMed

Maru, Shoko; Byrnes, Joshua; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

2015-01-01

Substantial variation in economic analyses of cardiovascular disease management programs hinders not only the proper assessment of cost-effectiveness but also the identification of heterogeneity of interest such as patient characteristics. The authors discuss the impact of reporting and methodological variation on the cost-effectiveness of cardiovascular disease management programs by introducing issues that could lead to different policy or clinical decisions, followed by the challenges associated with net intervention effects and generalizability. The authors conclude with practical suggestions to mitigate the identified issues. Improved transparency through standardized reporting practice is the first step to advance beyond one-off experiments (limited applicability outside the study itself). Transparent reporting is a prerequisite for rigorous cost-effectiveness analyses that provide unambiguous implications for practice: what type of program works for whom and how.

Commentary: Medicaid reform issues affecting the Indian health care system.

PubMed Central

Wellever, A; Hill, G; Casey, M

1998-01-01

Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system. PMID:9491006

Analysis of documentary support for environmental restoration programs in Russia

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

Nechaev, A.F.; Projaev, V.V.

1995-12-31

Taking into account an importance of an adequate regulations for ensuring of radiological safety of the biosphere and for successful implementation of environmental restoration projects, contents of legislative and methodical documents as well as their comprehensitivity and substantiation are subjected to critical analysis. It is shown that there is much scope for further optimization of and improvements in regulatory basis both on Federal and regional levels.

A Comparison of the Effects of Classroom and Multi-User Virtual Environments on the Perceived Speaking Anxiety of Adult Post-Secondary English Language Learners

ERIC Educational Resources Information Center

Abal, Abdulaziz

2013-01-01

The population of English Language Learners (ELLs) globally has been increasing substantially every year. In the United States alone, adult ELLs are the fastest growing portion of learners in adult education programs (Yang, 2005). There is a significant need to improve the teaching of English to ELLs in the United States and other English-speaking…

Estimating Impacts of Treatment Random Assignment on Classroom Quality in the Head Start Impact Study: The Problem of Missing Data

ERIC Educational Resources Information Center

Friedman-Krauss, Allison H.; Connors, Maia C.; Morris, Pamela A.

2013-01-01

As a result of the 1998 reauthorization of Head Start, the Department of Health and Human Services conducted a national evaluation of the Head Start program. The goal of Head Start is to improve the school readiness skills of low-income children in the United States. There is a substantial body of experimental and correlational research that has…

Numerical and Physical Aspects of Aerodynamic Flows

DTIC Science & Technology

1992-01-15

accretion was also measured. detailed description of the IRT can be found in This test program also provided a new database for reference 4. code...Deflection lift flows and to develop a validation database 8 Slat Deflection with practical geometries/conditions for emerging computational methods. This...be substantially improved by their developers in the absence of a quality database at realistic conditions for a practical airfoil. The work reported

On-Line Thermal Barrier Coating Monitoring for Real-Time Failure Protection and Life Maximization

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

Dennis H. LeMieux

2004-10-01

Under the sponsorship of the U. S. Department of Energy's National Energy Laboratory, Siemens Westinghouse Power Corporation proposes a four year program titled, ''On-Line Thermal Barrier Coating (TBC) Monitor for Real-Time Failure Protection and Life Maximization'', to develop, build and install the first generation of an on-line TBC monitoring system for use on land -based advanced gas turbines (AGT). Federal deregulation in electric power generation has accelerated power plant owner's demand for improved reliability availability maintainability (RAM) of the land-based advanced gas turbines. As a result, firing temperatures have been increased substantially in the advanced turbine engines, and the TBCsmore » have been developed for maximum protection and life of all critical engine components operating at these higher temperatures. Losing TBC protection can therefore accelerate the degradation of substrate components materials and eventually lead to a premature failure of critical component and costly unscheduled power outages. This program seeks to substantially improve the operating life of high cost gas turbine components using TBC; thereby, lowering the cost of maintenance leading to lower cost of electricity. Siemens Westinghouse Power Corporation has teamed with Indigo Systems; a supplier of state-of-the-art infrared camera systems, and Wayne State University, a leading research organization.« less

Numerical Computation of a Continuous-thrust State Transition Matrix Incorporating Accurate Hardware and Ephemeris Models

NASA Technical Reports Server (NTRS)

Ellison, Donald; Conway, Bruce; Englander, Jacob

2015-01-01

A significant body of work exists showing that providing a nonlinear programming (NLP) solver with expressions for the problem constraint gradient substantially increases the speed of program execution and can also improve the robustness of convergence, especially for local optimizers. Calculation of these derivatives is often accomplished through the computation of spacecraft's state transition matrix (STM). If the two-body gravitational model is employed as is often done in the context of preliminary design, closed form expressions for these derivatives may be provided. If a high fidelity dynamics model, that might include perturbing forces such as the gravitational effect from multiple third bodies and solar radiation pressure is used then these STM's must be computed numerically. We present a method for the power hardward model and a full ephemeris model. An adaptive-step embedded eight order Dormand-Prince numerical integrator is discussed and a method for the computation of the time of flight derivatives in this framework is presented. The use of these numerically calculated derivatieves offer a substantial improvement over finite differencing in the context of a global optimizer. Specifically the inclusion of these STM's into the low thrust missiondesign tool chain in use at NASA Goddard Spaceflight Center allows for an increased preliminary mission design cadence.

Evaluation of the reach and impact of the 100% Jeune youth social marketing program in Cameroon: findings from three cross-sectional surveys.

PubMed

Plautz, Andrea; Meekers, Dominique

2007-02-26

The 100% Jeune youth social marketing program in Cameroon aims to address the high STI/HIV prevalence rates and the high levels of unwanted pregnancy. This study evaluates the 100% Jeune program, analyzing its reach and impact on condom use, level of sexual activity, and predictors of condom use. This analysis uses data from three waves of the Cameroon Adolescent Reproductive Health Survey, implemented at 18-month intervals between 2000 and 2003. The sample is restricted to unmarried youth aged 15-24; sample sizes are 1,956 youth in 2000, 3,237 in 2002, and 3,370 in 2003. Logistic regression analyses determine trends in reproductive health behavior and their predictors, as well as estimate the effect of program exposure on these variables. All regression analyses control for differences in sample characteristics. A comparison of trends over the 36-month study period shows that substantial positive changes occurred among youth. Results of dose response analyses indicate that some of these positive changes in condom use and predictors of use can be attributed to the 100% Jeune youth social marketing program. The program contributed to substantial increases in condom use, including consistent use with regular partners among youth of both sexes. Among males, it also contributed to consistent use with casual partners. While condom use increased with both regular and casual partners, levels of use are higher with the latter. Observed secular trends indicate that factors besides the 100% Jeune program also contributed to the observed improvements. Despite efforts to promote abstinence, the 100% Jeune program had no effect on levels of sexual activity or number of sexual partners. Likewise, there is no evidence that reproductive health programs for youth lead to increased sexual activity. Results show that 100% Jeune successfully used a variety of mass media and interpersonal communication channels to reach a high proportion of youth throughout the intervention period. In a context in which a variety of governmental and nongovernmental partners are increasing youth-focused reproductive health programming, the 100% Jeune program reached a higher proportion of youth than did other programs. Collective efforts of multiple organizations over time can lead to improvements in adolescent reproductive health. Resources should be allocated to identify and understand predictors of abstinence and partner reduction to inform future programming decisions.

Evaluation of the reach and impact of the 100% Jeune youth social marketing program in Cameroon: findings from three cross-sectional surveys

PubMed Central

Plautz, Andrea; Meekers, Dominique

2007-01-01

Background The 100% Jeune youth social marketing program in Cameroon aims to address the high STI/HIV prevalence rates and the high levels of unwanted pregnancy. This study evaluates the 100% Jeune program, analyzing its reach and impact on condom use, level of sexual activity, and predictors of condom use. Methods This analysis uses data from three waves of the Cameroon Adolescent Reproductive Health Survey, implemented at 18-month intervals between 2000 and 2003. The sample is restricted to unmarried youth aged 15–24; sample sizes are 1,956 youth in 2000, 3,237 in 2002, and 3,370 in 2003. Logistic regression analyses determine trends in reproductive health behavior and their predictors, as well as estimate the effect of program exposure on these variables. All regression analyses control for differences in sample characteristics. Results A comparison of trends over the 36-month study period shows that substantial positive changes occurred among youth. Results of dose response analyses indicate that some of these positive changes in condom use and predictors of use can be attributed to the 100% Jeune youth social marketing program. The program contributed to substantial increases in condom use, including consistent use with regular partners among youth of both sexes. Among males, it also contributed to consistent use with casual partners. While condom use increased with both regular and casual partners, levels of use are higher with the latter. Observed secular trends indicate that factors besides the 100% Jeune program also contributed to the observed improvements. Despite efforts to promote abstinence, the 100% Jeune program had no effect on levels of sexual activity or number of sexual partners. Likewise, there is no evidence that reproductive health programs for youth lead to increased sexual activity. Conclusion Results show that 100% Jeune successfully used a variety of mass media and interpersonal communication channels to reach a high proportion of youth throughout the intervention period. In a context in which a variety of governmental and nongovernmental partners are increasing youth-focused reproductive health programming, the 100% Jeune program reached a higher proportion of youth than did other programs. Collective efforts of multiple organizations over time can lead to improvements in adolescent reproductive health. Resources should be allocated to identify and understand predictors of abstinence and partner reduction to inform future programming decisions. PMID:17324289

Socioeconomic Status and Improvements in Lifestyle, Coronary Risk Factors, and Quality of Life: The Multisite Cardiac Lifestyle Intervention Program

PubMed Central

Govil, Sarah R.; Merritt-Worden, Terri; Ornish, Dean

2009-01-01

Objectives. We sought to clarify whether patients of low socioeconomic status (SES) can make lifestyle changes and show improved outcomes in coronary heart disease (CHD), similar to patients with higher SES. Methods. We examined lifestyle, risk factors, and quality of life over 3 months, by SES and gender, in 869 predominantly White, nonsmoking CHD patients (34% female) in the insurance-sponsored Multisite Cardiac Lifestyle Intervention Program. SES was defined primarily by education. Results. At baseline, less-educated participants were more likely to be disadvantaged (e.g., past smoking, sedentary lifestyle, high fat diet, overweight, depression) than were higher-SES participants. By 3 months, participants at all SES levels reported consuming 10% or less dietary fat, exercising 3.5 hours per week or more, and practicing stress management 5.5 hours per week or more. These self-reports were substantiated by improvements in risk factors (e.g., 5-kg weight loss, and improved blood pressure, low-density lipoprotein cholesterol, and exercise capacity; P < .001), and accompanied by improvements in well-being (e.g., depression, hostility, quality of life; P < .001). Conclusions. The observed benefits for CHD patients with low SES indicate that broadening accessibility of lifestyle programs through health insurance should be strongly encouraged. PMID:18923113

Integrating Research, Quality Improvement, and Medical Education for Better Handoffs and Safer Care: Disseminating, Adapting, and Implementing the I-PASS Program.

PubMed

Starmer, Amy J; Spector, Nancy D; West, Daniel C; Srivastava, Rajendu; Sectish, Theodore C; Landrigan, Christopher P

2017-07-01

In 2009 the I-PASS Study Group was formed by patient safety, medical education, health services research, and clinical experts from multiple institutions in the United States and Canada. When the I-PASS Handoff Program, which was developed by the I-PASS Study Group, was implemented in nine hospitals, it was associated with a 30% reduction in injuries due to medical errors and significant improvements in handoff processes, without any adverse effects on provider work flow. To effectively disseminate and adapt I-PASS for use across specialties and disciplines, a series of federally and privately funded dissemination and implementation projects were carried out following the publication of the initial study. The results of these efforts have informed ongoing initiatives intended to continue adapting and scaling the program. As of this writing, I-PASS Study Group members have directly worked with more than 50 hospitals to facilitate implementation of I-PASS. To further disseminate I-PASS, Study Group members delivered hundreds of academic presentations, including plenaries at scientific meetings, workshops, and institutional Grand Rounds. Some 3,563 individuals, representing more than 500 institutions in the 50 states in the United States, the District of Columbia, Puerto Rico, and 57 other countries, have requested access to I-PASS materials. Most recently, the I-PASS SM Patient Safety Institute has developed a virtual immersion training platform, mobile handoff observational tools, and processes to facilitate further spread of I-PASS. Implementation of I-PASS has been associated with substantial improvements in patient safety and can be applied to a variety of disciplines and types of patient handoffs. Widespread implementation of I-PASS has the potential to substantially improve patient safety in the United States and beyond. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Engaging and Retaining Abused Women in Perinatal Home Visitation Programs

PubMed Central

Alhusen, Jeanne L.; Bullock, Linda; Bhandari, Shreya; Ghazarian, Sharon; Udo, Ifeyinwa E.; Campbell, Jacquelyn

2013-01-01

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs’ federal government mandates for the appropriate identification and intervention of women and children exposed to IPV. PMID:24187115

Context matters: A community-based study of urban minority parents’ views on child health

PubMed Central

Bolar, Cassandra L.; Hernandez, Natalie; Akintobi, Tabia Henry; McAllister, Calvin; Ferguson, Aneeqah S.; Rollins, Latrice; Wrenn, Glenda; Okafor, Martha; Collins, David; Clem, Thomas

2016-01-01

Background Among children, there are substantial ethno-racial minority disparities across a broad range of health-related behaviors, experiences, and outcomes. Addressing these disparities is important, as childhood and adolescence establish health trajectories that extend throughout life. Methods The current study employed a community-based participatory research approach to gain community insight on child health priorities and to frame an intervention aimed at improving the health of minority children. Eight focus groups were conducted among seventy-five African American parents in a Southeastern city. The current study was guided by an ecological theoretical framework. Results Although the focus of this investigation was on community identification of child health priorities, participants cited, as root determinants, contextual factors, which included lack of healthy food options, lack of spaces for physical activity, and community violence. These co-occurring factors were related to limited engagement in outdoor activities and physical activity, increased obesity, and poor mental health and coping. Poor parenting was cited as the most substantial barrier to improving child health outcomes, and quality parenting was identified as the most important issue to address for community programs focused on promoting the health and success of children. For improving health outcomes for children in their neighborhoods, establishment of positive social capital and constructive activities were also cited. Conclusions These results reinforce social determinants of health as influences on child health outcomes and describe how community engagement can address potential solutions through interventions that resonate with program participants. PMID:27275021

Stellar and Binary Evolution in Star Clusters

NASA Technical Reports Server (NTRS)

McMillan, Stephen L. W.

2001-01-01

This paper presents a final report on research activities covered on Stellar and Binary Evolution in Star Clusters. Substantial progress was made in the development and dissemination of the "Starlab" software environment. Significant improvements were made to "kira," an N-body simulation program tailored to the study of dense stellar systems such as star clusters and galactic nuclei. Key advances include (1) the inclusion of stellar and binary evolution in a self-consistent manner, (2) proper treatment of the anisotropic Galactic tidal field, (3) numerous technical enhancements in the treatment of binary dynamics and interactions, and (4) full support for the special-purpose GRAPE-4 hardware, boosting the program's performance by a factor of 10-100 over the accelerated version. The data-reduction and analysis tools in Starlab were also substantially expanded. A Starlab Web site (http://www.sns.ias.edu/-starlab) was created and developed. The site contains detailed information on the structure and function of the various tools that comprise the package, as well as download information, "how to" tips and examples of common operations, demonstration programs, animations, etc. All versions of the software are freely distributed to all interested users, along with detailed installation instructions.

Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

PubMed

Lacey, Susan R; Goodyear-Bruch, Caryl; Olney, Adrienne; Hanson, Dave; Altman, Marian S; Varn-Davis, Natasha S; Brinker, Debbie; Lavandero, Ramón; Cox, Karen S

2017-08-01

Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes. ©2017 American Association of Critical-Care Nurses.

Toward full life cycle control: Adding maintenance measurement to the SEL

NASA Technical Reports Server (NTRS)

Rombach, H. Dieter; Ulery, Bradford T.; Valett, Jon D.

1992-01-01

Organization-wide measurement of software products and processes is needed to establish full life cycle control over software products. The Software Engineering Laboratory (SEL)--a joint venture between NASA GSFC, the University of Maryland, and Computer Sciences Corporation--started measurement of software development more than 15 years ago. Recently, the measurement of maintenance was added to the scope of the SEL. In this article, the maintenance measurement program is presented as an addition to the already existing and well-established SEL development measurement program and evaluated in terms of its immediate benefits and long-term improvement potential. Immediate benefits of this program for the SEL include an increased understanding of the maintenance domain, the differences and commonalities between development and maintenance, and the cause-effect relationships between development and maintenance. Initial results from a sample maintenance study are presented to substantiate these benefits. The long-term potential of this program includes the use of maintenance baselines to better plan and manage future projects and to improve development and maintenance practices for future projects wherever warranted.

Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries.

PubMed

Zhang, Ning Jackie; Wan, Thomas T H; Rossiter, Louis F; Murawski, Matthew M; Patel, Urvashi B

2008-05-01

To evaluate the impacts of the chronic disease management program on the outcomes and cost of care for Virginia Medicaid beneficiaries. A total of 35,628 patients and their physicians and pharmacists received interventions for five chronic diseases and comorbidities from 1999 to 2001. Comparisons of medical utilization and clinical outcomes between experimental groups and control group were conducted using ANOVA and ANCOVA analyses. Findings indicate that the disease state management (DSM) program statistically significantly improved patient's drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events. The average cost per hospitalization would have been $42 higher without the interventions. A coordinated disease management program designed for Medicaid patients experiencing significant chronic diseases can substantially improve clinical outcomes and reduce unnecessary medical utilization, while lowering costs, although these results were not observed across all disease groups. The DSM model may be potentially useful for Medicaid programs in states or other countries. If the adoption of the DSM model is to be promoted, evidence of its effectiveness should be tested in broader settings and best practice standards are expected.

Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China.

PubMed

Xu, Wenhong; Sun, Changxian; Lin, Zheng; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

2016-01-01

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible.

Alabama DOE/EPSCoR traineeship program. Final report, September 28, 1991--September 28, 1995

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

Pruitt, K.M.; April, G.C.

1995-12-01

This report covers programmatic accomplishments of the Alabama DOE/EPSCoR Traineeship Program for the period September 28, 1991 to September 29, 1995. The Alabama DOE/EPSCoR Traineeship Program is an integral part of this state`s efforts to address barriers that inhibit the full development and substantial growth of energy-related research at the six major research institutions and at Alabama`s Historically Black Colleges and Universities (HBCUs). To overcome these barriers it was determined that the following actions were needed: Area 1: Strengthening the Research Faculty Base Area 2: Increasing the Number of Outstanding Graduate Students Area 3: Improving the Research Environment Area 4:more » Developing the Human Resources Base Area 5. Improving the Energy-related Infrastructure, Collaborations and Communications. Although the DOE/EPSCoR Traineeship Grant complements each of the areas listed above, its primary emphasis is the enhancement of opportunities for graduate students. The extent to which this program has met this challenge during the three year funding period constitutes the substance of this report.« less

Space Station Mission Planning System (MPS) development study. Volume 2

NASA Technical Reports Server (NTRS)

Klus, W. J.

1987-01-01

The process and existing software used for Spacelab payload mission planning were studied. A complete baseline definition of the Spacelab payload mission planning process was established, along with a definition of existing software capabilities for potential extrapolation to the Space Station. This information was used as a basis for defining system requirements to support Space Station mission planning. The Space Station mission planning concept was reviewed for the purpose of identifying areas where artificial intelligence concepts might offer substantially improved capability. Three specific artificial intelligence concepts were to be investigated for applicability: natural language interfaces; expert systems; and automatic programming. The advantages and disadvantages of interfacing an artificial intelligence language with existing FORTRAN programs or of converting totally to a new programming language were identified.

Assessing the effects of regional payment for watershed services program on water quality using an intervention analysis model.

PubMed

Lu, Yan; He, Tian

2014-09-15

Much attention has been recently paid to ex-post assessments of socioeconomic and environmental benefits of payment for ecosystem services (PES) programs on poverty reduction, water quality, and forest protection. To evaluate the effects of a regional PES program on water quality, we selected chemical oxygen demand (COD) and ammonia-nitrogen (NH3-N) as indicators of water quality. Statistical methods and an intervention analysis model were employed to assess whether the PES program produced substantial changes in water quality at 10 water-quality sampling stations in the Shaying River watershed, China during 2006-2011. Statistical results from paired-sample t-tests and box plots of COD and NH3-N concentrations at the 10 stations showed that the PES program has played a positive role in improving water quality and reducing trans-boundary water pollution in the Shaying River watershed. Using the intervention analysis model, we quantitatively evaluated the effects of the intervention policy, i.e., the watershed PES program, on water quality at the 10 stations. The results suggest that this method could be used to assess the environmental benefits of watershed or water-related PES programs, such as improvements in water quality, seasonal flow regulation, erosion and sedimentation, and aquatic habitat. Copyright © 2014 Elsevier B.V. All rights reserved.

Old age income security in Canada.

PubMed

Willard, J W

1965-10-09

The position of older people in modern industrial society is markedly removed from the early industrial norm of continued participation in gainful employment until the end of life. Acceptance of a retirement age some 13 years before the end of average male life expectancy has brought with it serious social problems. At the same time, however, an increasingly productive economy has provided both the willingness and ability to complement the retirement provisions of individual initiative with public programs of old age income maintenance. This public support began in Canada with the voluntary approach embodied in the government annuities plan. A program of "public assistance" followed. These were succeeded, first, by the "universal payment" under the Old Age Security Act and, more recently, by the social insurance approach of the Canada Pension Plan. Along with improved public support, the role of occupational pension plans and of individually initiated retirement provisions continues to be substantial. Current interest in, and in some cases legislation on, such problems as vesting and solvency are leading to improvements in private pension programs.

Elimination sequence optimization for SPAR

NASA Technical Reports Server (NTRS)

Hogan, Harry A.

1986-01-01

SPAR is a large-scale computer program for finite element structural analysis. The program allows user specification of the order in which the joints of a structure are to be eliminated since this order can have significant influence over solution performance, in terms of both storage requirements and computer time. An efficient elimination sequence can improve performance by over 50% for some problems. Obtaining such sequences, however, requires the expertise of an experienced user and can take hours of tedious effort to affect. Thus, an automatic elimination sequence optimizer would enhance productivity by reducing the analysts' problem definition time and by lowering computer costs. Two possible methods for automating the elimination sequence specifications were examined. Several algorithms based on the graph theory representations of sparse matrices were studied with mixed results. Significant improvement in the program performance was achieved, but sequencing by an experienced user still yields substantially better results. The initial results provide encouraging evidence that the potential benefits of such an automatic sequencer would be well worth the effort.

A Programming Environment Evaluation Methodology for Object-Oriented Systems. Ph.D Thesis Final Report, 1 Jul. 1985 - 31 Dec. 1987

NASA Technical Reports Server (NTRS)

Dominick, Wayne D. (Editor); Moreau, Dennis R.

1987-01-01

The object-oriented design strategy as both a problem decomposition and system development paradigm has made impressive inroads into the various areas of the computing sciences. Substantial development productivity improvements have been demonstrated in areas ranging from artificial intelligence to user interface design. However, there has been very little progress in the formal characterization of these productivity improvements and in the identification of the underlying cognitive mechanisms. The development and validation of models and metrics of this sort require large amounts of systematically-gathered structural and productivity data. There has, however, been a notable lack of systematically-gathered information on these development environments. A large part of this problem is attributable to the lack of a systematic programming environment evaluation methodology that is appropriate to the evaluation of object-oriented systems.

School-based social skills training for preschool-age children with autism spectrum disorder.

PubMed

Radley, Keith C; Hanglein, Jeanine; Arak, Marisa

2016-11-01

Individuals with autism spectrum disorder display impairments in social interactions and communication that appear at early ages and result in short- and long-term negative outcomes. As such, there is a need for effective social skills training programs for young children with autism spectrum disorder-particularly interventions capable of being delivered in educational settings. The study evaluated the effects of the Superheroes Social Skills program on accurate demonstration of social skills in young children with autism spectrum disorder. Two preschool-age children with autism spectrum disorder participated in a weekly social skills intervention. A multiple probe design across skills was used to determine the effects of the intervention. Both participants demonstrated substantial improvements in skill accuracy. Social skills checklists also indicated improvements in social functioning over baseline levels. © The Author(s) 2016.

Patient and Nurse Experiences in a Rural Chronic Disease Management Program: A Qualitative Evaluation.

PubMed

Davisson, Erica A; Swanson, Elizabeth A

Rural status confounds chronic disease self-management. The purpose of this qualitative, descriptive study was to evaluate the nurse-led "Living Well" chronic disease management program reporting patient recruitment and retention issues since program initiation in 2013. The Chronic Care Model (CCM) was the guiding framework used to reinforce that interdisciplinary teams must have productive patient interactions for their program(s) to be sustainable. A rural, Midwest county clinic's chronic disease management program. Observations, interviews, and within- and across-case coding were used. Patients' responses were analyzed to identify (1) reasons for recruitment and retention problems and (2) program elements that were viewed as successful or needing improvement. A convenience sample of 6 rural, English-speaking adults (65 years or older, with no severe cognitive impairment) with at least one chronic condition was recruited and interviewed. Themes emerged related to nurse knowledge, availability, and value; peer support; overcoming barriers; adherence enhancement; and family/friends' involvement. Patients reported engagement in self-management activities because of program elements such as support groups and productive nurse-patient interactions. Interdisciplinary communication, commitment, and patient referral processes were identified as reasons for recruitment and retention issues. Findings substantiated that certain elements must be present and improved upon for future rural programs to be successful. Interdisciplinary communication may need to be improved to address recruitment and retention problems. It was clear from patient interviews that the nurse coordinators played a major role in patients' self-management adherence and overall satisfaction with the program. This is important to case management because results revealed the need for programs of this nature that incorporate the vital role of nurse coordinators and align with the CCM value of providing a supportive community health care resource for patients with chronic disease.

Disease management: old wine in new bottles?

PubMed

Ritterband, D R

2000-01-01

Disease management is a holistic, patient-focused approach to the treatment of disease across the spectrum of healthcare delivery. In its current form, disease management was created in response to the societal and economic burden that chronic illness contributes. There has recently been rapid growth in the development of disease management programs and sponsors are widespread within the industry, with the largest increase in independent vendors. Although growth has been substantial, the hurdles these programs have encountered have kept them from reaching their full potential. The challenges that exist include clinical, financial, and regulatory issues, and these challenges have significant meaning to healthcare managers. In deciding whether to develop or enhance programs, executives must consider their capability of outcomes measurement, their provider relationships, and the arrangements for program implementation. Ultimately, if programs provide improved health and quality of life for participants, cost savings will follow.

Weaving public health education into the fabric of a family medicine residency.

PubMed

Potts, Stacy E; Deligiannidis, Konstantinos E; Cashman, Suzanne B; Caggiano, Marie E; Carter, Lisa H; Haley, Heather-Lyn; Ferguson, Warren J

2011-10-01

Policymakers and accrediting bodies have recognized the importance of integrating public health, population health, and prevention into graduate medical education programs. The high prevalence of chronic illness, coupled with the impact of behavioral and societal determinants of health, necessitate an urgent call for family medicine residencies to prepare future leaders to meet these challenges. The University of Massachusetts Worcester Family Medicine Residency recently developed an integrated curriculum that strives to develop a culture of incorporating fundamental public health principles into everyday practice. This public health curriculum was designed to integrate new topics within the current residency structure through longitudinal and concentrated experiences. This strategy has substantially improved public health and prevention education without substantial impact on the already strained residency curricular structure. This paper describes the integration of public health and prevention education into a family medicine residency to help residents acquire the fundamental skills necessary to improve a population's health. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Costs and Consequences of a Cash Transfer for Hospital Births in a Rural District of Uttar Pradesh, India

PubMed Central

Coffey, Diane

2014-01-01

The Janani Suraksha Yojana, India’s “safe motherhood program,” is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program’s apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. PMID:24911512

Olympic weightlifting and plyometric training with children provides similar or greater performance improvements than traditional resistance training.

PubMed

Chaouachi, Anis; Hammami, Raouf; Kaabi, Sofiene; Chamari, Karim; Drinkwater, Eric J; Behm, David G

2014-06-01

A number of organizations recommend that advanced resistance training (RT) techniques can be implemented with children. The objective of this study was to evaluate the effectiveness of Olympic-style weightlifting (OWL), plyometrics, and traditional RT programs with children. Sixty-three children (10-12 years) were randomly allocated to a 12-week control OWL, plyometric, or traditional RT program. Pre- and post-training tests included body mass index (BMI), sum of skinfolds, countermovement jump (CMJ), horizontal jump, balance, 5- and 20-m sprint times, isokinetic force and power at 60 and 300° · s(-1). Magnitude-based inferences were used to analyze the likelihood of an effect having a standardized (Cohen's) effect size exceeding 0.20. All interventions were generally superior to the control group. Olympic weightlifting was >80% likely to provide substantially better improvements than plyometric training for CMJ, horizontal jump, and 5- and 20-m sprint times, whereas >75% likely to substantially exceed traditional RT for balance and isokinetic power at 300° · s(-1). Plyometric training was >78% likely to elicit substantially better training adaptations than traditional RT for balance, isokinetic force at 60 and 300° · s(-1), isokinetic power at 300° · s(-1), and 5- and 20-m sprints. Traditional RT only exceeded plyometric training for BMI and isokinetic power at 60° · s(-1). Hence, OWL and plyometrics can provide similar or greater performance adaptations for children. It is recommended that any of the 3 training modalities can be implemented under professional supervision with proper training progressions to enhance training adaptations in children.

Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications.

PubMed

Yang, Jin; Dehom, Salem; Sanders, Stephanie; Murry, Thomas; Krishna, Priya; Crawley, Brianna K

To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone. Retrospective study. Tertiary care academic center. A database was populated with patients treated for LPR. Patients were included in the study group if they completed a two-week anti-reflux program (diet, alkaline water, medications, behavioral modifications). Patients were included in the control group if they completed anti-reflux medications and behavioral modifications only. Patients completed the voice handicap index (VHI), reflux symptom index (RSI), cough severity index (CSI), dyspnea index (DI) and eating assessment tool (EAT-10) surveys and underwent laryngoscopy for examination and reflux finding score (RFS) quantification. Of 105 study group patients, 96 (91%) reported subjective improvement in their LPR symptoms after an average 32-day first follow-up and their RSI and CSI scores improved significantly. No significant differences were found in VHI, DI, or EAT-10 scores. Fifteen study patients who had previously failed adequate high-dose medication trials reported improvement and their CSI and EAT-10 scores improved significantly. Ninety-five percent of patients with a chief complaint of cough reported improvement and their CSI scores improved significantly from 12.3 to 8.2. Among 81 controls, only 39 (48%) patients reported improvement after an average 62-day first follow-up. Their RSI scores did not significantly change. The anti-reflux program yielded rapid and substantial results for a large cohort of patients with LPR. It compared favorably with medication and behavioral modification alone. It was effective in improving cough and treating patients who had previously failed medications alone. Copyright © 2017 Elsevier Inc. All rights reserved.

Coordinated Parallel Runway Approaches

NASA Technical Reports Server (NTRS)

Koczo, Steve

1996-01-01

The current air traffic environment in airport terminal areas experiences substantial delays when weather conditions deteriorate to Instrument Meteorological Conditions (IMC). Expected future increases in air traffic will put additional pressures on the National Airspace System (NAS) and will further compound the high costs associated with airport delays. To address this problem, NASA has embarked on a program to address Terminal Area Productivity (TAP). The goals of the TAP program are to provide increased efficiencies in air traffic during the approach, landing, and surface operations in low-visibility conditions. The ultimate goal is to achieve efficiencies of terminal area flight operations commensurate with Visual Meteorological Conditions (VMC) at current or improved levels of safety.

Strengthening Human Immunodeficiency Virus and Tuberculosis Prevention Capacity among South African Healthcare Workers: A Mixed Methods Study of a Collaborative Occupational Health Program.

PubMed

Liautaud, Alexandre; Adu, Prince A; Yassi, Annalee; Zungu, Muzimkhulu; Spiegel, Jerry M; Rawat, Angeli; Bryce, Elizabeth A; Engelbrecht, Michelle C

2018-06-01

Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. Participants recruited ( n  = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p  = 0.002) and skills/practices (+14%, p  = 0.002). Pre-program attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.

The Influence of a Constraint and Bimanual Training Program Using a Variety of Modalities, on Upper Extremity Functions and Gait Parameters Among Children with Hemiparetic Cerebral Palsy: A Case Series.

PubMed

Cohen-Holzer, Marilyn; Sorek, Gilad; Schless, Simon; Kerem, Julie; Katz-Leurer, Michal

2016-01-01

To assess the influence of an intensive combined constraint and bimanual upper extremity (UE) training program using a variety of modalities including the fitness room and pool, on UE functions as well as the effects of the program on gait parameters among children with hemiparetic cerebral palsy. Ten children ages 6-10 years participated in the program for 2 weeks, 5 days per week for 6 hr each day. Data from the Assisting Hand Assessment (AHA) for bimanual function , the Jebsen-Taylor Test of Hand Function (JTTHF) for unimanual function, the six-minute walk test (6MWT), and the temporal-spatial aspects of gait using the GAITRite walkway were collected prior to, immediately post and 3-months post-intervention. A significant improvement was noted in both unimanual as well as bimanual UE performance; A significant improvement in the 6MWT was noted, from a median of 442 meter [range: 294-558] at baseline to 466 [432-592] post intervention and 528 [425-609] after 3 months (p = .03). Combining intensive practice in a variety of modalities, although targeting to the UE is associated with substantial improvement both in the upper as well as in the lower extremity function.

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

Simpson, L.; Britt, J.; Birkmire, R.

ITN Energy Systems, Inc., and Global Solar Energy, Inc., assisted by NREL's PV Manufacturing R&D program, have continued to advance CIGS production technology by developing trajectory-oriented predictive/control models, fault-tolerance control, control platform development, in-situ sensors, and process improvements. Modeling activities included developing physics-based and empirical models for CIGS and sputter-deposition processing, implementing model-based control, and applying predictive models to the construction of new evaporation sources and for control. Model-based control is enabled by implementing reduced or empirical models into a control platform. Reliability improvement activities include implementing preventive maintenance schedules; detecting failed sensors/equipment and reconfiguring to tinue processing; and systematicmore » development of fault prevention and reconfiguration strategies for the full range of CIGS PV production deposition processes. In-situ sensor development activities have resulted in improved control and indicated the potential for enhanced process status monitoring and control of the deposition processes. Substantial process improvements have been made, including significant improvement in CIGS uniformity, thickness control, efficiency, yield, and throughput. In large measure, these gains have been driven by process optimization, which in turn have been enabled by control and reliability improvements due to this PV Manufacturing R&D program.« less

High Quantum Efficiency OLED Lighting Systems

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

Shiang, Joseph

The overall goal of the program was to apply improvements in light outcoupling technology to a practical large area plastic luminaire, and thus enable the product vision of an extremely thin form factor high efficiency large area light source. The target substrate was plastic and the baseline device was operating at 35 LPW at the start of the program. The target LPW of the program was a >2x improvement in the LPW efficacy and the overall amount of light to be delivered was relatively high 900 lumens. Despite the extremely difficult challenges associated with scaling up a wet solution processmore » on plastic substrates, the program was able to make substantial progress. A small molecule wet solution process was successfully implemented on plastic substrates with almost no loss in efficiency in transitioning from the laboratory scale glass to large area plastic substrates. By transitioning to a small molecule based process, the LPW entitlement increased from 35 LPW to 60 LPW. A further 10% improvement in outcoupling efficiency was demonstrated via the use of a highly reflecting cathode, which reduced absorptive loss in the OLED device. The calculated potential improvement in some cases is even larger, ~30%, and thus there is considerable room for optimism in improving the net light coupling efficacy, provided absorptive loss mechanisms are eliminated. Further improvements are possible if scattering schemes such as the silver nanowire based hard coat structure are fully developed. The wet coating processes were successfully scaled to large area plastic substrate and resulted in the construction of a 900 lumens luminaire device.« less

The Risks Of Using Workplace Wellness Programs To Foster A Culture Of Health.

PubMed

Madison, Kristin M

2016-11-01

In many respects, employers are well positioned to take a leading role in helping create a culture of health. Employers have access to many programs that could be beneficial to their employees' health. The potential for financial gains related to health improvement may motivate employers to offer these programs, and if the gains are realized, they may help finance the programs. At the same time, employers' involvement in such programs may create substantial risks. Enthusiasm about the financial and health gains that wellness programs might yield coexists with concerns about health costs shouldered by employees, the possibility of employment discrimination, and the potential for employers' invasion of employees' privacy. A fragmented regulatory regime, including a recently issued final rule under the Americans with Disabilities Act, has been created to address these concerns. Whether the regime strikes the right balance between wellness program benefits and risks remains to be determined. Project HOPE—The People-to-People Health Foundation, Inc.

A two-year follow-up case of chronic fatigue syndrome: substantial improvement in personality following a yoga-based lifestyle intervention.

PubMed

Yadav, Raj Kumar; Sarvottam, Kumar; Magan, Dipti; Yadav, Rashmi

2015-04-01

Chronic Fatigue Syndrome (CFS) is characterized by excessive fatigue after minimal physical or mental exertion, muscle and joint pain, poor concentration, dizziness, and sleep disturbances. We report here the effect of a yoga-based lifestyle intervention in a 30-year old male patient with a documented diagnosis of CFS with compromised quality of life (QoL) and altered personality. The patient initially attended a short-term yoga-based lifestyle intervention program that consisted of yoga-postures, breathing exercises (pranayama), meditation, group discussions, and individualized advice on stress management, diet and physical activity besides group support. Thereafter, patient attended 5 more such programs. There was a notable and consistent improvement in his clinical profile, positive aspects of personality and subjective well-being, and reduction in anxiety following this yoga-based lifestyle intervention. Overall, the results suggest that lifestyle intervention may improve clinical condition and personality in patients with CFS.

Engage: The Science Speaker Series - A novel approach to improving science outreach and communication

NASA Astrophysics Data System (ADS)

von der Linden, Jens; Hilton, Eric; Mitchell, Rachel; Rosenfield, Phil

2011-10-01

Communicating the results and significance of basic research to the general public is of critical importance. At present, very few programs exist to allow young scientists the opportunity to practice their public outreach skills. Although the need for science outreach is recognized, graduate programs often fail to provide any training in making science accessible. Engage represents a unique, graduate student-led effort to improve public outreach skills. Founded in 2009, Engage was created by three science graduate students at the University of Washington. The students developed an interdisciplinary curriculum to investigate why science outreach often fails, to improve graduate student communication skills, and to help students create a dynamic, public-friendly talk about their research. The course incorporates story-telling, improvisational arts, and development of analogy, all with a focus on clarity, brevity and accessibility. This free, public-friendly speaker series is hosted at the University of Washington and has substantial public attendance and participation.

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency.

PubMed

Hanna, Timothy P; Kangolle, Alfred C T

2010-10-13

Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) PROCESS: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) OUTCOME: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important.

Developing Asthma-Friendly Childcare Centers with Online Training and Evaluation

PubMed Central

Nowakowski, Alexandra Catherine Hayes; Carretta, Henry Joseph; Pineda, Nicole; Dudley, Julie Kurlfink; Forrest, Jamie R.

2016-01-01

In 2011, the Florida Asthma Coalition (FAC) began offering its Asthma-Friendly Childcare Center (AFCC) training online. This course teaches childcare center employees the fundamentals of effective asthma management. It covers basic asthma physiology, ways to recognize asthma attacks, techniques to help children experiencing attacks, and strategies to create healthy environments for asthmatics. A team of health services researchers evaluated both years of the online training. Evaluators used a quasi-experimental design with pretest, posttest, and follow-up assessment. Questions measured knowledge gain and retention, user satisfaction, and implementation of management strategies. Over 650 people from nearly all 67 Florida counties took AFCC training online between 2011 and 2013. Test scores improved by a minimum of 11% points in all program years evaluated. Gains in both knowledge and confidence were substantial and highly significant across years. While individual trainees did forget some content on follow-up, they seemed to retain the specific messages most relevant for their own workplaces. Most trainees also planned to implement multiple management strategies recommended by the training. A large majority of participants rated the training as excellent on all quality metrics, including relevance of content and time efficiency of the online format. Nearly all respondents perceived the training as useful for both providing improved care and fulfilling licensure or certification requirements. Many participants also indicated that their centers would pursue formal certification as AFCCs via the program offered by FAC. The online AFCC course performed strongly in its first years, yielding both high participant satisfaction and substantial improvement in workplace asthma management activity. This training holds promise for introducing and improving multidimensional asthma management strategies at childcare facilities nationwide. PMID:27014676

The use of VA Disability Compensation and Social Security Disability Insurance among working-aged veterans.

PubMed

Wilmoth, Janet M; London, Andrew S; Heflin, Colleen M

2015-07-01

Although there is substantial disability among veterans, relatively little is known about working-aged veterans' uptake of Department of Veterans Affairs (VA) Disability Compensation and Social Security Disability Insurance (DI). This study identifies levels of veteran participation in VA disability and/or DI benefit programs, examines transitions into and out of VA and DI programs among veterans, and estimates the size and composition of the veteran population receiving VA and/or DI benefits over time. Data from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation (SIPP) are used to describe VA and DI program participation among veterans under the age of 65. The majority of working-aged veterans do not receive VA or DI benefits and joint participation is low, but use of these programs has increased over time. A higher percentage of veterans receive VA compensation, which ranges from 4.9% in 1992 to 13.2% in 2008, than DI compensation, which ranges from 2.9% in 1992 to 6.7% in 2008. The rate of joint participation ranges from less than 1% in 1992 to 3.6% in 2008. Veterans experience few transitions between VA and DI programs during the 36-48 months they are observed. The number of veterans receiving benefits from VA and/or DI nearly doubled between 1992 and 2008. There have been substantial shifts in the composition of veterans using these programs, as cohorts who served prior to 1964 are replaced by those who served after 1964. The findings suggest potential gaps in veterans' access to disability programs that might be addressed through improved coordination of VA and DI benefits. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment.

PubMed

Dimeo, F; Schwartz, S; Wesel, N; Voigt, A; Thiel, E

2008-08-01

Fatigue is a relevant problem of cancer patients during and after treatment. Several studies have shown that exercise can improve quality of life and functional status of cancer patients undergoing chemo- or radiotherapy. However, there is a lack of information about the effects of this intervention on persistent cancer-related fatigue. Therefore, we assessed the effects of an exercise program on cancer-related fatigue after treatment. A consecutive series of 32 cancer patients with mild to severe persistent fatigue [scores on the Brief Fatigue Inventory (BFI) > 25] participated in a 3-week exercise program consisting of endurance (30 min walking on a treadmill) and resistance/coordination exercises for the major muscle groups. Fatigue, mood, and anxiety were assessed with questionnaires and physical performance with a stress test before and after the program. At the end of the program, we observed a significant increase of physical performance (workload at the anaerobic threshold pre 61 +/- 26 W, post 78 +/- 31 W, P < 0.0001) and reduction of global fatigue (Functional Assessment of Cancer Therapy: pre 45.7 +/- 13.4, post 52.6 +/- 12.4, P < 0.0001; BFI: pre 37.9 +/- 18.3, post 31.2 +/-17.1, P < 0.001). However, no significant improvement of cognitive fatigue or reduction of anxiety was observed. A 3-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients after treatment. However, this intervention does not affect depression, anxiety, or cognitive fatigue.

Integrating RNA sequencing into neuro-oncology practice.

PubMed

Rogawski, David S; Vitanza, Nicholas A; Gauthier, Angela C; Ramaswamy, Vijay; Koschmann, Carl

2017-11-01

Malignant tumors of the central nervous system (CNS) cause substantial morbidity and mortality, yet efforts to optimize chemo- and radiotherapy have largely failed to improve dismal prognoses. Over the past decade, RNA sequencing (RNA-seq) has emerged as a powerful tool to comprehensively characterize the transcriptome of CNS tumor cells in one high-throughput step, leading to improved understanding of CNS tumor biology and suggesting new routes for targeted therapies. RNA-seq has been instrumental in improving the diagnostic classification of brain tumors, characterizing oncogenic fusion genes, and shedding light on intratumor heterogeneity. Currently, RNA-seq is beginning to be incorporated into regular neuro-oncology practice in the form of precision neuro-oncology programs, which use information from tumor sequencing to guide implementation of personalized targeted therapies. These programs show great promise in improving patient outcomes for tumors where single agent trials have been ineffective. As RNA-seq is a relatively new technique, many further applications yielding new advances in CNS tumor research and management are expected in the coming years. Copyright © 2017 Elsevier Inc. All rights reserved.

Measuring conflict management, emotional self-efficacy, and problem solving confidence in an evaluation of outdoor programs for inner-city youth in Baltimore, Maryland.

PubMed

Caldas, Stephanie V; Broaddus, Elena T; Winch, Peter J

2016-08-01

Substantial evidence supports the value of outdoor education programs for promoting healthy adolescent development, yet measurement of program outcomes often lacks rigor. Accurately assessing the impacts of programs that seek to promote positive youth development is critical for determining whether youth are benefitting as intended, identifying best practices and areas for improvement, and informing decisions about which programs to invest in. We generated brief, customized instruments for measuring three outcomes among youth participants in Baltimore City Outward Bound programs: conflict management, emotional self-efficacy, and problem solving confidence. Measures were validated through exploratory and confirmatory factor analyses of pilot-testing data from two groups of program participants. We describe our process of identifying outcomes for measurement, developing and adapting measurement instruments, and validating these instruments. The finalized measures support evaluations of outdoor education programs serving urban adolescent youth. Such evaluations enhance accountability by determining if youth are benefiting from programs as intended, and strengthen the case for investment in programs with demonstrated success. Copyright © 2016 Elsevier Ltd. All rights reserved.

THE CDF ARCHIVE: HERSCHEL PACS AND SPIRE SPECTROSCOPIC DATA PIPELINE AND PRODUCTS FOR PROTOSTARS AND YOUNG STELLAR OBJECTS

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

Green, Joel D.; Yang, Yao-Lun; II, Neal J. Evans

2016-03-15

We present the COPS-DIGIT-FOOSH (CDF) Herschel spectroscopy data product archive, and related ancillary data products, along with data fidelity assessments, and a user-created archive in collaboration with the Herschel-PACS and SPIRE ICC groups. Our products include datacubes, contour maps, automated line fitting results, and best 1D spectra products for all protostellar and disk sources observed with PACS in RangeScan mode for two observing programs: the DIGIT Open Time Key Program (KPOT-nevans-1 and SDP-nevans-1; PI: N. Evans), and the FOOSH Open Time Program (OT1-jgreen02-2; PI: J. Green). In addition, we provide our best SPIRE-FTS spectroscopic products for the COPS Open Time Program (OT2-jgreen02-6;more » PI: J. Green) and FOOSH sources. We include details of data processing, descriptions of output products, and tests of their reliability for user applications. We identify the parts of the data set to be used with caution. The resulting absolute flux calibration has improved in almost all cases. Compared to previous reductions, the resulting rotational temperatures and numbers of CO molecules have changed substantially in some sources. On average, however, the rotational temperatures have not changed substantially (<2%), but the number of warm (T{sub rot} ∼ 300 K) CO molecules has increased by about 18%.« less

The CDF Archive: Herschel PACS and SPIRE Spectroscopic Data Pipeline and Products for Protostars and Young Stellar Objects

NASA Astrophysics Data System (ADS)

Green, Joel D.; Yang, Yao-Lun; Evans, Neal J., II; Karska, Agata; Herczeg, Gregory; van Dishoeck, Ewine F.; Lee, Jeong-Eun; Larson, Rebecca L.; Bouwman, Jeroen

2016-03-01

We present the COPS-DIGIT-FOOSH (CDF) Herschel spectroscopy data product archive, and related ancillary data products, along with data fidelity assessments, and a user-created archive in collaboration with the Herschel-PACS and SPIRE ICC groups. Our products include datacubes, contour maps, automated line fitting results, and best 1D spectra products for all protostellar and disk sources observed with PACS in RangeScan mode for two observing programs: the DIGIT Open Time Key Program (KPOT_nevans1 and SDP_nevans_1; PI: N. Evans), and the FOOSH Open Time Program (OT1_jgreen02_2; PI: J. Green). In addition, we provide our best SPIRE-FTS spectroscopic products for the COPS Open Time Program (OT2_jgreen02_6; PI: J. Green) and FOOSH sources. We include details of data processing, descriptions of output products, and tests of their reliability for user applications. We identify the parts of the data set to be used with caution. The resulting absolute flux calibration has improved in almost all cases. Compared to previous reductions, the resulting rotational temperatures and numbers of CO molecules have changed substantially in some sources. On average, however, the rotational temperatures have not changed substantially (<2%), but the number of warm (Trot ∼ 300 K) CO molecules has increased by about 18%.

Time Course of Improvements in Power Characteristics in Elite Development Netball Players Entering a Full-Time Training Program.

PubMed

McKeown, Ian; Chapman, Dale W; Taylor, Kristie Lee; Ball, Nick B

2016-05-01

We describe the time course of adaptation to structured resistance training on entering a full-time high-performance sport program. Twelve international caliber female netballers (aged 19.9 ± 0.4 years) were monitored for 18 weeks with countermovement (CMJ: performed with body weight and 15 kg) and drop jumps (0.35-m box at body weight) at the start of each training week. Performance did not improve linearly or concurrently with loaded CMJ power improving 11% by Week 5 (effect size [ES] 0.93 ± 0.72) in contrast, substantial positive changes were observed for unloaded CMJ power (12%; ES 0.78 ± 0.39), and CMJ velocity (unloaded: 7.1%; ES 0.66 ± 0.34; loaded: 7.5%; ES 0.90 ± 0.41) by week 7. Over the investigation duration, large improvements were observed in unloaded CMJ power (24%; ES 1.45 ± 1.11) and velocity (12%; ES 1.13 ± 0.76). Loaded CMJ power also showed a large improvement (19%; ES 1.49 ± 0.97) but only moderate changes were observed for loaded CMJ velocity (8.4%; ES 1.01 ± 0.67). Jump height changes in either unloaded or loaded CMJ were unclear over the 18-week period. Drop jump performance improved throughout the investigation period with moderate positive changes in reactive strength index observed (35%; ES 0.97 ± 0.69). The adaptation response to a structured resistance training program does not occur linearly in young female athletes. Caution should be taken if assessing jump height only, as this will provide a biased observation to a training response. Frequently assessing CMJ performance can aid program design coaching decisions to ensure improvements are seen past the initial neuromuscular learning phase in performance training.

Residential Central Air Conditioning and Heat Pump Installation – Workshop Outcomes

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

Goetzler, William; Zogg, Robert; Young, Jim

DOE's Building Technologies Office works with researchers and industry partners to develop and deploy technologies that can substantially reduce energy consumption in residential and commercial buildings. This report aims to advance BTO’s energy savings, emissions reduction, and other program goals by identifying research and development (R&D), demonstration and deployment, and other non-regulatory initiatives for improving the design and installation of residential central air conditioners (CAC) and central heat pumps (CHP). Improving the adoption of CAC/CHP design and installation best practices has significant potential to reduce equipment costs, improve indoor air quality and comfort, improve system performance, and most importantly, reducemore » household energy consumption and costs for heating and cooling by addressing a variety of common installation issues.« less

External Tank - The Structure Backbone

NASA Technical Reports Server (NTRS)

Welzyn, Kenneth; Pilet, Jeffrey C.; Diecidue-Conners, Dawn; Worden, Michelle; Guillot, Michelle

2011-01-01

The External Tank forms the structural backbone of the Space Shuttle in the launch configuration. Because the tank flies to orbital velocity with the Space Shuttle Orbiter, minimization of weight is mandatory, to maximize payload performance. Choice of lightweight materials both for structure and thermal conditioning was necessary. The tank is large, and unique manufacturing facilities, tooling, handling, and transportation operations were required. Weld processes and tooling evolved with the design as it matured through several block changes, to reduce weight. Non Destructive Evaluation methods were used to assure integrity of welds and thermal protection system materials. The aluminum-lithium alloy was used near the end of the program and weld processes and weld repair techniques had to be refined. Development and implementation of friction stir welding was a substantial technology development incorporated during the Program. Automated thermal protection system application processes were developed for the majority of the tank surface. Material obsolescence was an issue throughout the 40 year program. The final configuration and tank weight enabled international space station assembly in a high inclination orbit allowing international cooperation with the Russian Federal Space Agency. Numerous process controls were implemented to assure product quality, and innovative proof testing was accomplished prior to delivery. Process controls were implemented to assure cleanliness in the production environment, to control contaminants, and to preclude corrosion. Each tank was accepted via rigorous inspections, including non-destructive evaluation techniques, proof testing, and all systems testing. In the post STS-107 era, the project focused on ascent debris risk reduction. This was accomplished via stringent process controls, post flight assessment using substantially improved imagery, and selective redesigns. These efforts were supported with a number of test programs to simulate combined environments. Processing improvements included development and use of low spray guns for foam application, additional human factors considerations for production, use of high fidelity mockups during hardware processing with video review, improved tank access, extensive use of non destructive evaluation, and producibility enhancements. Design improvements included redesigned bipod fittings, a bellows heater, a feedline camera active during ascent flight, removal of the protuberance airload ramps, redesigned ice frost ramps, and titanium brackets replaced aluminum brackets on the liquid oxygen feedline. Post flight assessment improved due to significant addition of imagery assets, greatly improving situational awareness. The debris risk was reduced by two orders of magnitude. During this time a major natural disaster was overcome when Katrina damaged the manufacturing facility. Numerous lessons from these efforts are documented within the paper.

The NRL (Naval Research Laboratory) Phase-Locked Gyrotron Oscillator Program for SDIO/IST

DTIC Science & Technology

1988-07-11

are neglected as are space - charge effects . The cold cavity eigenfrequency for the TE6 2 1 mode is 35.08 GHz. The calculated efficiency, output power...improved beam quality on the gyrotron operation, and to eliminate the unknown space charge effects present in the original experiment, in which a...substantial fraction of the diode current is reflected before reaching the gyrotron cavity and may cause space charge problems before being collected on

Building a Navigation System to Reduce Cancer Disparities in Urban Black Older Adults

PubMed Central

Bone, Lee; Edington, Kristen; Rosenberg, Jessica; Wenzel, Jennifer; Garza, Mary A.; Klein, Catherine; Schmitt, Lisa; Ford, Jean G.

2014-01-01

Background Although cancer outcomes have improved in recent decades, substantial disparities by race, ethnicity, income and education persist. Increasingly, patient navigation services are demonstrating success in improving cancer detection, treatment and care and in reducing cancer health disparities. To advance progress in developing patient navigation programs, extensive descriptions of each component of the program must be made available to researchers and health service providers. Objective To describe the components of a patient navigation program designed to improve cancer screening based on informed decision-making on cancer screening and cancer treatment services among predominantly Black older adults in Baltimore City. Methods A community-academic participatory approach was used to develop a patient navigation program in Baltimore, Maryland. The components of the patient navigation system included the development of a community academic (advisory) committee (CAC); recruitment and selection of community health workers (CHWs)/navigators and supervisory staff; initial training and continuing education of the CHWs/navigators; and evaluation of CHWs/navigators. The study was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Conclusions The incorporation of community-based participatory research (CPBR) principles into each facet of this patient navigation program facilitated the attainment of the intervention’s objectives. This patient navigation program successfully delivered cancer navigation services to 1302 urban Black older adults. Appropriately recruited, selected and trained CHWs monitored by an experienced supervisor and investigators are the key elements in a patient navigation program. This model has the potential to be adapted by research and health service providers. PMID:23793252

Bounds on the minimum number of recombination events in a sample history.

PubMed Central

Myers, Simon R; Griffiths, Robert C

2003-01-01

Recombination is an important evolutionary factor in many organisms, including humans, and understanding its effects is an important task facing geneticists. Detecting past recombination events is thus important; this article introduces statistics that give a lower bound on the number of recombination events in the history of a sample, on the basis of the patterns of variation in the sample DNA. Such lower bounds are appropriate, since many recombination events in the history are typically undetectable, so the true number of historical recombinations is unobtainable. The statistics can be calculated quickly by computer and improve upon the earlier bound of Hudson and Kaplan 1985. A method is developed to combine bounds on local regions in the data to produce more powerful improved bounds. The method is flexible to different models of recombination occurrence. The approach gives recombination event bounds between all pairs of sites, to help identify regions with more detectable recombinations, and these bounds can be viewed graphically. Under coalescent simulations, there is a substantial improvement over the earlier method (of up to a factor of 2) in the expected number of recombination events detected by one of the new minima, across a wide range of parameter values. The method is applied to data from a region within the lipoprotein lipase gene and the amount of detected recombination is substantially increased. Further, there is strong clustering of detected recombination events in an area near the center of the region. A program implementing these statistics, which was used for this article, is available from http://www.stats.ox.ac.uk/mathgen/programs.html. PMID:12586723

The Value of Information in Decision-Analytic Modeling for Malaria Vector Control in East Africa.

PubMed

Kim, Dohyeong; Brown, Zachary; Anderson, Richard; Mutero, Clifford; Miranda, Marie Lynn; Wiener, Jonathan; Kramer, Randall

2017-02-01

Decision analysis tools and mathematical modeling are increasingly emphasized in malaria control programs worldwide to improve resource allocation and address ongoing challenges with sustainability. However, such tools require substantial scientific evidence, which is costly to acquire. The value of information (VOI) has been proposed as a metric for gauging the value of reduced model uncertainty. We apply this concept to an evidenced-based Malaria Decision Analysis Support Tool (MDAST) designed for application in East Africa. In developing MDAST, substantial gaps in the scientific evidence base were identified regarding insecticide resistance in malaria vector control and the effectiveness of alternative mosquito control approaches, including larviciding. We identify four entomological parameters in the model (two for insecticide resistance and two for larviciding) that involve high levels of uncertainty and to which outputs in MDAST are sensitive. We estimate and compare a VOI for combinations of these parameters in evaluating three policy alternatives relative to a status quo policy. We find having perfect information on the uncertain parameters could improve program net benefits by up to 5-21%, with the highest VOI associated with jointly eliminating uncertainty about reproductive speed of malaria-transmitting mosquitoes and initial efficacy of larviciding at reducing the emergence of new adult mosquitoes. Future research on parameter uncertainty in decision analysis of malaria control policy should investigate the VOI with respect to other aspects of malaria transmission (such as antimalarial resistance), the costs of reducing uncertainty in these parameters, and the extent to which imperfect information about these parameters can improve payoffs. © 2016 Society for Risk Analysis.

Development of Urine Receptacle Assembly for the Crew Exploration Vehicle

NASA Technical Reports Server (NTRS)

Cibuzar, Branelle Rae; Thomas, Evan; Peterson, Laurie; Goforth, Johanna

2008-01-01

The Urine Receptacle Assembly (URA) initially was developed for Apollo as a primary means of urine collection. The aluminum housing with stainless steel honeycomb insert provided all male crewmembers with a non-invasive means of micturating into a urine capturing device and then venting to space. The performance of the URA was a substantial improvement over previous devices but its performance was not well understood. The Crew Exploration Vehicle (CEV) program is exploring the URA as a contingency liquid waste management system for the vehicle. URA improvements are required to meet CEV requirements, including: consumables minimization, flow performance, acceptable hygiene standards, crew comfort, and female crewmember capability. This paper presents the results of a historical review of URA performance during the Apollo program, recent URA performance tests on the reduced gravity aircraft flight under varying flow conditions, and a proposed development plan for the URA to meet CEV needs.

[The strategy for establishment of comprehensive cervical cancer prevention and control in the world].

PubMed

Bao, H L; Fang, L W; Wang, L H

2017-01-06

Cervical cancer is one of the most common malignancies among women. Screening programs for cervical cancer have been implemented in many developed countries. Comprehensive systems for cervical cancer prevention and control have improved over the past 30 years, which has led to a significant decline in the morbidity and mortality of cervical cancer. Since 2009, the Chinese government has conducted the Cervical Cancer and Breast Cancer Screening Program for Rural Women on a national scale, which has substantially improved cervical cancer prevention and control. However, a comprehensive system for cervical cancer prevention has been not established in China. It is essential to investigate suitable strategies for cervical cancer prevention system in the country by referring to the experiences of developed nations in comparison with the situation in China, with respect to system operations, compatibility with the existing health care system, choice of suitable technologies, and information and evaluation platforms.

The Knowledge Program: an Innovative, Comprehensive Electronic Data Capture System and Warehouse

PubMed Central

Katzan, Irene; Speck, Micheal; Dopler, Chris; Urchek, John; Bielawski, Kay; Dunphy, Cheryl; Jehi, Lara; Bae, Charles; Parchman, Alandra

2011-01-01

Data contained in the electronic health record (EHR) present a tremendous opportunity to improve quality-of-care and enhance research capabilities. However, the EHR is not structured to provide data for such purposes: most clinical information is entered as free text and content varies substantially between providers. Discrete information on patients’ functional status is typically not collected. Data extraction tools are often unavailable. We have developed the Knowledge Program (KP), a comprehensive initiative to improve the collection of discrete clinical information into the EHR and the retrievability of data for use in research, quality, and patient care. A distinct feature of the KP is the systematic collection of patient-reported outcomes, which is captured discretely, allowing more refined analyses of care outcomes. The KP capitalizes on features of the Epic EHR and utilizes an external IT infrastructure distinct from Epic for enhanced functionality. Here, we describe the development and implementation of the KP. PMID:22195124

Improvements in chronic diseases with a comprehensive natural medicine approach: a review and case series.

PubMed

Nader, T; Rothenberg, S; Averbach, R; Charles, B; Fields, J Z; Schneider, R H

2000-01-01

Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multimodality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson's disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program.

Improvements in Chronic Diseases With a Comprehensive Natural Medicine Approach: A Review and Case Series

PubMed Central

Nader, Tony; Rothenberg, Stuart; Averbach, Richard; Charles, Barry; Fields, Jeremy Z.; Schneider, Robert H.

2008-01-01

Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multi-modality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson’s disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program. PMID:10971882

The Quest for Greater Chemical Energy Storage: A Deceiving Game of Nanometer Manipulation

NASA Astrophysics Data System (ADS)

Lindsay, C. Michael

2015-06-01

It is well known that modern energetic materials based on organic chemistry have nearly reached a plateau in performance with only ~ 40% improvement realized over the past half century. This fact has stimulated research on alternative chemical energy storage schema in various US government funded ``High Energy Density Materials'' (HEDM) programs since the 1950's. These efforts have examined a wide range of phenomena such as free radical stabilization, metallic hydrogen, metastable helium, polynitrogens, extended molecular solids, nanothermites, and others. In spite of the substantial research investments, significant improvements in energetic material performance have not been forthcoming. In this talk we will survey various fundamental modes of chemical energy storage, lesson's learned in the various HEDM programs, and areas that are being explored currently. A recurring theme in all of this work is the challenge to successfully manipulate and stabilize matter at the ~ 1 nm scale.

Diskless supercomputers: Scalable, reliable I/O for the Tera-Op technology base

NASA Technical Reports Server (NTRS)

Katz, Randy H.; Ousterhout, John K.; Patterson, David A.

1993-01-01

Computing is seeing an unprecedented improvement in performance; over the last five years there has been an order-of-magnitude improvement in the speeds of workstation CPU's. At least another order of magnitude seems likely in the next five years, to machines with 500 MIPS or more. The goal of the ARPA Teraop program is to realize even larger, more powerful machines, executing as many as a trillion operations per second. Unfortunately, we have seen no comparable breakthroughs in I/O performance; the speeds of I/O devices and the hardware and software architectures for managing them have not changed substantially in many years. We have completed a program of research to demonstrate hardware and software I/O architectures capable of supporting the kinds of internetworked 'visualization' workstations and supercomputers that will appear in the mid 1990s. The project had three overall goals: high performance, high reliability, and scalable, multipurpose system.

The Teachers of Quality Academy: Evaluation of the Effectiveness and Impact of a Health Systems Science Training Program.

PubMed

Walsh, Danielle S; Lazorick, Suzanne; Lawson, Luan; Lake, Donna; Garrison, Herbert G; Higginson, Jason; Vos, Paul; Baxley, Elizabeth

2018-05-01

This project aimed to evaluate the effectiveness of a faculty development program in health systems science (HSS)-the Teachers of Quality Academy (TQA). Participants in TQA and a comparison group were evaluated before, during, and 1 year after the program using self-perception questionnaires, tests of HSS knowledge, and tracking of academic productivity and career advancement. Among program completers (n = 27), the mean self-assessed ratings of knowledge and skills of HSS topics immediately after the program, as compared to baseline, increased significantly compared to controls (n = 30). Participants demonstrated progressive improvement of self-perceived skills and attitudes, and retention of HSS knowledge, from baseline to completion of the program. Participants also demonstrated substantially higher HSS scholarly productivity, leadership, and career advancement compared to the comparison group. The TQA effectively created a faculty cadre able to role model, teach, and create a curriculum in HSS competencies for medical students, resident physicians, and other health professionals.

SWOT analysis: strengths, weaknesses, opportunities and threats of the Israeli Smallpox Revaccination Program.

PubMed

Huerta, Michael; Balicer, Ran D; Leventhal, Alex

2003-01-01

During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated "first responders" among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached, we conducted a SWOT analysis of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. SWOT analysis--a practical tool for the study of public health policy decisions and the social and political contexts in which they are reached--revealed clear and substantial strengths and weaknesses of the current smallpox revaccination program, intrinsic to the vaccine itself. A number of threats were identified that may jeopardize the success of the current program, chief among them the appearance of severe complications of vaccination. Our finding of a lack of a generation of knowledge on smallpox vaccination highlights the need for improved physician education and dissipation of misconceptions that are prevalent in the public today.

Survey of the Child Neurology Program Coordinator Association: Workforce Issues and Readiness for the Next Accreditation System.

PubMed

Feist, Terri B; Campbell, Julia L; LaBare, Julie A; Gilbert, Donald L

2016-03-01

In preparation for the implementation of the Next Accreditation System in Child Neurology, the authors organized the first meeting of child neurology program coordinators in October 2014. A workforce and program-readiness survey was conducted initially. Coordinator job titles varied widely. Most respondents (65%) managed 1 or more fellowships plus child neurology residency. Most had worked in graduate medical education less than 5 years (53%), with no career path (88%), supervised by someone without graduate medical education experience (85%), in divisions where faculty knowledge was judged inadequate (72%). A small proportion of programs had established clinical competency committee policies (28%) and was ready to implement milestone-based evaluations (56%). A post-conference survey demonstrated substantial improvements in relevant skills. The complexity of residency program management in the Next Accreditation System era supports substantive modifications to the program coordinator role. Such changes should include defined career pathway, managerial classification, administrative support, and continuing education. © The Author(s) 2015.

Designing programs to improve diets for maternal and child health: estimating costs and potential dietary impacts of nutrition-sensitive programs in Ethiopia, Nigeria, and India.

PubMed

Masters, William A; Rosettie, Katherine L; Kranz, Sarah; Danaei, Goodarz; Webb, Patrick; Mozaffarian, Dariush

2018-05-01

Improving maternal and child nutrition in resource-poor settings requires effective use of limited resources, but priority-setting is constrained by limited information about program costs and impacts, especially for interventions designed to improve diet quality. This study utilized a mixed methods approach to identify, describe and estimate the potential costs and impacts on child dietary intake of 12 nutrition-sensitive programs in Ethiopia, Nigeria and India. These potential interventions included conditional livestock and cash transfers, media and education, complementary food processing and sales, household production and food pricing programs. Components and costs of each program were identified through a novel participatory process of expert regional consultation followed by validation and calibration from literature searches and comparison with actual budgets. Impacts on child diets were determined by estimating of the magnitude of economic mechanisms for dietary change, comprehensive reviews of evaluations and effectiveness for similar programs, and demographic data on each country. Across the 12 programs, total cost per child reached (net present value, purchasing power parity adjusted) ranged very widely: from 0.58 to 2650 USD/year among five programs in Ethiopia; 2.62 to 1919 USD/year among four programs in Nigeria; and 27 to 586 USD/year among three programs in India. When impacts were assessed, the largest dietary improvements were for iron and zinc intakes from a complementary food production program in Ethiopia (increases of 17.7 mg iron/child/day and 7.4 mg zinc/child/day), vitamin A intake from a household animal and horticulture production program in Nigeria (335 RAE/child/day), and animal protein intake from a complementary food processing program in Nigeria (20.0 g/child/day). These results add substantial value to the limited literature on the costs and dietary impacts of nutrition-sensitive interventions targeting children in resource-limited settings, informing policy discussions and serving as critical inputs to future cost-effectiveness analyses focusing on disease outcomes.

Designing programs to improve diets for maternal and child health: estimating costs and potential dietary impacts of nutrition-sensitive programs in Ethiopia, Nigeria, and India

PubMed Central

Rosettie, Katherine L; Kranz, Sarah; Danaei, Goodarz; Webb, Patrick; Mozaffarian, Dariush; Bhattacharjee, Lalita; Chandrasekhar, S; Christensen, Cheryl; Desai, Sonalde; Kazi-Hutchins, Nabeeha; Levin, Carol; Paarlberg, Robert; Vosti, Steven; Adekugbe, Olayinka; Atomsa, Gudina Egata; Badham, Jane; Baye, Kaleab; Beyero, Mesfin; Covic, Namukolo; Dalton, Babukiika; Dufour, Charlotte; Fracassi, Patrizia; Getahun, Zewditu; Haidar, Jemal; Hailu, Tesfaye; Kebede, Aweke; Kinabo, Joyce; Kussaga, Jamal Bakari; Mavrotas, George; Mwanja, Wilson Waiswa; Oguntona, Babatunde; Oladipo, Abiodun; Oniang’o, Ruth; Sibanda, Simbarashe; Sodjinou, Roger; Tom, Carol; Wamani, Henry; Wendelin, Akwilina; Adhikari, Ramesh Kant; Amatya, Archana; Bhattarai, Manav; Brahmbhatt, Viral; Chandyo, Ram Krishna; Gulati, Seema; Kapil, Umesh; Mehta, Ranju; Mohan, Sailesh; Prabhakaran, D; Prakash, V; Puri, Seema; Roy, S K; Sharma, Rekha; Shivakoti, Sabnam; Thorne-Lyman, Andrew; Rana, Pooja Pandey; Trilok-Kumar, Geeta

2018-01-01

Abstract Improving maternal and child nutrition in resource-poor settings requires effective use of limited resources, but priority-setting is constrained by limited information about program costs and impacts, especially for interventions designed to improve diet quality. This study utilized a mixed methods approach to identify, describe and estimate the potential costs and impacts on child dietary intake of 12 nutrition-sensitive programs in Ethiopia, Nigeria and India. These potential interventions included conditional livestock and cash transfers, media and education, complementary food processing and sales, household production and food pricing programs. Components and costs of each program were identified through a novel participatory process of expert regional consultation followed by validation and calibration from literature searches and comparison with actual budgets. Impacts on child diets were determined by estimating of the magnitude of economic mechanisms for dietary change, comprehensive reviews of evaluations and effectiveness for similar programs, and demographic data on each country. Across the 12 programs, total cost per child reached (net present value, purchasing power parity adjusted) ranged very widely: from 0.58 to 2650 USD/year among five programs in Ethiopia; 2.62 to 1919 USD/year among four programs in Nigeria; and 27 to 586 USD/year among three programs in India. When impacts were assessed, the largest dietary improvements were for iron and zinc intakes from a complementary food production program in Ethiopia (increases of 17.7 mg iron/child/day and 7.4 mg zinc/child/day), vitamin A intake from a household animal and horticulture production program in Nigeria (335 RAE/child/day), and animal protein intake from a complementary food processing program in Nigeria (20.0 g/child/day). These results add substantial value to the limited literature on the costs and dietary impacts of nutrition-sensitive interventions targeting children in resource-limited settings, informing policy discussions and serving as critical inputs to future cost-effectiveness analyses focusing on disease outcomes. PMID:29522103

The Glen Canyon Dam adaptive management program: progress and immediate challenges

USGS Publications Warehouse

Hamill, John F.; Melis, Theodore S.; Boon, Philip J.; Raven, Paul J.

2012-01-01

Adaptive management emerged as an important resource management strategy for major river systems in the United States (US) in the early 1990s. The Glen Canyon Dam Adaptive Management Program (‘the Program’) was formally established in 1997 to fulfill a statutory requirement in the 1992 Grand Canyon Protection Act (GCPA). The GCPA aimed to improve natural resource conditions in the Colorado River corridor in the Glen Canyon National Recreation Area and Grand Canyon National Park, Arizona that were affected by the Glen Canyon dam. The Program achieves this by using science and a variety of stakeholder perspectives to inform decisions about dam operations. Since the Program started the ecosystem is now much better understood and several biological and physical improvements have been achieved. These improvements include: (i) an estimated 50% increase in the adult population of endangered humpback chub (Gila cypha) between 2001 and 2008, following previous decline; (ii) a 90% decrease in non-native rainbow trout (Oncorhynchus mykiss), which are known to compete with and prey on native fish, as a result of removal experiments; and (iii) the widespread reappearance of sandbars in response to an experimental high-flow release of dam water in March 2008.Although substantial progress has been made, the Program faces several immediate challenges. These include: (i) defining specific, measurable objectives and desired future conditions for important natural, cultural and recreational attributes to inform science and management decisions; (ii) implementing structural and operational changes to improve collaboration among stakeholders; (iii) establishing a long-term experimental programme and management plan; and (iv) securing long-term funding for monitoring programmes to assess ecosystem and other responses to management actions. Addressing these challenges and building on recent progress will require strong and consistent leadership from the US Department of the Interior officials who guide the Program.

Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database.

PubMed

Malec, James F; Kean, Jacob

2016-07-15

This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p < 0.001). Intensive outpatient/community-based programs showed greater improvements on MPAI-4 Ability (F = 14.135, p < 0.001), Adjustment (F = 12.939, p < 0.001), and Participation (F = 16.679, p < 0.001) indices than supported living programs; whereas, intensive residential programs showed improvement primarily in Adjustment and Participation. Age at injury and time in program had small effects on outcome; the effect of chronicity was small to moderate. Examination of more chronic cases (>1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity.

Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database

PubMed Central

Kean, Jacob

2016-01-01

Abstract This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p < 0.001). Intensive outpatient/community-based programs showed greater improvements on MPAI-4 Ability (F = 14.135, p < 0.001), Adjustment (F = 12.939, p < 0.001), and Participation (F = 16.679, p < 0.001) indices than supported living programs; whereas, intensive residential programs showed improvement primarily in Adjustment and Participation. Age at injury and time in program had small effects on outcome; the effect of chronicity was small to moderate. Examination of more chronic cases (>1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity. PMID:26414433

Use of evidence-based treatments in substance abuse treatment programs serving American Indian and Alaska Native communities.

PubMed

Novins, Douglas K; Croy, Calvin D; Moore, Laurie A; Rieckmann, Traci

2016-04-01

Research and health surveillance activities continue to document the substantial disparities in the impacts of substance abuse on the health of American Indian and Alaska Native (AI/AN) people. While Evidence-Based Treatments (EBTs) hold substantial promise for improving treatment for AI/ANs with substance use problems (as they do for non-AI/ANs), anecdotal reports suggest that their use is limited. In this study, we examine the awareness of, attitudes toward, and use of EBTs in substance abuse treatment programs serving AI/AN communities. Data are drawn from the first national survey of tribal substance abuse treatment programs. Clinicians or clinical administrators from 192 programs completed the survey. Participants were queried about their awareness of, attitudes toward, and use of 9 psychosocial and 3 medication EBTs. Cognitive Behavioral Therapy (82.2%), Motivational Interviewing (68.6%), and Relapse Prevention Therapy (66.8%) were the most commonly implemented psychosocial EBTs; medications for psychiatric comorbidity was the most commonly implemented medication treatment (43.2%). Greater EBT knowledge and use were associated with both program (e.g., funding) and staff (e.g., educational attainment) characteristics. Only two of the commonly implemented psychosocial EBTs (Motivational Interviewing and Relapse Prevention Therapy) were endorsed as culturally appropriate by a majority of programs that had implemented them (55.9% and 58.1%, respectively). EBT knowledge and use is higher in substance abuse treatment programs serving AI/AN communities than has been previously estimated. However, many users of these EBTs continue to have concerns about their cultural appropriateness, which likely limits their further dissemination. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Training and Support of Sessional Staff to Improve Quality of Teaching and Learning at Universities.

PubMed

Knott, Gillian; Crane, Linda; Heslop, Ian; Glass, Beverley D

2015-06-25

Sessional staff is increasingly involved in teaching at universities, playing a pivotal role in bridging the gap between theory and practice for students, especially in the health professions, including pharmacy. Although sessional staff numbers have increased substantially in recent years, limited attention has been paid to the quality of teaching and learning provided by this group. This review will discuss the training and support of sessional staff, with a focus on Australian universities, including the reasons for and potential benefits of training, and structure and content of training programs. Although sessional staff views these programs as valuable, there is a lack of in-depth evaluations of the outcomes of the programs for sessional staff, students and the university. Quality assurance of such programs is only guaranteed, however, if these evaluations extend to the impact of this training and support on student learning.

Transferring learning from faculty development to the classroom.

PubMed

Rock, Kim Z

2014-12-01

This study’s purpose was to better understand the transfer of learning by uncovering how various factors supported the integration of health information technology knowledge and skills gleaned from the Health Resources and Services Administration–funded faculty development programs into nursing education curricula. Through interviews with 20 participants from four programs, this study confirmed the importance of findings related to faculty, program, and work environment characteristics for supporting successful transfer of learning and substantiates a variety of other transfer-of-learning research. New or seldom discussed supportive individual characteristics were found, including leadership abilities, lifelong learning, ability to recognize limitations, persistence, creativity, and risk taking. The importance of networking, diversity of perspectives, postconference support, and teams in program designs were found to positively influence transfer. The variety of supportive factors and barriers in the participants’ work environments strengthens the assertions that transfer may be context dependent. Findings provided insight for recommendations to improve learning transfer. Copyright 2014, SLACK Incorporated.

Flight testing the Digital Electronic Engine Control (DEEC) A unique management experience

NASA Technical Reports Server (NTRS)

Putnam, T. W.; Burcham, F. W., Jr.; Kock, B. M.

1983-01-01

The concept for the DEEC had its origin in the early 1970s. At that time it was recognized that the F100 engine performance, operability, reliability, and cost could be substantially improved by replacing the original mechanical/supervisory electronic control system with a full-authority digital control system. By 1978, the engine manufacturer had designed and initiated the procurement of flight-qualified control system hardware. As a precursor to an integrated controls program, a flight evaluation of the DEEC system on the F-15 aircraft was proposed. Questions regarding the management of the DEEC flight evaluation program are discussed along with the program elements, the technical results of the F-15 evaluation, and the impact of the flight evaluation on after-burning turbofan controls technology and its use in and application to military aircraft. The lessons learned through the conduct of the program are discussed.

Design and implementation of an inpatient disease management program.

PubMed

Cooper, G S; Armitage, K B; Ashar, B; Costantini, O; Creighton, F A; Raiz, P; Wong, R C; Carlson, M D

2000-07-01

To describe the development and implementation of an inpatient disease management program. Prospective observational study. On the basis of opportunities for improving quality or efficiency of inpatient and emergency department care, 4 diagnoses, including congestive heart failure (CHF), gastrointestinal hemorrhage, community-acquired pneumonia and sickle-cell crisis were selected for implementation of a disease management program. For each diagnosis, a task force assembled a disease management team led by a "physician champion" and nurse care manager and identified opportunities for improvement through medical literature review and interviews with caregivers. A limited number of disease-specific guidelines and corresponding interventions were selected with consensus of the team and disseminated to caregivers. Physician and nurse team leaders were actively involved in patient care to facilitate adherence to guidelines. For quarter 2 to 4 of 1997, there were improvements in angiotensin-converting enzyme inhibitor use, daily weight compliance, assessment of left ventricular function, hospital costs, and length of stay for care-managed patients with CHF. Differences in utilization-related outcomes persisted even after adjustment for severity of illness. For the other 3 diagnoses, the observational period was shorter (quarter 4 only), and hence preliminary data showed similar hospital costs and length of stay for care-managed and noncare-managed patients. An interdisciplinary approach to inpatient disease management resulted in substantial improvements in both quality and efficiency of care for patients with CHF. Additional data are needed to determine the program's impact on outcomes of other targeted diagnoses.

The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program.

PubMed

Minor, Kyle S; Friedman-Yakoobian, Michelle; Leung, Y Jude; Meyer, Eric C; Zimmet, Suzanna V; Caplan, Brina; Monteleone, Thomas; Bryant, Caitlin; Guyer, Margaret; Keshavan, Matcheri S; Seidman, Larry J

2015-05-01

Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP(R), Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement. The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP(R) (n = 46 with social functioning and 47 with role functioning measures at both time points). Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not. Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.

PubMed

Deyle, Gail D; Allison, Stephen C; Matekel, Robert L; Ryder, Michael G; Stang, John M; Gohdes, David D; Hutton, Jeremy P; Henderson, Nancy E; Garber, Matthew B

2005-12-01

Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis (OA) of the knee. The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinically based physical therapy program. One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinic treatment group (n=66; 61% female, 39% male; mean age [+/-SD]=64+/-10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [+/-SD]=62+/-9 years). Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.

Army Energy and Water Reporting System Assessment

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

Deprez, Peggy C.; Giardinelli, Michael J.; Burke, John S.

There are many areas of desired improvement for the Army Energy and Water Reporting System. The purpose of system is to serve as a data repository for collecting information from energy managers, which is then compiled into an annual energy report. This document summarizes reported shortcomings of the system and provides several alternative approaches for improving application usability and adding functionality. The U.S. Army has been using Army Energy and Water Reporting System (AEWRS) for many years to collect and compile energy data from installations for facilitating compliance with Federal and Department of Defense energy management program reporting requirements. Inmore » this analysis, staff from Pacific Northwest National Laboratory found that substantial opportunities exist to expand AEWRS functions to better assist the Army to effectively manage energy programs. Army leadership must decide if it wants to invest in expanding AEWRS capabilities as a web-based, enterprise-wide tool for improving the Army Energy and Water Management Program or simply maintaining a bottom-up reporting tool. This report looks at both improving system functionality from an operational perspective and increasing user-friendliness, but also as a tool for potential improvements to increase program effectiveness. The authors of this report recommend focusing on making the system easier for energy managers to input accurate data as the top priority for improving AEWRS. The next major focus of improvement would be improved reporting. The AEWRS user interface is dated and not user friendly, and a new system is recommended. While there are relatively minor improvements that could be made to the existing system to make it easier to use, significant improvements will be achieved with a user-friendly interface, new architecture, and a design that permits scalability and reliability. An expanded data set would naturally have need of additional requirements gathering and a focus on integrating with other existing data sources, thus minimizing manually entered data.« less

Small angle X-ray scattering and cross-linking for data assisted protein structure prediction in CASP 12 with prospects for improved accuracy.

PubMed

Ogorzalek, Tadeusz L; Hura, Greg L; Belsom, Adam; Burnett, Kathryn H; Kryshtafovych, Andriy; Tainer, John A; Rappsilber, Juri; Tsutakawa, Susan E; Fidelis, Krzysztof

2018-03-01

Experimental data offers empowering constraints for structure prediction. These constraints can be used to filter equivalently scored models or more powerfully within optimization functions toward prediction. In CASP12, Small Angle X-ray Scattering (SAXS) and Cross-Linking Mass Spectrometry (CLMS) data, measured on an exemplary set of novel fold targets, were provided to the CASP community of protein structure predictors. As solution-based techniques, SAXS and CLMS can efficiently measure states of the full-length sequence in its native solution conformation and assembly. However, this experimental data did not substantially improve prediction accuracy judged by fits to crystallographic models. One issue, beyond intrinsic limitations of the algorithms, was a disconnect between crystal structures and solution-based measurements. Our analyses show that many targets had substantial percentages of disordered regions (up to 40%) or were multimeric or both. Thus, solution measurements of flexibility and assembly support variations that may confound prediction algorithms trained on crystallographic data and expecting globular fully-folded monomeric proteins. Here, we consider the CLMS and SAXS data collected, the information in these solution measurements, and the challenges in incorporating them into computational prediction. As improvement opportunities were only partly realized in CASP12, we provide guidance on how data from the full-length biological unit and the solution state can better aid prediction of the folded monomer or subunit. We furthermore describe strategic integrations of solution measurements with computational prediction programs with the aim of substantially improving foundational knowledge and the accuracy of computational algorithms for biologically-relevant structure predictions for proteins in solution. © 2018 Wiley Periodicals, Inc.

Impact of family planning programs in reducing high-risk births due to younger and older maternal age, short birth intervals, and high parity.

PubMed

Brown, Win; Ahmed, Saifuddin; Roche, Neil; Sonneveldt, Emily; Darmstadt, Gary L

2015-08-01

Several studies show that maternal and neonatal/infant mortality risks increase with younger and older maternal age (<18 and >34 years), high parity (birth order >3), and short birth intervals (<24 months). Family planning programs are widely viewed as having contributed to substantial maternal and neonatal mortality decline through contraceptive use--both by reducing unwanted births and by reducing the burden of these high-risk births. However, beyond averting births, the empirical evidence for the role of family planning in reducing high-risk births at population level is limited. We examined data from 205 Demographic and Health Surveys (DHS), conducted between 1985 and 2013, to describe the trends in high-risk births and their association with the pace of progress in modern contraceptive prevalence rate (yearly increase in rate of MCPR) in 57 developing countries. Using Blinder-Oaxaca decomposition technique, we then examine the contributions of family planning program, economic development (GDP per capita), and educational improvement (secondary school completion rate) on the progress of MCPR in order to link the net contribution of family planning program to the reduction of high-risk births mediated through contraceptive use. Countries that had the fastest progress in improving MCPR experienced the greatest declines in high-risk births due to short birth intervals (<24 months), high parity births (birth order >3), and older maternal age (>35 years). Births among younger women <18 years, however, did not decline significantly during this period. The decomposition analysis suggests that 63% of the increase in MCPR was due to family planning program efforts, 21% due to economic development, and 17% due to social advancement through women's education. Improvement in MCPR, predominately due to family planning programs, is a major driver of the decline in the burden of high-risk births due to high parity, shorter birth intervals, and older maternal age in developing countries. The lack of progress in the decline of births in younger women <18 years of age underscores the need for more attention to ensure that quality contraceptive methods are available to adolescent women in order to delay first births. This study substantiates the significance of family planning programming as a major health intervention for preventing high-risk births and associated maternal and child mortality, but it highlights the need for concerted efforts to strengthen service provision for adolescents. Copyright © 2015 Elsevier Inc. All rights reserved.

Training the gastrointestinal endoscopy trainer.

PubMed

Waschke, Kevin A; Anderson, John; Macintosh, Donald; Valori, Roland M

2016-06-01

Endoscopy training has traditionally been accomplished by an informal process in the endoscopy unit that parallels apprenticeship training seen in other areas of professional education. Subsequent to an audit, a series of interventions were implemented in the English National Health Service to support both service delivery and to improve endoscopy training. The resulting training centers deliver a variety of hands-on endoscopy courses, established in parallel with the roll out of a colon cancer screening program that monitors and documents quality outcomes among endoscopists. The program developed a 'training the trainer' module that subsequently became known as the Training the Colonoscopy Trainer course (TCT). Several years after its implementation, colonoscopy quality outcomes in the UK have improved substantially. The core TCT program has spread to other countries with demonstration of a marked impact on endoscopy training and performance. The aim of this chapter is to describe the principles that underlie effective endoscopy training in this program using the TCT as an example. While the review focuses on the specific example of colonoscopy training, the approach is generic to the teaching of any technical skill; it has been successfully transferred to the teaching of laparoscopic surgery as well as other endoscopic techniques. Copyright © 2016 Elsevier Ltd. All rights reserved.

Towards a research strategy to support public health programs for behaviour change.

PubMed

Redman, S

1996-08-01

Major public health programs have had mixed results in improving health behaviours. In part, the failure to modify some key health behaviours is attributable to a lack of appropriate research on which to base behaviour-change programs. The research published by the Australian Journal of Public Health (now the Australian and New Zealand Journal of Public Health), as representative of Australian research, was analysed. The analysis indicated shortcomings in existing research as a basis for practitioners to build effective programs. While the Journal publishes a substantial amount of health-behaviour research, few studies used a randomised trial to assess the effects of interventions. Little research was designed to help practitioners to: identify the types of strategies that would reliably result in behaviour change; identify strategies to work with hard-to-reach groups like women from Aboriginal and non-English-speaking backgrounds; assess the costs and cost-effectiveness of different strategies; disseminate effective strategies at a state or national level. If improvements in public health are to occur, there is a need to develop and implement a strategy to ensure that research more effectively meets the needs of public health practitioners.

Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China

PubMed Central

Xu, Wenhong; Sun, Changxian; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

2016-01-01

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible. PMID:27684637

Ultralightweight optics for space applications

NASA Astrophysics Data System (ADS)

Mayo, James W.; DeHainaut, Linda L.; Bell, Kevin D.; Smith, Winfred S.; Killpatrick, Don H.; Dyer, Richard W.

2000-07-01

Lightweight, deployable space optics has been identified as a key technology for future cost-effective, space-based systems. The United States Department of Defense has partnered with the National Aeronautical Space Administration to implement a space mirror technology development activity known as the Advanced Mirror System Demonstrator (AMSD). The AMSD objectives are to advance technology in the production of low-mass primary mirror systems, reduce mirror system cost and shorten mirror- manufacturing time. The AMSD program will offer substantial weight, cost and production rate improvements over Hubble Space Telescope mirror technology. A brief history of optical component development and a review of optical component state-of-the-art technology will be given, and the AMSD program will be reviewed.

Combination of immunotherapy with chemotherapy and radiotherapy in lung cancer: is this the beginning of the end for cancer?

PubMed Central

Lazzari, Chiara; Karachaliou, Niki; Bulotta, Alessandra; Viganó, Mariagrazia; Mirabile, Aurora; Brioschi, Elena; Santarpia, Mariacarmela; Gianni, Luca; Rosell, Rafael; Gregorc, Vanesa

2018-01-01

Immune checkpoint inhibitors have significantly improved overall survival with an acceptable safety profile in a substantial proportion of non-small cell lung cancer (NSCLC) patients. However, not all patients are sensitive to immune checkpoint blockade and, in some cases, programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors accelerate tumor progression. Several combination strategies are under evaluation, including the concomitant or sequential evaluation of chemotherapy or radiotherapy with immunotherapy. The current review provides an overview on the molecular rationale for the investigation of combinatorial approaches with chemotherapy or radiotherapy. Moreover, the results of completed clinical studies will be reported. PMID:29662546

Fraud at the Global Fund? A viewpoint.

PubMed

Brown, Jonathan C; Griekspoor, Wilfred

2013-01-01

The Global Fund to Fight AIDS, Tuberculosis and Malaria has contributed to remarkable health improvements in the three diseases since its creation in 2002. However, media reports about "astonishing losses" and fraud in Fund programs in 2011 caused several donors to suspend funding. The Fund's annual round of new financing was canceled, and a substantial reform program is being implemented. Two former senior managers of the Fund contend that fraud was never a major problem; rather than imposing harsh new controls on recipient countries that might impede health outcomes, the Fund should maintain the core elements of its innovative model and make selective rather than sweeping changes in its operations. Copyright © 2012 John Wiley & Sons, Ltd.

The Implementation of Virtual Instruction in Relation to X-ray Anatomy and Positioning in a Chiropractic Degree Program: A Descriptive Paper.

PubMed

Rush, Perry O; Boone, William R

2009-01-01

This article provides information regarding the introduction of virtual education into classroom instruction, wherein a method of classroom instruction was developed with the use of a computer, digital camera, and various software programs. This approach simplified testing procedures, thus reducing institutional costs substantially by easing the demand for manpower, and seemed to improve average grade performance. Organized files with hundreds of digital pictures have created a range of instructor resources. Much of the new course materials were organized onto compact disks to complement course notes. Customizing presentations with digital technology holds potential benefits for students, instructors and the institution.

Combination of immunotherapy with chemotherapy and radiotherapy in lung cancer: is this the beginning of the end for cancer?

PubMed

Lazzari, Chiara; Karachaliou, Niki; Bulotta, Alessandra; Viganó, Mariagrazia; Mirabile, Aurora; Brioschi, Elena; Santarpia, Mariacarmela; Gianni, Luca; Rosell, Rafael; Gregorc, Vanesa

2018-01-01

Immune checkpoint inhibitors have significantly improved overall survival with an acceptable safety profile in a substantial proportion of non-small cell lung cancer (NSCLC) patients. However, not all patients are sensitive to immune checkpoint blockade and, in some cases, programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors accelerate tumor progression. Several combination strategies are under evaluation, including the concomitant or sequential evaluation of chemotherapy or radiotherapy with immunotherapy. The current review provides an overview on the molecular rationale for the investigation of combinatorial approaches with chemotherapy or radiotherapy. Moreover, the results of completed clinical studies will be reported.

A photovoltaic industry overview - The results of a survey on photovoltaic technology industrialization

NASA Technical Reports Server (NTRS)

Ferber, R. R.; Costogue, E. N.; Thornhill, J. W.; Shimada, K.

1981-01-01

The National Photovoltaics Program of the United States Department of Energy has the objective of bringing photovoltaic power systems to a point where they can supply a significant portion of the United States energy requirements by the year 2000. This is planned to be accomplished through substantial research and technology development activities aimed at achieving major cost reductions and market penetration. This paper presents information derived from a limited survey performed to obtain photovoltaic industry attitudes concerning industrialization, and to determine current industry plans to meet the DOE program goals. Silicon material production, a key photovoltaic manufacturing industry, is highlighted with regards to implementation of technology improvement and silicon material supply outlook.

Southwest Pacific Ocean Circulation and Climate Experiment (SPICE) scientific advances and future west pacific coordination

NASA Astrophysics Data System (ADS)

Ganachaud, A. S.; Sprintall, J.; Lin, X.; Ando, K.

2016-02-01

The Southwest Pacific Ocean Circulation and Climate Experiment (SPICE) is an international research program under the auspices of CLIVAR (Climate Variability and Predictability). The key objectives are to understand the Southwest Pacific Ocean circulation and Convergence Zone (SPCZ) dynamics, as well as their influence on regional and basin-scale climate patterns. It was designed to measure and monitor the ocean circulation, and to validate and improve numerical models. South Pacific oceanic waters are carried from the subtropical gyre centre in the westward flowing South Equatorial Current (SEC), towards the southwest Pacific-a major circulation pathway that redistributes water from the subtropics to the equator and Southern Ocean. Water transit through the Coral and Solomon Seas is potentially of great importance to tropical climate prediction because changes in either the temperature or the amount of water arriving at the equator have the capability to modulate ENSO and produce basin-scale climate feedbacks. On average, the oceanic circulation is driven by the Trade Winds, and subject to substantial variability, related with the SPCZ position and intensity. The circulation is complex, with the SEC splitting into zonal jets upon encountering island archipelagos, before joining either the East Australian Current or the New Guinea Costal UnderCurrent towards the equator. SPICE included large, coordinated in situ measurement programs and high resolution numerical simulations of the area. After 8 years of substantial in situ oceanic observational and modeling efforts, our understanding of the region has much improved. We have a refined description of the SPCZ behavior, boundary currents, pathways, and water mass transformation, including the previously undocumented Solomon Sea. The transports are large and vary substantially in a counter-intuitive way, with asymmetries and gating effects that depend on time scales. We will review the recent advancements and discuss our current knowledge gaps and important emerging research directions. In particular we will discuss how SPICE, along with the Northwestern Pacific Ocean Circulation and Climate Experiment (NPOCE) and Indonesian ThroughFlow (ITF) programs could evolve toward an integrative observing system under CLIVAR coordination.

Implementation and evaluation of a nursing home fall management program.

PubMed

Rask, Kimberly; Parmelee, Patricia A; Taylor, Jo A; Green, Diane; Brown, Holly; Hawley, Jonathan; Schild, Laura; Strothers, Harry S; Ouslander, Joseph G

2007-03-01

To evaluate the feasibility and effectiveness of a falls management program (FMP) for nursing homes (NHs). A quality improvement project with data collection throughout FMP implementation. NHs in Georgia owned and operated by a single nonprofit organization. All residents of participating NHs. A convenience sample of 19 NHs implemented the FMP. The FMP is a multifaceted quality improvement and culture change intervention. Key components included organizational leadership buy-in and support, a designated facility-based falls coordinator and interdisciplinary team, intensive education and training, and ongoing consultation and oversight by advanced practice nurses with expertise in falls management. Process-of-care documentation using a detailed 24-item audit tool and fall and physical restraint use rates derived from quality improvement software currently used in all Georgia NHs (MyInnerView). Care process documentation related to the assessment and management of fall risk improved significantly during implementation of the FMP. Restraint use decreased substantially during the project period, from 7.9% to 4.4% in the intervention NHs (a relative reduction of 44%), and decreased in the nonintervention NHs from 7.0% to 4.9% (a relative reduction of 30%). Fall rates remained stable in the intervention NHs (17.3 falls/100 residents per month at start and 16.4 falls/100 residents per month at end), whereas fall rates increased 26% in the NHs not implementing the FMP (from 15.0 falls/100 residents/per month to 18.9 falls/100 residents per month). Implementation was associated with significantly improved care process documentation and a stable fall rate during a period of substantial reduction in the use of physical restraints. In contrast, fall rates increased in NHs owned by the same organization that did not implement the FMP. The FMP may be a helpful tool for NHs to manage fall risk while attempting to reduce physical restraint use in response to the Centers for Medicare and Medicaid Services quality initiatives.

Improvements in HIV Care Engagement and Viral Load Suppression Following Enrollment in a Comprehensive HIV Care Coordination Program

PubMed Central

Irvine, Mary K.; Chamberlin, Stephanie A.; Robbins, Rebekkah S.; Myers, Julie E.; Braunstein, Sarah L.; Mitts, Beau J.; Harriman, Graham A.; Nash, Denis

2015-01-01

Background. Substantial evidence gaps remain regarding human immunodeficiency virus (HIV) intervention strategies that improve engagement in care (EiC) and viral load suppression (VLS). We assessed EiC and VLS before and after enrollment in a comprehensive intervention for persons at risk of poor HIV care outcomes. Methods. New York City's Ryan White Part A HIV Care Coordination Program (CCP), launched at 28 agencies in 2009, applies multiple strategies to promote optimal utilization of medical and social services. Using laboratory test records from an HIV surveillance registry, we examined pre–post outcomes among 3641 CCP clients enrolled before April 2011. For the year before and after enrollment, we assessed EiC (defined as ≥2 tests, ≥90 days apart, with ≥1 in each half-year) and VLS (defined as viral load [VL] ≤200 copies/mL on latest VL test in the second half of the year). We estimated relative risks (RRs), comparing pre- and postenrollment proportions achieving EiC and VLS. Results. Among newly diagnosed clients, 90.5% (95% confidence interval [CI], 87.9%–93.2%) and 66.2% (95% CI, 61.9%–70.6%) achieved EiC and VLS, respectively. Among previously diagnosed clients, EiC increased from 73.7% to 91.3% (RR = 1.24; 95% CI, 1.21–1.27) and VLS increased from 32.3% to 50.9% (RR = 1.58; 95% CI, 1.50–1.66). Clients without evidence of HIV care during the 6 months preenrollment contributed most to overall improvements. Pre–post improvements were robust, retaining statistical significance within most sociodemographic and clinical subgroups, and in 89% (EiC) and 75% (VLS) of CCP agencies. Conclusions. Clients in comprehensive HIV care coordination for persons with evident barriers to care showed substantial and consistent improvement in short-term outcomes. PMID:25301208

Internal dosimetry monitoring equipment: Present and future

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

Selby, J.; Carbaugh, E.H.; Lynch, T.P.

1993-09-01

We have attempted to characterize the current and future status of in vivo and in vitro measurement programs coupled with the associated radioanalytical methods and workplace monitoring. Developments in these areas must be carefully integrated by internal dosimetrists, radiochemists and field health physicists. Their goal should be uniform improvement rather than to focus on one specific area (e.g., dose modeling) to the neglect of other areas where the measurement capabilities are substantially less sophisticated and, therefore, the potential source of error is greatest.

Health Mentor-Reported Outcomes and Perceptions of Student Team Performance in a Longitudinal Interprofessional Education Program.

PubMed

Umland, Elena; Collins, Lauren; Baronner, Ashley; Lim, Edwin; Giordano, Carolyn

2016-01-01

The need to evaluate the impact of interprofessional education (IPE) on learner outcomes is clear, but assessment of IPE's impact on patient health and well-being is lacking. This mixed-methods study evaluated perspectives of community volunteers, health mentors (HMs) who have at least one chronic condition, who participated in an IPE curriculum. In May 2014, 93 HMs concluding the Health Mentors Program completed a survey evaluating their student teams according to the Interprofessional Education Collaborative core competencies' four domains and program impact on health/wellbeing using a 4-point Likert scale (1=strongly disagree; 4=strongly agree). The average response to statements regarding the four domains of values/ethics, roles/responsibilities, communication, and teamwork statements were all >3.0. HMs rated program satisfaction on a 10-point scale (1=least satisfied, 10=most satisfied) and answered open-ended outcome questions. The average program satisfaction score was 9.13±1.43; increased motivation to make and maintain healthy behaviors was reported. In a follow-up focus group with 10 mentors, high satisfaction levels from working with interprofessional student teams were reported, and substantial improvements in managing health conditions and improving overall health status were relayed. Further studies will determine if the patient-reported outcomes of the mentors correlate with objective health measures.

Quantifying surgical complexity with machine learning: looking beyond patient factors to improve surgical models.

PubMed

Van Esbroeck, Alexander; Rubinfeld, Ilan; Hall, Bruce; Syed, Zeeshan

2014-11-01

To investigate the use of machine learning to empirically determine the risk of individual surgical procedures and to improve surgical models with this information. American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data from 2005 to 2009 were used to train support vector machine (SVM) classifiers to learn the relationship between textual constructs in current procedural terminology (CPT) descriptions and mortality, morbidity, Clavien 4 complications, and surgical-site infections (SSI) within 30 days of surgery. The procedural risk scores produced by the SVM classifiers were validated on data from 2010 in univariate and multivariate analyses. The procedural risk scores produced by the SVM classifiers achieved moderate-to-high levels of discrimination in univariate analyses (area under receiver operating characteristic curve: 0.871 for mortality, 0.789 for morbidity, 0.791 for SSI, 0.845 for Clavien 4 complications). Addition of these scores also substantially improved multivariate models comprising patient factors and previously proposed correlates of procedural risk (net reclassification improvement and integrated discrimination improvement: 0.54 and 0.001 for mortality, 0.46 and 0.011 for morbidity, 0.68 and 0.022 for SSI, 0.44 and 0.001 for Clavien 4 complications; P < .05 for all comparisons). Similar improvements were noted in discrimination and calibration for other statistical measures, and in subcohorts comprising patients with general or vascular surgery. Machine learning provides clinically useful estimates of surgical risk for individual procedures. This information can be measured in an entirely data-driven manner and substantially improves multifactorial models to predict postoperative complications. Copyright © 2014 Elsevier Inc. All rights reserved.

Impact resistance of composite fan blades

NASA Technical Reports Server (NTRS)

1974-01-01

Results are presented of a program to determine the impact resistance of composite fan blades subjected to foreign object damage (FOD) while operating under conditions simulating a short take-off and landing (STOL) engine at takeoff. The full-scale TF39 first-stage fan blade was chosen as the base design for the demonstration component since its configuration and operating tip speeds are similar to a typical STOL fan blade several composite configurations had already been designed and evaluated under previous programs. The first portion of the program was devoted toward fabricating and testing high impact resistant, aerodynamically acceptable composite blades which utilized only a single material system in any given blade. In order to increase the blade impact capability beyond this point, several mixed material (hybrid) designs were investigated using S-glass and Kevlar as well as boron and graphite fibers. These hybrid composite blades showed a marked improvement in resistance to bird impact over those blades made of a single composite material. The work conducted under this program has demonstrated substantial improvement in composite fan blades with respect to FOD resistance and has indicated that the hybrid design concept, which utilizes different types of fibers in various portions of a fan blade design depending on the particular requirements of the different areas and the characteristics of the different fibers involved, shows a significant improvement over those designs utilizing only one material system.

Old Age Income Security in Canada

PubMed Central

Willard, J. W.

1965-01-01

The position of older people in modern industrial society is markedly removed from the early industrial norm of continued participation in gainful employment until the end of life. Acceptance of a retirement age some 13 years before the end of average male life expectancy has brought with it serious social problems. At the same time, however, an increasingly productive economy has provided both the willingness and ability to complement the retirement provisions of individual initiative with public programs of old age income maintenance. This public support began in Canada with the voluntary approach embodied in the government annuities plan. A program of “public assistance” followed. These were succeeded, first, by the “universal payment” under the Old Age Security Act and, more recently, by the social insurance approach of the Canada Pension Plan. Along with improved public support, the role of occupational pension plans and of individually initiated retirement provisions continues to be substantial. Current interest in, and in some cases legislation on, such problems as vesting and solvency are leading to improvements in private pension programs. PMID:5828720

Weatherization Works: Final Report of the National Weatherization Evaluation

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

Brown, M.A.

2001-02-01

In 1990, the US Department of Energy (DOE) sponsored a comprehensive evaluation of its Weatherization Assistance Program, the nation's largest residential energy conservation program. Oak Ridge National Laboratory (ORNL) managed the five-part study. This document summarizes the findings of the evaluation. Its conclusions are based mainly on data from the 1989 program year. The evaluation concludes that the Program meets the objectives of its enabling legislation and fulfills its mission statement. Specifically, it saves energy, lowers fuel bills, and improves the health and safety of dwellings occupied by low-income people. In addition, the Program achieves its mission in a cost-effectivemore » manner based on each of three perspectives employed by the evaluators. Finally, the evaluation estimates that the investments made in 1989 will, over a 20-year lifetime, save the equivalent of 12 million barrels of oil, roughly the amount of oil added to the Strategic Petroleum Reserve in each of the past several years. The Program's mission is to reduce the heating and cooling costs for low-income families--particularly the elderly, persons with disabilities, and children by improving the energy efficiency of their homes and ensuring their health and safety. Substantial progress has been made, but the job is far from over. The Department of Health and Human Services (HHS) reports that the average low-income family spends 12 percent of its income on residential energy, compared to only 3% for the average-income family. Homes where low-income families live also have a greater need for energy efficiency improvements, but less money to pay for them.« less

Structure, Process, and Culture of Intensive Care Units Treating Patients with Severe Traumatic Brain Injury: Survey of Centers Participating in the American College of Surgeons Trauma Quality Improvement Program.

PubMed

Alali, Aziz S; McCredie, Victoria A; Mainprize, Todd G; Gomez, David; Nathens, Avery B

2017-10-01

Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI. One hundred forty-two TMDs (76%) completed the survey. Severe TBI patients are admitted to dedicated neurocritical care units in 52 hospitals (37%), trauma ICUs in 44 hospitals (31%), general ICUs in 34 hospitals (24%), and surgical ICUs in 11 hospitals (8%). Fifty-seven percent are closed units. Board-certified intensivists directed 89% of ICUs, whereas 17% were led by neurointensivists. Sixty percent of ICU directors were general surgeons. Thirty-nine percent of hospitals had critical care fellowships and 11% had neurocritical care fellowships. Fifty-nine percent of ICUs had standard order sets and 61% had standard protocols specific for TBI, with the most common protocol relating to intracranial pressure management (53%). Only 43% of TMDs were satisfied with the current level of neurosurgeons' engagement in the ICU management of TBI; 46% believed that neurosurgeons should be more engaged; 11% believed they should be less engaged. In the largest survey of North American ICUs caring for TBI patients, there is substantial variation in the current approaches to ICU care for TBI, highlighting multiple opportunities for comparative effectiveness research.

The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project.

PubMed

Shuler, Melinda S; Yeatts, Karin B; Russell, Donald W; Trees, Amy S; Sutherland, Susan E

2015-01-01

A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021. The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

Shuttle Centaur engine cooldown evaluation and effects of expanded inlets on start transient

NASA Technical Reports Server (NTRS)

1987-01-01

As part of the integration of the RL10 engine into the Shuttle Centaur vehicle, a satisfactory method of conditioning the engine to operating temperatures had to be established. This procedure, known as cooldown, is different from the existing Atlas Centaur due to vehicle configuration and mission profile differenced. The program is described, and the results of a Shuttle Centaur cooldown program are reported. Mission peculiarities cause substantial variation in propellant inlet conditions between the substantiated Atlas Centaur and Shuttle Centaur with the Shuttle Centaur having much larger variation in conditions. A test program was conducted to demonstrate operation of the RL10 engine over the expanded inlet conditions. As a result of this program, the Shuttle Centaur requirements were proven satisfactory. Minor configuration changes incorporated as a result of this program provide substantial reduction in cooldown propellant consumption.

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

PubMed

Joshi, M S; Bernard, D B

1999-08-01

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

Consumer Enrollment and Experiences in the Cash and Counseling Program

PubMed Central

Schore, Jennifer; Foster, Leslie; Phillips, Barbara

2007-01-01

Study Context Consumer direction of Medicaid supportive services raises concerns about who should be permitted to self-direct, whether consumers should be allowed to pay family members, whether a self-directed option increases demand for services, and how to ensure quality. The Cash and Counseling programs contained features designed to address these concerns. Demonstration Enrollment Many consumers used representatives to manage the allowance on their behalf and others chose to disenroll, suggesting that beneficiaries were capable of deciding for themselves whether the programs were suitable for them. Participation among eligible beneficiaries during the demonstration was modest, suggesting that consumer direction did not itself substantially increase the demand for services. Consumer Experiences Most consumers were able to assume the role of employer without difficulty, many hiring relatives or acquaintances as workers. In each state, more than 85 percent reported they would recommend the program to others seeking more control over their care, and more than half said the program had “improved their lives a great deal.” PMID:17244292

PSYCHOLOGY IN THE TEACHER PREPARATION PROGRAM.

ERIC Educational Resources Information Center

HERBERT, JOHN; WILLIAMS, DONALD

SUBSTANTIAL CHANGE IN THE FORM AND SUBSTANCE OF PSYCHOLOGY OFFERINGS IN TEACHER PREPARATION PROGRAMS MAY BE IMMINENT. ALTHOUGH THERE SEEMS TO BE SUBSTANTIAL AGREEMENT THAT PSYCHOLOGY SHOULD BE TAUGHT, AGREEMENT THAT CHANGES MUST BE MADE IS GENERAL. COURSE OBJECTIVES FORMULATED BY THE PSYCHOLOGICAL FOUNDATIONS PLANNING GROUP ARE LISTED. IT IS…

Mentoring by design: integrating medical professional competencies into bioengineering and medical physics graduate training.

PubMed

Woods, Kendra V; Peek, Kathryn E; Richards-Kortum, Rebecca

2014-12-01

Many students in bioengineering and medical physics doctoral programs plan careers in translational research. However, while such students generally have strong quantitative abilities, they often lack experience with the culture, communication norms, and practice of bedside medicine. This may limit students' ability to function as members of multidisciplinary translational research teams. To improve students' preparation for careers in cancer translational research, we developed and implemented a mentoring program that is integrated with students' doctoral studies and aims to promote competencies in communication, biomedical ethics, teamwork, altruism, multiculturalism, and accountability. Throughout the program, patient-centered approaches and professional competencies are presented as foundational to optimal clinical care and integral to translational research. Mentoring is conducted by senior biomedical faculty and administrators and includes didactic teaching, online learning, laboratory mini-courses, clinical practicums, and multidisciplinary patient planning conferences (year 1); student development and facilitation of problem-based patient cases (year 2); and individualized mentoring based on research problems and progress toward degree completion (years 3-5). Each phase includes formative and summative evaluations. Nineteen students entered the program from 2009 through 2011. On periodic anonymous surveys, the most recent in September 2013, students indicated that the program substantially improved their knowledge of cancer biology, cancer medicine, and academic medicine; that the mentors were knowledgeable, good teachers, and dedicated to students; and that the program motivated them to become well-rounded scientists and scholars. We believe this program can be modified and disseminated to other graduate research and professional health care programs.

Caution on the use of liquid nitrogen traps in stable hydrogen isotope-ratio mass spectrometry

USGS Publications Warehouse

Coplen, Tyler B.; Qi, Haiping

2010-01-01

An anomalous stable hydrogen isotopic fractionation of 4 ‰ in gaseous hydrogen has been correlated with the process of adding liquid nitrogen (LN2) to top off the dewar of a stainless-steel water trap on a gaseous hydrogen-water platinum equilibration system. Although the cause of this isotopic fractionation is unknown, its effect can be mitigated by (1) increasing the capacity of any dewars so that they do not need to be filled during a daily analytic run, (2) interspersing isotopic reference waters among unknowns, and (3) applying a linear drift correction and linear normalization to isotopic results with a program such as Laboratory Information Management System (LIMS) for Light Stable Isotopes. With adoption of the above guidelines, measurement uncertainty can be substantially improved. For example, the long-term (months to years) δ2H reproducibility (1& sigma; standard deviation) of nine local isotopic reference waters analyzed daily improved substantially from about 1‰ to 0.58 ‰. This isotopically fractionating mechanism might affect other isotope-ratio mass spectrometers in which LN2 is used as a moisture trap for gaseous hydrogen

Communication-and-resolution programs: the challenges and lessons learned from six early adopters.

PubMed

Mello, Michelle M; Boothman, Richard C; McDonald, Timothy; Driver, Jeffrey; Lembitz, Alan; Bouwmeester, Darren; Dunlap, Benjamin; Gallagher, Thomas

2014-01-01

In communication-and-resolution programs (CRPs), health systems and liability insurers encourage the disclosure of unanticipated care outcomes to affected patients and proactively seek resolutions, including offering an apology, an explanation, and, where appropriate, reimbursement or compensation. Anecdotal reports from the University of Michigan Health System and other early adopters of CRPs suggest that these programs can substantially reduce liability costs and improve patient safety. But little is known about how these early programs achieved success. We studied six CRPs to identify the major challenges in and lessons learned from implementing these initiatives. The CRP participants we interviewed identified several factors that contributed to their programs' success, including the presence of a strong institutional champion, investing in building and marketing the program to skeptical clinicians, and making it clear that the results of such transformative change will take time. Many of the early CRP adopters we interviewed expressed support for broader experimentation with these programs even in settings that differ from their own, such as systems that do not own and control their liability insurer, and in states without strong tort reforms.

Reporting and identifying child physical abuse: How well are we doing?

PubMed

Ho, Grace W K; Bettencourt, Amie; Gross, Deborah A

2017-12-01

Entry into the child protection system in the US begins with a child maltreatment report. Some evidence suggests that report source and child age are related to report outcomes, but there has been no national study of these relationships. The purpose of this secondary data analysis was to describe the distribution of report sources for child physical abuse (CPA), and examine whether (a) the source of a report and (b) child age contribute to the likelihood of substantiation of the reported abuse. Multilevel logistic regressions were conducted using a US national sample of 204,414 children investigated for CPA in 2013 in a dataset obtained from the National Child Abuse and Neglect Data System. Results showed that fewer than one in seven children reported for CPA were confirmed victims of abuse. Professionally mandated reporters initiated the majority of CPA reports, and their reports were more likely to be substantiated compared with nonprofessionals. However, reports made by even the most accurate professional group (legal/law enforcement) had only a 26% chance of substantiation, and some professional groups had a lower likelihood of substantiation than nonprofessionals. Reports made by professionals were less likely to be substantiated as child age increased. More research is warranted to develop and test the effectiveness of training programs to improve CPA reporting and identification. © 2017 Wiley Periodicals, Inc.

DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates: An Intrarater and Interrater Agreement Study.

PubMed

Fahed, Robert; Lecler, Augustin; Sabben, Candice; Khoury, Naim; Ducroux, Célina; Chalumeau, Vanessa; Botta, Daniele; Kalsoum, Erwah; Boisseau, William; Duron, Loïc; Cabral, Dominique; Koskas, Patricia; Benaïssa, Azzedine; Koulakian, Hasmik; Obadia, Michael; Maïer, Benjamin; Weisenburger-Lile, David; Lapergue, Bertrand; Wang, Adrien; Redjem, Hocine; Ciccio, Gabriele; Smajda, Stanislas; Desilles, Jean-Philippe; Mazighi, Mikaël; Ben Maacha, Malek; Akkari, Inès; Zuber, Kevin; Blanc, Raphaël; Raymond, Jean; Piotin, Michel

2018-01-01

We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy. Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics. Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (κ=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement. Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial. © 2017 American Heart Association, Inc.

Lowering employee health care costs through the Healthy Lifestyle Incentive Program.

PubMed

Merrill, Ray M; Hyatt, Beverly; Aldana, Steven G; Kinnersley, Dan

2011-01-01

To evaluate the impact of the Healthy Lifestyle Incentive Program (HLIP), a worksite health program, on lowering prescription drug and medical costs. Health care cost data for Salt Lake County employees during 2004 through 2008 were linked with HLIP enrollment status. Additional program information was obtained from a cross-sectional survey administered in 2008. The program includes free annual screenings, tailored feedback on screening results, financial incentives for maintaining and modifying certain behaviors, and periodic educational programs and promotions to raise awareness of health topics. Frequency and cost of prescription drug and medical claims. Participation increased from 16% to 23% in men and 34% to 45% in women over the 5-year study period and was associated with a significantly greater level of physical activity and improved general health. Participants were generally satisfied with the HLIP (43% were very satisfied, 51% satisfied, 5% dissatisfied, and 1% very dissatisfied). The primary factors contributing to participation were financial incentives (more so among younger employees), followed by a desire to improve health (more so among older employees). Over the study period, the cost savings in lower prescription drug and medical costs was $3,568,837. For every dollar spent on the HLIP the county saved $3.85. Financial incentives and then a desire for better health were the primary reasons for participation. The HLIP resulted in substantial health care cost savings for Salt Lake County Government.

Progress toward improved leadership and management training in pathology.

PubMed

Weiss, Ronald L; Hassell, Lewis A; Parks, Eric R

2014-04-01

Competency gaps in leadership and laboratory management skills continue to exist between what training programs deliver and what recent graduates and future employers expect. A number of recent surveys substantiate this. Interest in delivering content in these areas is challenged by time constraints, the presence of knowledgeable faculty role models, and the necessary importance placed on diagnostic skills development, which overshadows any priority trainees have toward developing these skills. To describe the problem, the near-future horizon, the current solutions, and the recommendations for improving resident training in laboratory management. The demands of new health care delivery models and the value being placed on these skills by the Pathology Milestones and Next Accreditation System initiative of the Accreditation Council for Graduate Medical Education for training programs emphasizes their importance. This initiative includes 6 milestone competencies in laboratory management. Organizations like the American Society for Clinical Pathology, the American Pathology Foundation, the College of American Pathologists, and the Association of Pathology Chairs Program Directors Section recognize these competencies and are working to create new tools for training programs to deploy. It is our recommendation that (1) every training program develop a formal educational strategy for management training, (2) greater opportunity and visibility be afforded for peer-reviewed publications on management topics in mainstream pathology literature, and (3) pathology milestones-oriented tools be developed to assist program directors and their trainees in developing this necessary knowledge and skills.

Informing Estimates of Program Effects for Studies of Mathematics Professional Development Using Teacher Content Knowledge Outcomes.

PubMed

Phelps, Geoffrey; Kelcey, Benjamin; Jones, Nathan; Liu, Shuangshuang

2016-10-03

Mathematics professional development is widely offered, typically with the goal of improving teachers' content knowledge, the quality of teaching, and ultimately students' achievement. Recently, new assessments focused on mathematical knowledge for teaching (MKT) have been developed to assist in the evaluation and improvement of mathematics professional development. This study presents empirical estimates of average program change in MKT and its variation with the goal of supporting the design of experimental trials that are adequately powered to detect a specified program effect. The study drew on a large database representing five different assessments of MKT and collectively 326 professional development programs and 9,365 teachers. Results from cross-classified hierarchical growth models found that standardized average change estimates across the five assessments ranged from a low of 0.16 standard deviations (SDs) to a high of 0.26 SDs. Power analyses using the estimated pre- and posttest change estimates indicated that hundreds of teachers are needed to detect changes in knowledge at the lower end of the distribution. Even studies powered to detect effects at the higher end of the distribution will require substantial resources to conduct rigorous experimental trials. Empirical benchmarks that describe average program change and its variation provide a useful preliminary resource for interpreting the relative magnitude of effect sizes associated with professional development programs and for designing adequately powered trials. © The Author(s) 2016.

Perceived barriers and enablers of physical activity in postpartum women: a qualitative approach.

PubMed

Saligheh, Maryam; McNamara, Beverley; Rooney, Rosanna

2016-06-02

Postpartum women's recovery from birth can be assisted through increased physical activity (PA). However, women face substantial barriers to participating in exercise and require support to enable them to benefit from increased PA. This study sought to explore women's beliefs about and experiences of PA and exercise during the 6 weeks to 12 months postpartum period. A cohort of 14 postpartum women from a survey study of the barriers and enablers to exercise participation agreed to take part in interview sessions to provide an in-depth understanding of the women's perceptions of the postpartum period and their physical activity during this time. Findings are presented with reference to the social ecological framework and indicate postpartum women face substantial personal and environmental barriers to PA and exercise participation: fatigue, a lack of motivation and confidence, substantial time constraints, lack of access to affordable and appropriate activities and poor access to public transport. In contrast, enablers such as possessing greater social support, in particular partner support, improved PA and exercise participation. The findings encourage facilitation of exercise through mothers' groups, mothers' exercise clubs or postnatal classes suggesting behavioral and social change is needed. Interaction between individuals, community, organizations and policy makers is required. In addition, the provision of specifically tailored and appropriate exercise programs could potentially enable increased PA in postpartum women, thereby improving their health.

A Randomized Controlled Trial of the Web-Based OurRelationship Program: Effects on Relationship and Individual Functioning

PubMed Central

Doss, Brian D.; Cicila, Larisa N.; Georgia, Emily J.; Roddy, McKenzie K.; Nowlan, Kathryn M.; Benson, Lisa A.; Christensen, Andrew

2016-01-01

Objective Within the United States, one-third of married couples are distressed and almost half of first marriages (and more than half of unmarried cohabiting relationships) end in divorce/separation. Additionally, relationship distress has been linked to mental and physical health problems in partners and their children. Although couple therapy is effective in reducing relationship distress, it is utilized by less than one third of divorcing couples. Therefore, more accessible interventions for relationship distress are needed. Method This study tests the efficacy of the OurRelationship (OR) program, an eight-hour online program adapted from an empirically-based, in-person couple therapy. In the program, couples complete online activities and have four, 15-minute calls with project staff. Nationwide, 300 heterosexual couples (N = 600 participants) participated; couples were generally representative of the US in terms of race, ethnicity, and education. Couples were randomly assigned to begin the program immediately or to a two month waitlist control group. Results Compared to the waitlist group, intervention couples reported significant improvements in relationship satisfaction (Cohen’s d=0.69), relationship confidence (d=0.47), and negative relationship quality (d=0.57). Additionally, couples reported significant improvements in multiple domains of individual functioning, especially when individuals began the program with difficulties in that domain: depressive (d=0.71) and anxious symptoms (d=0.94), perceived health (d=0.51), work functioning (d=0.57), and quality of life (d=0.44). Conclusions In a nationally-representative sample of couples, the OR program was effective in significantly improving both relationship and individual functioning, suggesting it can substantially increase the reach of current interventions through its low-cost, web-based format. PMID:26999504

Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care.

PubMed

Kirschner, Kirsten; Braspenning, Jozé; Jacobs, J E Annelies; Grol, Richard

2013-01-01

The involvement of target users in the design choices of a pay-for-performance program may enhance its impact, but little is known about the views of participants in these programs. To explore general practices' experiences with pay-for-performance in primary care we conducted a qualitative study in general practices in the Netherlands. Thirty out of 65 general practices participating in a pay-for-performance program, stratified for bonus, were invited for a semistructured interview on feasibility, feedback and the bonus, spending of the bonus, unintended consequences, and future developments. Content analysis was used to process the resulting transcripts. We included 29 practices. The feasibility of the pay-for-performance program was questioned due to the substantial time investment. The feedback on clinical care, practice management and patient experience was mostly discussed in the team, and used for improvement plans, but was also qualified as annoying for one GP and for another GP it brought feelings of insecurity. Most practices considered the bonus a stimulus to improve quality of care, in addition to compensation for their effort and time invested. Distinctive performance features were not displayed, for instance, on a website. The bonus was mainly spent on new equipment or team building. Practices referred to gaming and focusing on those aspects that were incentivised ('tunnel vision') as unintended consequences. Future developments should be directed to absolute thresholds, new indicators to keep the process going, and an independent audit. Linking a part of the bonus to innovation was also suggested. The participants thought the pay-for-performance program was a labour-intensive positive breakthrough to stimulate quality improvement, but warned of unintended consequences of the program and the sustainability of the indicator set.

Improving the efficiency and standards of a National Immunization Program Review: lessons learnt from United Republic of Tanzania.

PubMed

Lyimo, Dafrossa; Kamugisha, Christopher; Yohana, Emmanuel; Eshetu, Messeret; Wallace, Aaron; Ward, Kirsten; Mantel, Carsten; Hennessey, Karen

2017-01-01

A National Immunization Program Review (NIP Review) is a comprehensive external assessment of the performance of a country's immunization programme. The number of recommended special-topic NIP assessments, such as those for vaccine introduction or vaccine management, has increased. These assessments often have substantial overlap with NIP reviews, raising concern about duplication. Innovative technical and management approaches, including integrating several assessments into one, were applied in the United Republic of Tanzania's 2015 NIP Review. These approaches and processes were documented and a post-Review survey and group discussion. The Tanzania Review found that integrating assessments so they can be conducted at one time was feasible and efficient. There are concrete approaches for successfully managing a Review that can be shared and practiced including having a well-planned desk review and nominating topic-leads. The use of tablets for data entry has the potential to improve Review data quality and timely analysis; however, careful team training is needed. A key area to improve was to better coordinate and link findings from the national-level and field teams.

Improving Hospital-Wide Early Resource Allocation through Machine Learning.

PubMed

Gartner, Daniel; Padman, Rema

2015-01-01

The objective of this paper is to evaluate the extent to which early determination of diagnosis-related groups (DRGs) can be used for better allocation of scarce hospital resources. When elective patients seek admission, the true DRG, currently determined only at discharge, is unknown. We approach the problem of early DRG determination in three stages: (1) test how much a Naïve Bayes classifier can improve classification accuracy as compared to a hospital's current approach; (2) develop a statistical program that makes admission and scheduling decisions based on the patients' clincial pathways and scarce hospital resources; and (3) feed the DRG as classified by the Naïve Bayes classifier and the hospitals' baseline approach into the model (which we evaluate in simulation). Our results reveal that the DRG grouper performs poorly in classifying the DRG correctly before admission while the Naïve Bayes approach substantially improves the classification task. The results from the connection of the classification method with the mathematical program also reveal that resource allocation decisions can be more effective and efficient with the hybrid approach.

Fatigue methodology III; Proceedings of the AHS National Technical Specialists' Meeting on Advanced Rotorcraft Structures, Scottsdale, AZ, Oct. 3-5, 1989

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

Not Available

1989-01-01

Papers on rotorcraft and fatigue methodology are presented, covering topics such as reliability design for rotorcraft, a comparison between theory and fatigue test data on stress concentration factors, the retirement lives of rolling element bearings, hydrogen embrittlement risk analysis for high hardness steel parts, and rotating system load monitoring with minimum fixed system instrumentation. Additional topics include usage data collection to improve structural integrity of operational helicopters, usage monitory of military helicopters, improvements to the fatigue substantiation of the H-60 composite tail rotor blade, helicopter surviellance programs, and potential application of automotive fatigue technology in rotorcraft design. Also, consideration ismore » given to fatigue evaluation of C/MH-53 E main rotor damper threaded joints, SH-2F airframe fatigue test program, a ply termination concept for improving fracture and fatigue strength of composite laminates, the analysis and testing of composite panels subject to muzzle blast effects, the certification plan for an all-composite main rotor flexbeam, and the effects of stacking sequence on the flexural strength of composite beams.« less

EMPRESS: A European Project to Enhance Process Control Through Improved Temperature Measurement

NASA Astrophysics Data System (ADS)

Pearce, J. V.; Edler, F.; Elliott, C. J.; Rosso, L.; Sutton, G.; Andreu, A.; Machin, G.

2017-08-01

A new European project called EMPRESS, funded by the EURAMET program `European Metrology Program for Innovation and Research,' is described. The 3 year project, which started in the summer of 2015, is intended to substantially augment the efficiency of high-value manufacturing processes by improving temperature measurement techniques at the point of use. The project consortium has 18 partners and 5 external collaborators, from the metrology sector, high-value manufacturing, sensor manufacturing, and academia. Accurate control of temperature is key to ensuring process efficiency and product consistency and is often not achieved to the level required for modern processes. Enhanced efficiency of processes may take several forms including reduced product rejection/waste; improved energy efficiency; increased intervals between sensor recalibration/maintenance; and increased sensor reliability, i.e., reduced amount of operator intervention. Traceability of temperature measurements to the International Temperature Scale of 1990 (ITS-90) is a critical factor in establishing low measurement uncertainty and reproducible, consistent process control. Introducing such traceability in situ (i.e., within the industrial process) is a theme running through this project.

Cognitive remediation therapy (CRT) benefits more to patients with schizophrenia with low initial memory performances.

PubMed

Pillet, Benoit; Morvan, Yannick; Todd, Aurelia; Franck, Nicolas; Duboc, Chloé; Grosz, Aimé; Launay, Corinne; Demily, Caroline; Gaillard, Raphaël; Krebs, Marie-Odile; Amado, Isabelle

2015-01-01

Cognitive deficits in schizophrenia mainly affect memory, attention and executive functions. Cognitive remediation is a technique derived from neuropsychology, which aims to improve or compensate for these deficits. Working memory, verbal learning, and executive functions are crucial factors for functional outcome. Our purpose was to assess the impact of the cognitive remediation therapy (CRT) program on cognitive difficulties in patients with schizophrenia, especially on working memory, verbal memory, and cognitive flexibility. We collected data from clinical and neuropsychological assessments in 24 patients suffering from schizophrenia (Diagnostic and Statistical Manual of mental Disorders-Fourth Edition, DSM-IV) who followed a 3-month (CRT) program. Verbal and visuo-spatial working memory, verbal memory, and cognitive flexibility were assessed before and after CRT. The Wilcoxon test showed significant improvements on the backward digit span, on the visual working memory span, on verbal memory and on flexibility. Cognitive improvement was substantial when baseline performance was low, independently from clinical benefit. CRT is effective on crucial cognitive domains and provides a huge benefit for patients having low baseline performance. Such cognitive amelioration appears highly promising for improving the outcome in cognitively impaired patients.

Benefits of Exercise on the Executive Functions in People with Parkinson Disease: A Controlled Clinical Trial.

PubMed

de Oliveira, Renata Terra; Felippe, Lilian Assunção; Bucken Gobbi, Lilian Teresa; Barbieri, Fabio Augusto; Christofoletti, Gustavo

2017-05-01

We have made a 3-arm trial (group vs. individual exercise vs. no treatment) to test the effects of a 6-month exercise program upon the executive functions in participants with Parkinson disease. Twenty-four subjects were randomly allocated in 3 groups and undertook individualized exercises (G1, n = 8), group exercises (G2, n = 8), or monitoring (G3, n = 8). Executive functions were evaluated by means of the Wisconsin card sorting test and the Raven colored matrices, both assessed at the beginning of the program and after 6 months. The statistical analyses consisted of the application of repeated measurement tests, with a significant level of 5%. The findings showed similar behavior of groups in terms of the Wisconsin card sorting test (P = 0.792), reporting no benefit of the program on such instrument. Differently, Raven colored matrices evidenced a significant benefit provided by the intervention (P = 0.032). Compared with the control group, individuals from G1 had a substantial improvement on executive functions (P = 0.031) and from G2 had a trend of significance (P = 0.072). Findings of this study show that 6 months of exercise improved some aspects of executive functions when compared with control peers. Individual therapy seems to have a more prominent improvement than group therapy.

Engaging Frontline Staff in Performance Improvement: The American Organization of Nurse Executives Implementation of Transforming Care at the Bedside Collaborative.

PubMed

Needleman, Jack; Pearson, Marjorie L; Upenieks, Valda V; Yee, Tracy; Wolstein, Joelle; Parkerton, Melissa

2016-02-01

Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff. In a mixed-methods analysis, multiple data sources, including leader surveys, unit staff surveys, administrative data, time study data, and collaborative documents were used. All units reported establishing unit-based teams, of which >90% succeeded in conducting tests of change, with unit staff selecting topics and making decisions on adoption. Fifty-five percent of unit staff reported participating in unit meetings, and 64%, in tests of change. Unit managers reported substantial increase in staff support for the initiative. An average 36 tests of change were conducted per unit, with 46% of tested innovations sustained, and 20% spread to other units. Some 95% of managers and 97% of chief nursing officers believed that the program had made unit staff more likely to initiate change. Among staff, 83% would encourage adoption of the initiative. Given the strong positive assessment of TCAB, evidence of substantial engagement of staff in the work, and the high volume of innovations tested, implemented, and sustained, TCAB appears to be a productive model for organizing and implementing a program of frontline-led improvement.

Psychological Factors and Cardiac Risk And Impact of Exercise Training Programs—A Review of Ochsner Studies

PubMed Central

Lavie, Carl J.; Milani, Richard V.; Artham, Surya M.; Gilliland, Yvonne

2007-01-01

Although under-emphasized, substantial evidence indicates that psychological distress, especially depression, hostility, and anxiety, are risk factors for coronary heart disease (CHD) and affect recovery following major coronary heart disease events. We review several major studies from Ochsner Medical Center demonstrating the high prevalence of psychological distress in CHD patients and the marked benefits that occur following formal cardiac rehabilitation and exercise training programs. These benefits include reductions in psychological stress, improvements in CHD risk factors that accompany high stress, and reduced all-cause mortality. These data support the benefits of exercise training and increased levels of fitness to improve psychological stress and subsequent prognosis. PMID:21603539

Accelerating plant breeding.

PubMed

De La Fuente, Gerald N; Frei, Ursula K; Lübberstedt, Thomas

2013-12-01

The growing demand for food with limited arable land available necessitates that the yield of major food crops continues to increase over time. Advances in marker technology, predictive statistics, and breeding methodology have allowed for continued increases in crop performance through genetic improvement. However, one major bottleneck is the generation time of plants, which is biologically limited and has not been improved since the introduction of doubled haploid technology. In this opinion article, we propose to implement in vitro nurseries, which could substantially shorten generation time through rapid cycles of meiosis and mitosis. This could prove a useful tool for speeding up future breeding programs with the aim of sustainable food production. Copyright © 2013 Elsevier Ltd. All rights reserved.

Incorporating robotic-assisted telerehabilitation in a home program to improve arm function following stroke.

PubMed

Linder, Susan M; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Rosenfeldt, Anson B; Clark, Cindy; Wolf, Steven L; Alberts, Jay L

2013-09-01

After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function. The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment. The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period. The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points. This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.

Improving Elementary School Quality Through the Use of a Social-Emotional and Character Development Program: A Matched-Pair, Cluster-Randomized, Controlled Trial in Hawai’i

PubMed Central

Snyder, Frank J.; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac J.; Flay, Brian R.

2012-01-01

BACKGROUND School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school-wide social-emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched-pair, cluster-randomized, controlled design. The Positive Action Hawai’i trial included 20 racially/ethnically diverse schools and was conducted from 2002–2003 through 2005–2006. METHODS School-level archival data, collected by the Hawai’i Department of Education, were used to examine program effects at 1-year post-trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well-being, involvement, and satisfaction, as well as overall school quality. Matched-paired t-tests were used for the primary analysis, and sensitivity analyses included permutation tests and random-intercept growth curve models. RESULTS Analyses comparing change from baseline to 1-year post-trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school-quality indicators showed improvement in student safety and well-being, involvement, satisfaction, quality student support, focused and sustained action, standards-based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. CONCLUSIONS School quality was substantially improved, providing evidence that a school-wide social-emotional and character education program can enhance school quality and facilitate whole-school change. PMID:22142170

Improving elementary school quality through the use of a social-emotional and character development program: a matched-pair, cluster-randomized, controlled trial in Hawai'i.

PubMed

Snyder, Frank J; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac J; Flay, Brian R

2012-01-01

School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school-wide social-emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched-pair, cluster-randomized, controlled design. The Positive Action Hawai'i trial included 20 racially/ethnically diverse schools and was conducted from 2002-2003 through 2005-2006. School-level archival data, collected by the Hawai'i Department of Education, were used to examine program effects at 1-year post-trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well-being, involvement, and satisfaction, as well as overall school quality. Matched-paired t-tests were used for the primary analysis, and sensitivity analyses included permutation tests and random-intercept growth curve models. Analyses comparing change from baseline to 1-year post-trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school-quality indicators showed improvement in student safety and well-being, involvement, satisfaction, quality student support, focused and sustained action, standards-based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. School quality was substantially improved, providing evidence that a school-wide social-emotional and character education program can enhance school quality and facilitate whole-school change. © 2011, American School Health Association.

The efficacy of a multidisciplinary group program for patients with refractory chronic pain

PubMed Central

Inoue, Masayuki; Inoue, Shinsuke; Ikemoto, Tatsunori; Arai, Young-Chang P; Nakata, Masatoshi; Miyazaki, Atsuko; Nishihara, Makoto; Kawai, Takashi; Hatakeyama, Noboru; Yamaguchi, Setsuko; Shimo, Kazuhiro; Miyagawa, Hirofumi; Hasegawa, Tomomi; Sakurai, Hiroki; Hasegawa, Yoshinobu; Ohmichi, Yusuke; Ushida, Takahiro

2014-01-01

BACKGROUND: Chronic pain is a major problem because it can result in not only a reduction in activities of daily living and quality of life but also requires initiation of social assistance. Seeking only to eliminate pain itself would appear to be too narrow an objective, in addition to often being unachievable; therefore, a multifaceted, comprehensive approach with multiple objectives is needed. OBJECTIVE: To describe the effects of a program (the ‘Chronic Pain Class’) offering cognitive behavioural therapy to small groups of individuals with refractory chronic pain in Japan. Exercise was an important feature of the program. METHODS: A total of 46 patients who were experiencing treatment difficulties and decreased activity participated in the program. The programs were conducted in groups of five to seven patients who met weekly for nine weeks. Weekly sessions, which were approximately 2 h in duration, combined lectures with exercise. Several measures related to pain and physical function were administered at the beginning and the conclusion of the program. RESULTS: Nine patients dropped out during the program. A number of measures (eg, pain intensity, disability, catastrophizing thoughts) showed significant improvements after intervention (P<0.002 after Bonferroni correction). Furthermore, most measures of physical function showed substantial improvement, especially seated forward bends, zig-zag walking, self-care and 6 min walk test (P<0.001). CONCLUSION: The results of the present study provide evidence that a combination of cognitive behavioural therapy and exercise should be recommended to patients with refractory chronic pain. PMID:24992454

The New Jersey Medicaid ACO Demonstration Project: seeking opportunities for better care and lower costs among complex low-income patients.

PubMed

Cantor, Joel C; Chakravarty, Sujoy; Tong, Jian; Yedidia, Michael J; Lontok, Oliver; DeLia, Derek

2014-12-01

A small but growing number of states are turning to accountable care concepts to improve their Medicaid programs. In 2011 New Jersey enacted the Medicaid Accountable Care Organization (ACO) Demonstration Project to offer local provider coalitions the opportunity to share any savings they generate. Impetus came from initiatives in Camden that aim to reduce costs through improved care coordination among hospital high users and that have received considerable media attention and substantial federal and private grant support. Though broadly similar to Medicare and commercial ACOs, the New Jersey demonstration addresses the unique concerns faced by Medicaid populations. Using hospital all-payer billing data, we estimate savings from care improvement efforts among inpatient and emergency department high users in thirteen communities that are candidates for participation in the New Jersey demonstration. We also examine their characteristics to inform Medicaid accountable care strategies. We find substantial variation in the share of high-user hospital patients across the study communities and high rates of avoidable use and costs among these patients. The potential savings among Medicaid enrollees are considerable, particularly if Medicaid ACOs can develop ways to successfully address the high burden of chronic illness and behavioral health conditions prevalent in the prospective demonstration communities. Copyright © 2014 by Duke University Press.

Automation, decision support, and expert systems in nephrology.

PubMed

Soman, Sandeep; Zasuwa, Gerard; Yee, Jerry

2008-01-01

Increasing data suggest that errors in medicine occur frequently and result in substantial harm to the patient. The Institute of Medicine report described the magnitude of the problem, and public interest in this issue, which was already large, has grown. The traditional approach in medicine has been to identify the persons making the errors and recommend corrective strategies. However, it has become increasingly clear that it is more productive to focus on the systems and processes through which care is provided. If these systems are set up in ways that would both make errors less likely and identify those that do occur and, at the same time, improve efficiency, then safety and productivity would be substantially improved. Clinical decision support systems (CDSSs) are active knowledge systems that use 2 or more items of patient data to generate case specific recommendations. CDSSs are typically designed to integrate a medical knowledge base, patient data, and an inference engine to generate case specific advice. This article describes how automation, templating, and CDSS improve efficiency, patient care, and safety by reducing the frequency and consequences of medical errors in nephrology. We discuss practical applications of these in 3 settings: a computerized anemia-management program (CAMP, Henry Ford Health System, Detroit, MI), vascular access surveillance systems, and monthly capitation notes in the hemodialysis unit.

The Practice of Respect in the ICU.

PubMed

Brown, Samuel M; Azoulay, Elie; Benoit, Dominique; Butler, Terri Payne; Folcarelli, Patricia; Geller, Gail; Rozenblum, Ronen; Sands, Ken; Sokol-Hessner, Lauge; Talmor, Daniel; Turner, Kathleen; Howell, Michael D

2018-06-01

Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.

Breaking bad news is a teachable skill in pediatric residents: A feasibility study of an educational intervention.

PubMed

Reed, Suzanne; Kassis, Karyn; Nagel, Rollin; Verbeck, Nicole; Mahan, John D; Shell, Richard

2015-06-01

Patients and physicians identify communication of bad news as a skill in need of improvement. Our objectives were to measure change in performance of first-year pediatric residents in the delivery of bad news after an educational intervention and to measure if changes in performance were sustained over time. Communication skills of 29 residents were assessed via videotaped standardized patient (SP) encounters at 3 time points: baseline, immediately post-intervention, and 3 months post-intervention. Educational intervention used was the previously published "GRIEV_ING Death Notification Protocol." The intraclass correlation coefficient demonstrated substantial inter-rater agreement with the assessment tool. Performance scores significantly improved from baseline to immediate post-intervention. Performance at 3 months post-intervention showed no change in two subscales and small improvement in one subscale. We concluded that breaking bad news is a complex and teachable skill that can be developed in pediatric residents. Improvement was sustained over time, indicating the utility of this educational intervention. This study brings attention to the need for improved communication training, and the feasibility of an education intervention in a large training program. Further work in development of comprehensive communication curricula is necessary in pediatric graduate medical education programs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Alternative strategies for space station financing

NASA Technical Reports Server (NTRS)

Walklet, D. C.; Heenan, A. T.

1983-01-01

The attributes of the proposed space station program are oriented toward research activities and technologies which generate long term benefits for mankind. Unless such technologies are deemed of national interest and thus are government funded, they must stand on their own in the market place. Therefore, the objectives of a United States space station should be based on commercial criteria; otherwise, such a project attracts no long term funding. There is encouraging evidence that some potential space station activities should generate revenues from shuttle related projects within the decade. Materials processing concepts as well as remote sensing indicate substantial potential. Futhermore, the economics and thus the commercial feasibility of such projects will be improved by the operating efficiencies available with an ongoing space station program.

Accreditation status of U.S. military graduate medical education programs.

PubMed

De Lorenzo, Robert A

2008-07-01

Military graduate medical education (GME) comprises a substantial fraction of U.S. physician training capacity. The wars in Iraq and Afghanistan have placed substantial stress on military medicine, and lay and professional press accounts have raised awareness of the effects on military GME. To date, however, objective data on military GME quality remains sparse. Determine the accreditation status of U.S. military GME programs. Additionally, military GME program data will be compared to national (U.S.) accreditation lengths. Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) data. All military-sponsored core programs in specialties with at least three residencies were included. Military-affiliated but civilian-sponsored programs were excluded. The current and past cycle data were used for the study. For each specialty, the current mean accreditation length and the net change in cycle was calculated. National mean accreditation lengths by specialty for 2005 to 2006 were obtained from the ACGME. Comparison between the overall mean national and military accreditation lengths was performed with a z test. All other comparisons employed descriptive statistics. Ninety-nine military programs in 15 specialties were included in the analysis. During the study period, 1 program was newly accredited, and 6 programs had accreditation withdrawn or were closed. The mean accreditation length of the military programs was 4.0 years. The overall national mean for the same specialties is 3.5 years (p < 0.01). In previous cycles, 68% of programs had accreditation of 4 years or longer, compared to 70% in the current cycle, while 13% had accreditation of 2 years or less in the previous cycle compared to 14% in the current cycle. Ten (68%) of the military specialties had mean accreditation lengths greater than the national average, while 5 (33%) were below it. Ten (68%) specialties had stable or improving cycle lengths when compared to previous cycles. Military GME accreditation cycle lengths are, overall, longer than national averages. Trends show many military programs are experiencing either stable or slightly lengthening accreditation compared to previous cycles. A few specialties show a declining trend. There has been a modest 5% decline in the number of military core residency programs since 2000.

The benefits of improved national elevation data

USGS Publications Warehouse

Snyder, Gregory I.

2013-01-01

This article describes how the National Enhanced Elevation Assessment (NEEA) has identified substantial benefits that could come about if improved elevation data were publicly available for current and emerging applications and business uses such as renewable energy, precision agriculture, and intelligent vehicle navigation and safety. In order to support these diverse needs, new national elevation data with higher resolution and accuracy are needed. The 3D Elevation Program (3DEP) initiative was developed to meet the majority of these needs and it is expected that 3DEP will result in new, unimagined information services that would result in job growth and the transformation of the geospatial community. Private-sector data collection companies are continuously evolving sensors and positioning technologies that are needed to collect improved elevation data. An initiative of this scope might also provide an opportunity for companies to improve their capabilities and produce even higher data quality and consistency at a pace that might not have otherwise occurred.

Basic research for the geodynamics program

NASA Technical Reports Server (NTRS)

Mueller, Ivan I.

1988-01-01

Additional results are presented concerning a study that considers improvements over present Earth Rotation Parameter (ERP) determination methods by directly combining observations from various space geodetic systems in one adjustment. Earlier results are extended, showing that in addition to slight improvements in accuracy, substantial (a factor of three or more) improvements in precision and significant reductions in correlations between various parameters can be obtained (by combining Lunar Laser Ranging - LLR, Satellite Laser Ranging - SLR to Lageos, and Very Long Baseline Interferometry - VLBI data in one adjustment) as compared to results from individual systems. Smaller improvements are also seen over the weighted means of the individual system results. Although data transmission would not be significantly reduced, negligible additional computer time would be required if (standardized) normal equations were available from individual solutions. Suggestions for future work and implications for the New Earth Rotation Service (IERS) are also presented.

The Impact Of Medicare ACOs On Improving Integration And Coordination Of Physical And Behavioral Health Care.

PubMed

Fullerton, Catherine A; Henke, Rachel M; Crable, Erika L; Hohlbauch, Andriana; Cummings, Nicholas

2016-07-01

The accountable care organization (ACO) model holds the promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume. One key to managing the total cost of care is improving care coordination for and treatment of people with behavioral health disorders. We examined qualitative data from ninety organizations participating in Medicare ACO demonstration programs from 2012 through 2015 to determine whether and how they focused on behavioral health care. These ACOs had mixed degrees of engagement in improving behavioral health care for their populations. The biggest challenges included a lack of behavioral health care providers, data availability, and sustainable financing models. Nonetheless, we found substantial interest in integrating behavioral health care into primary care across a majority of the ACOs. Project HOPE—The People-to-People Health Foundation, Inc.

Improving The Discipline of Cost Estimation and Analysis

NASA Technical Reports Server (NTRS)

Piland, William M.; Pine, David J.; Wilson, Delano M.

2000-01-01

The need to improve the quality and accuracy of cost estimates of proposed new aerospace systems has been widely recognized. The industry has done the best job of maintaining related capability with improvements in estimation methods and giving appropriate priority to the hiring and training of qualified analysts. Some parts of Government, and National Aeronautics and Space Administration (NASA) in particular, continue to need major improvements in this area. Recently, NASA recognized that its cost estimation and analysis capabilities had eroded to the point that the ability to provide timely, reliable estimates was impacting the confidence in planning many program activities. As a result, this year the Agency established a lead role for cost estimation and analysis. The Independent Program Assessment Office located at the Langley Research Center was given this responsibility. This paper presents the plans for the newly established role. Described is how the Independent Program Assessment Office, working with all NASA Centers, NASA Headquarters, other Government agencies, and industry, is focused on creating cost estimation and analysis as a professional discipline that will be recognized equally with the technical disciplines needed to design new space and aeronautics activities. Investments in selected, new analysis tools, creating advanced training opportunities for analysts, and developing career paths for future analysts engaged in the discipline are all elements of the plan. Plans also include increasing the human resources available to conduct independent cost analysis of Agency programs during their formulation, to improve near-term capability to conduct economic cost-benefit assessments, to support NASA management's decision process, and to provide cost analysis results emphasizing "full-cost" and "full-life cycle" considerations. The Agency cost analysis improvement plan has been approved for implementation starting this calendar year. Adequate financial and human resources are being made available to accomplish the goals of this important effort, and all indications are that NASA's cost estimation and analysis core competencies will be substantially improved within the foreseeable future.

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency

PubMed Central

2010-01-01

Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important. PMID:20942937

Positive outcomes following gait therapy intervention for hip osteoarthritis: A longitudinal study.

PubMed

Solomonow-Avnon, Deborah; Herman, Amir; Levin, Daniel; Rozen, Nimrod; Peled, Eli; Wolf, Alon

2017-10-01

Footwear-generated biomechanical manipulation of lower-limb joints was shown to beneficially impact gait and quality of life in knee osteoarthritis patients, but has not been tested in hip osteoarthritis patients. We examined a customized gait treatment program using a biomechanical device shown in previous investigations to be capable of manipulating hip biomechanics via foot center of pressure (COP) modulation. The objective of this study was to assess the treatment program for hip osteoarthritis patients, enrolled in a 1-year prospective investigation, by means of objective gait and spatiotemporal parameters, and subjective quality of life measures. Gait analysis and completion of questionnaires were performed at the start of the treatment (baseline), and after 3, 6, and 12 months. Outcome parameters were evaluated over time using linear mixed effects models, and association between improvement in quality of life measures and change in objective outcomes was tested using mixed effect linear regression models. Quality of life measures improved compared to baseline, accompanied by increased gait speed and cadence. Sagittal-plane hip joint kinetics, kinematics, and spatiotemporal parameters changed throughout the study compared to baseline, in a manner suggesting improvement of gait. The most substantial improvement occurred within 3 months after treatment initiation, after which improvement approximately plateaued, but was sustained at 12 months. Speed and cadence, as well as several sagittal-plane gait parameters, were significant predictors of improvement in quality of life. Evidence suggests that a biomechanical gait therapy program improves subjective and objective outcomes measures and is a valid treatment option for hip osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2222-2232, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory of individuals with chronic stroke

PubMed Central

Rand, Debbie; Eng, Janice J.; Liu-Ambrose, Teresa; Tawashy, Amira E.

2011-01-01

Background Physical activity has been shown to be beneficial for improving cognitive function in healthy older adults. However there is limited research on the benefits of physical activity on cognitive performance after stroke. Objective To determine if a combined exercise and recreation program can improve the executive functioning and memory in individuals with chronic stroke. Methods 11 ambulatory subjects with chronic stroke (mean age 67±10.8 years) participated in a 6 month program of exercise for 2 hours and recreation for 1 hour weekly. Executive functions and memory were assessed at baseline, 3, and 6 months by a battery of standard neuropsychological tests including response inhibition, cognitive flexibility, dual task (motor plus cognitive) and memory. Motor ability was also assessed. Non-parametric statistics were used to assess the differences between the three assessments. Results At baseline, substantial deficits in all aspects of executive functioning were revealed. From baseline to 3 mo, the mean improvement was 10±14% (χ2=9.3, p=0.0025) for the dual task (Walking while Talking), −3±22% (χ2=2.4, p>0.05) for response inhibition (Stroop test) and 61±69% (χ2=8.0, p=0.04) for memory (Rey Auditory Verbal Learning Test - long delay). From baseline to 6 months, the mean improvement was 7±7.5% (χ2=12.0, p=0.007) for response inhibition (Stroop Test). In addition, knee strength and walking speed improved significantly at 3 months. Conclusions This pilot study suggests that exercise and recreation may improve memory and executive functions of community dwelling individuals with stroke. Further studies require a larger sample size and a control group. PMID:20460494

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

Peters, R.H.; Clingan, M.R.; Randolph, R.F.

The U. S. Bureau of Mines has prepared this report on strategies for maintaining high job attendance among underground coal miners because high absenteeism is a threat to miners' safety and seriously hampers productivity. A substantial number of research studies on the effectiveness of various strategies for reducing absenteeism among the employees of nonmining industries have been reported in the literature. These strategies have aimed at improving job attendance through one or more of the following: (1) improving employment procedures, (2) overcoming problems that adversely affect one's ability to attend work, and (3) increasing miners' motivation to attend work. Manymore » of these strategies appear applicable to the mining industry, and are reviewed in the first half of this report. The second half of this report describes how one could develop and implement a program for maintaining high attendance at underground coal mines. The steps include measuring and evaluating attendance levels, formulating attendance goals and an absenteeism policy, developing and implementing an attendance promotion program and periodically going through the preceding steps (known as recycling).« less

NASA Astrophysics Data System (ADS)

McHugh, K. M.; Key, J. F.

1994-06-01

Spray forming is a near- net- shape fabrication technology in which a spray of finely atomized liquid droplets is deposited onto a suitably shaped substrate or pattern to produce a coherent solid. The technology offers unique opportunities for simplifying materials processing, often while substantially improving product quality. Spray forming is applicable to a wide range of metals and nonmetals and offers property improvements resulting from rapid solidification (e.g., refined microstructures, extended solid solubilities, and reduced segregation). Economic benefits result from process simplification and the elimination of unit operations. Researchers at the Idaho National Engineering Laboratory (INEL) are developing spray forming technology for producing near- net- shape solids and coatings of a variety of metals, polymers, and composite materials using de Laval nozzles. This article briefly describes the atomization behavior of liquid metals in linear de Laval nozzles and illustrates the versatility of the process by summarizing results from two spray forming programs. In one program, low-carbon steel strip >0.75 mm thick was produced; in the other, polymer membranes ˜5 μm thick were spray formed.

Pain management and opioid risk mitigation in the military.

PubMed

Sharpe Potter, Jennifer; Bebarta, Vikhyat S; Marino, Elise N; Ramos, Rosemarie G; Turner, Barbara J

2014-05-01

Opioid analgesics misuse is a significant military health concern recognized as a priority issue by military leadership. Opioids are among those most commonly prescribed medications in the military for pain management. The military has implemented opioid risk mitigation strategies, including the Sole Provider Program and the Controlled Drug Management Analysis and Reporting Tool, which are used to identify and monitor for risk and misuse. However, there are substantial opportunities to build on these existing systems to better ensure safer opioid prescribing and monitor for misuse. Opioid risk mitigation strategies implemented by the civilian sector include establishing clinical guidelines for opioid prescribing and prescription monitoring programs. These strategies may help to inform opioid risk mitigation in the military health system. Reducing the risk of opioid misuse and improving quality of care for our Warfighters is necessary. This must be done through evidence-based approaches with an investment in research to improve patient care and prevent opioid misuse as well as its sequelae. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Programming generality into a performance feedback writing intervention: A randomized controlled trial.

PubMed

Hier, Bridget O; Eckert, Tanya L

2016-06-01

Substantial numbers of students in the United States are performing below grade-level expectations in core academic areas, and these deficits are most pronounced in the area of writing. Although performance feedback procedures have been shown to produce promising short-term improvements in elementary-aged students' writing skills, evidence of maintenance and generalization of these intervention effects is limited. The purpose of this study was to examine the immediate, generalized, and sustained effects of incorporating multiple exemplar training into the performance feedback procedures of a writing intervention using a randomized controlled trial (RCT). Results indicated that although the addition of multiple exemplar training did not improve students' writing performance on measures of stimulus and response generalization, it did result in greater maintenance of intervention effects in comparison to students who received performance feedback without generality programming and students who engaged in weekly writing practice alone. Copyright © 2016 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Dementia Care Management in an Underserved Community: The Comparative Effectiveness of Two Different Approaches.

PubMed

Chodosh, Joshua; Colaiaco, Benjamin A; Connor, Karen Ilene; Cope, Dennis Wesley; Liu, Hangsheng; Ganz, David Avram; Richman, Mark Jason; Cherry, Debra Lynn; Blank, Joseph Moshe; Carbone, Raquel Del Pilar; Wolf, Sheldon Mark; Vickrey, Barbara Grace

2015-08-01

To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected. © The Author(s) 2015.

The quest for greater chemical energy storage in energetic materials: Grounding expectations

NASA Astrophysics Data System (ADS)

Lindsay, C. Michael; Fajardo, Mario E.

2017-01-01

It is well known that the performance of modern energetic materials based on organic chemistry has plateaued, with only ˜ 40% improvements realized over the past half century. This fact has stimulated research on alternative chemical energy storage schemes in various U.S. government funded "High Energy Density Materials" (HEDM) programs since the 1950's. These efforts have examined a wide range of phenomena such as free radical stabilization, metallic hydrogen, metastable helium, polynitrogens, extended molecular solids, nanothermites, and others. In spite of the substantial research investments, significant improvements in energetic material performance have not been forthcoming. This paper discusses the lessons learned in the various HEDM programs, the different degrees of freedom in which to store energy in materials, and the fundamental limitations and orders of magnitude of the energies involved. The discussion focuses almost exclusively on the topic of energy density and only mentions in passing other equally important properties of explosives and propellants such as gas generation and reaction rate.

Health Worker mHealth Utilization: A Systematic Review

PubMed Central

White, Alice; Thomas, Deborah S.K.; Ezeanochie, Nnamdi; Bull, Sheana

2016-01-01

This systematic review describes mHealth interventions directed at healthcare workers in low resource settings from the PubMed database from March, 2009 to May, 2015. Thirty-one articles were selected for final review. Four categories emerged from the reviewed articles: data collection during patient visits; communication between health workers and patients; communication between health workers; and public health surveillance. Most studies used a combination of quantitative and qualitative methods to assess acceptability of use, barriers to use, changes in healthcare delivery, and improved health outcomes. Few papers included theory explicitly to guide development and evaluation of their mHealth programs. Overall, evidence indicated that mobile technology tools, such as smartphones and tablets, substantially benefit healthcare workers, their patients, and health care delivery. Limitations to mHealth tools included insufficient program use and sustainability, unreliable Internet and electricity, and security issues. Despite these limitations, this systematic review demonstrates the utility of using mHealth in low-resource settings and the potential for widespread health system improvements using technology. PMID:26955009

Economic Evidence for U.S. Asthma Self-Management Education and Home-Based Interventions

PubMed Central

Hsu, Joy; Wilhelm, Natalie; Lewis, Lillianne; Herman, Elizabeth

2016-01-01

The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (e.g., higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments. PMID:27658535

Quality improvement and cost reduction realized by a purchaser through diabetes disease management.

PubMed

Snyder, James W; Malaskovitz, Joyce; Griego, Janet; Persson, Jeffrey; Flatt, Kristy

2003-01-01

This report documents the clinical improvements and costs experienced by a purchaser after introduction of a diabetes disease management program. A purchaser contracted with American Healthways, a disease management organization, to initiate a diabetes disease management program called Diabetes Decisions. Started in 1998, the program grew to include 662 participants. The results reported are based on the continuously participating population (12 months of participation in the program for the reporting year). Participants were entered into American Healthways' clinical information system and risk-stratified, and an individualized treatment plan was devised. Outbound telephone calls by specially trained nurses were a key intervention. Data were collected on key process measures, financial parameters, and participant satisfaction. By year 3, there were 422 continuously participating participants. From baseline to the third year of the program, significant increases in frequency of A1C testing (21.3% to 82.2%), dilated retinal exams (17.2% to 70.7%), and performance of foot exams (2.0% to 75.6%) were noted. For 166 participants with five A1C determinations, A1C values dropped from 8.89% to 7.88%. Participants experienced a 36% drop in inpatient costs. Without adjustment for medical inflation, total medical costs decreased by 26.8% from the baseline period, dropping to $268.63 per diabetes participant per month (PDPPM) by year 3, a gross savings of $98.49 PDPPM. After subtracting the fees paid to Diabetes Decisions, a net savings of $986,538 was realized. This yielded a return on investment of 3.37. By investing in a diabetes disease management program, a purchaser was able to realize significant improvements in clinical care, substantial cost savings, and a favorable return on investment.

Inpatient Cognitive Behavior Therapy for Adolescents with Anorexia Nervosa: Immediate and Longer-Term Effects

PubMed Central

Dalle Grave, Riccardo; Calugi, Simona; El Ghoch, Marwan; Conti, Maddalena; Fairburn, Christopher G.

2014-01-01

Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based on the enhanced cognitive behavior therapy (CBT-E). The patients were assessed before and after hospitalization, and 6 and 12 months later. Results: Twenty-six patients (96%) completed the program. In these patients, there was a substantial improvement in weight, eating disorder features, and general psychopathology that was well maintained at 12-month follow-up. Conclusion: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa. PMID:24575055

Worksite health and wellness programs: Canadian achievements & prospects.

PubMed

Després, Jean-Pierre; Alméras, Natalie; Gauvin, Lise

2014-01-01

Canada has experienced a substantial reduction in mortality related to cardiovascular disease (CVD). There is a general consensus that more effective and widespread health promotion interventions may lead to further reductions in CVD risk factors and actual disease states. In this paper, we briefly outline the prevalence of selected risk factors for CVD in Canada, describe characteristics of the Canadian labor market and workforce, and depict what is known about health and wellness program delivery systems in Canadian workplaces. Our review indicates that there have been numerous and diverse relevant legislative and policy initiatives to create a context conducive to improve the healthfulness of Canadian workplaces. However, there is still a dearth of evidence on the effectiveness of the delivery system and the actual impact of workplace health and wellness programs in reducing CVD risk in Canada. Thus, while a promising model, more research is needed in this area. Copyright © 2014 Elsevier Inc. All rights reserved.

Research and development program for the development of advanced time-temperature dependent constitutive relationships. Volume 1: Theoretical discussion

NASA Technical Reports Server (NTRS)

Cassenti, B. N.

1983-01-01

The results of a 10-month research and development program for the development of advanced time-temperature constitutive relationships are presented. The program included (1) the effect of rate of change of temperature, (2) the development of a term to include time independent effects, and (3) improvements in computational efficiency. It was shown that rate of change of temperature could have a substantial effect on the predicted material response. A modification to include time-independent effects, applicable to many viscoplastic constitutive theories, was shown to reduce to classical plasticity. The computation time can be reduced by a factor of two if self-adaptive integration is used when compared to an integration using ordinary forward differences. During the course of the investigation, it was demonstrated that the most important single factor affecting the theoretical accuracy was the choice of material parameters.

Mandatory universal drug plan, access to health care and health: Evidence from Canada.

PubMed

Wang, Chao; Li, Qing; Sweetman, Arthur; Hurley, Jeremiah

2015-12-01

This paper examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public health care system with free physician and hospital services. Using the Canadian National Population Health Survey from 1994 to 2003 and implementing a difference-in-differences estimation strategy, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization. Findings from quantile regressions suggest that there was a large improvement in the health status of less healthy individuals. Further analysis by pre-policy drug insurance status and the presence of chronic conditions reveals a marked increase in the probability of taking medication and visiting a general practitioner among the previously uninsured and those with a chronic condition. Copyright © 2015 Elsevier B.V. All rights reserved.

Exploring patient experiences and perspectives of a heart failure telerehabilitation program: A mixed methods approach.

PubMed

Hwang, Rita; Mandrusiak, Allison; Morris, Norman R; Peters, Robyn; Korczyk, Dariusz; Bruning, Jared; Russell, Trevor

To describe patient experiences and perspectives of a group-based heart failure (HF) telerehabilitation program delivered to the homes via online video-conferencing. Limited information currently exists on patient experiences of telerehabilitation for HF. Patient feedback and end-user perspectives provide important information regarding the acceptability of this new delivery model which may have a substantial impact on future uptake. We used mixed-methods design with purposive sampling of patients with HF. We used self-report surveys and semi-structured interviews to measure patient experiences and perspectives following a 12-week telerehabilitation program. The telerehabilitation program encompassed group-based exercise and education, and were delivered in real-time via videoconferencing. Interviews were transcribed and coded, with thematic analysis undertaken. Seventeen participants with HF (mean age [SD] of 69 [12] years and 88% males) were recruited. Participants reported high visual clarity and ease of use for the monitoring equipment. Major themes included motivating and inhibiting influences related to telerehabilitation and improvement suggestions. Participants liked the health benefits, access to care and social support. Participants highlighted a need for improved audio clarity and connectivity as well computer training for those with limited computer experience. The majority of participants preferred a combined face-to-face and online delivery model. Participants in this study reported high visual clarity and ease-of-use, but provided suggestions for further improvements in group-based video telerehabilitation for HF. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Public-Private Partnerships Working Beyond Scale Challenges toward Water Quality Improvements from Private Lands

NASA Astrophysics Data System (ADS)

Enloe, Stephanie K.; Schulte, Lisa A.; Tyndall, John C.

2017-10-01

In recognition that Iowa agriculture must maintain long-term production of food, fiber, clean water, healthy soil, and robust rural economies, Iowa recently devised a nutrient reduction strategy to set objectives for water quality improvements. To demonstrate how watershed programs and farmers can reduce nutrient and sediment pollution in Iowa waters, the Iowa Water Quality Initiative selected the Boone River Watershed Nutrient Management Initiative as one of eight demonstration projects. For over a decade, diverse public, private, and non-profit partner organizations have worked in the Boone River Watershed to engage farmers in water quality management efforts. To evaluate social dynamics in the Boone River Watershed and provide partners with actionable recommendations, we conducted and analyzed semi-structured interviews with 33 program leaders, farmers, and local agronomists. We triangulated primary interview data with formal analysis of Boone River Watershed documents such as grant applications, progress reports, and outreach materials. Our evaluation suggests that while multi-stakeholder collaboration has enabled partners to overcome many of the traditional barriers to watershed programming, scale mismatches caused by external socio-economic and ecological forces still present substantial obstacles to programmatic resilience. Public funding restrictions and timeframes, for example, often cause interruptions to adaptive management of water quality monitoring and farmer engagement. We present our findings within a resilience framework to demonstrate how multi-stakeholder collaboration can help sustain adaptive watershed programs to improve socio-ecological function in agricultural watersheds such as the Boone River Watershed.

The research rotation: competency-based structured and novel approach to research training of internal medicine residents.

PubMed

Kanna, Balavenkatesh; Deng, Changchun; Erickson, Savil N; Valerio, Jose A; Dimitrov, Vihren; Soni, Anita

2006-10-17

In the United States, the Accreditation Council of graduate medical education (ACGME) requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM) residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents. We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation". Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine. Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.

The research rotation: competency-based structured and novel approach to research training of internal medicine residents

PubMed Central

Kanna, Balavenkatesh; Deng, Changchun; Erickson, Savil N; Valerio, Jose A; Dimitrov, Vihren; Soni, Anita

2006-01-01

Background In the United States, the Accreditation Council of graduate medical education (ACGME) requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM) residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents. Methods We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation". Results Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine. Conclusion Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program. PMID:17044924

Variation in the Implementation of California's Full Service Partnerships for Persons with Serious Mental Illness

PubMed Central

Gilmer, Todd P; Katz, Marian L; Stefancic, Ana; Palinkas, Lawrence A

2013-01-01

Objective. This study examined variation in the implementation of California's Full Service Partnerships (FSPs), which are supported housing programs that do “whatever it takes” to improve outcomes among persons with serious mental illness who are homeless or at risk of homelessness. Data Sources/Setting. Ninety-three FSPs in California. Study Design. A mixed methods approach was selected to develop a better understanding of the complexity of the FSP programs. The design structure was a combined explanatory and exploratory sequential design (qual→QUAN→qual) where a qualitative focus group was used to develop a quantitative survey that was followed by qualitative site visits. The survey was used to describe the breadth of variation based on fidelity to the Housing First model, while the site visits were used to provide a depth of information on high- versus low-fidelity programs. Principal Findings. We found substantial variation in implementation among FSPs. Fidelity was particularly low along domains related with housing and service philosophy, indicating that many FSPs implemented a rich array of services but applied housing readiness requirements and did not adhere to consumer choice in housing. Conclusions. There remains room for improvement in the recovery-orientation of FSPs. Fortunately, we have identified several processes by which program managers and counties can increase the fidelity of their programs. PMID:24138021

Advanced Fuel Cell System Thermal Management for NASA Exploration Missions

NASA Technical Reports Server (NTRS)

Burke, Kenneth A.

2009-01-01

The NASA Glenn Research Center is developing advanced passive thermal management technology to reduce the mass and improve the reliability of space fuel cell systems for the NASA exploration program. An analysis of a state-of-the-art fuel cell cooling systems was done to benchmark the portion of a fuel cell system s mass that is dedicated to thermal management. Additional analysis was done to determine the key performance targets of the advanced passive thermal management technology that would substantially reduce fuel cell system mass.

Stratified charge rotary engine for general aviation

NASA Technical Reports Server (NTRS)

Mount, R. E.; Parente, A. M.; Hady, W. F.

1986-01-01

A development history, a current development status assessment, and a design feature and performance capabilities account are given for stratified-charge rotary engines applicable to aircraft propulsion. Such engines are capable of operating on Jet-A fuel with substantial cost savings, improved altitude capability, and lower fuel consumption by comparison with gas turbine powerplants. Attention is given to the current development program of a 400-hp engine scheduled for initial operations in early 1990. Stratified charge rotary engines are also applicable to ground power units, airborne APUs, shipboard generators, and vehicular engines.

Biomass fuels update. TVAs biomass fuels program

NASA Astrophysics Data System (ADS)

1982-02-01

Equipment was installed and tests were conducted on the ethanol from hardwood project. Location of hardwoods, to improve forest management, and to reduce the cost of harvesting woody biomass was assessed. Substantial underutilized cropland exists in the Valley, and a questionnaire survey was administered to supplement available cropland data. The potential liquid fuel yields and production management practices for alternative starch, sugar, and vegetable oil crops were determined to obtain benchmark data and to evaluate alcohol production from alternative agricultural feedstocks. Workshops were conducted to provide information on production of alcohol.

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

ASFAW BEYENE

Since its establishment in 1990, San Diego State University’s Industrial Assessment Center (IAC) has served close to 400 small and medium-sized manufacturing plants in Southern California. SDSU/IAC’s efforts to transfer state-of-the-art technologies to industry have increased revenues, cultivated creativity, improved efficiencies, and benefited the environment. A substantial benefit from the program has been the ongoing training of engineering faculty and students. During this funding cycle, SDSU/IAC has trained 31 students, 7 of the graduate. A total of 92 assessments and 108 assessment days were completed, resulting in 638 assessment recommendations.

Implementation of a clinical quality control program in a mammography screening service of Brazil.

PubMed

DE Souza Sabino, Silvia Maria Prioli; Silva, Thiago Buosi; Watanabe, Anapaula Hidemi Uema; Syrjänen, Kari; Carvalho, André Lopes; Mauad, Edmundo Carvalho

2014-09-01

To evaluate the effect of a clinical quality control program on the final quality of a mammography screening service. We conducted retrospective assessment of the clinical quality of 5,000 mammograms taken in a Mammography Screening Program between November 2010 and September 2011, following the implementation of a Clinical Quality Control Program based on the European Guidelines. Among the 105,000 evaluated quality items, there were 8,588 failures (8.2%) - 1.7 failures per examination. Altogether, 89% of the failures were associated with positioning. The recall rate due to a technical error reached a maximum of 0.5% in the early phase of the observation period and subsequently stabilized (0.09%). The ongoing education and monitoring combined with personalized training increased the critical thinking of the involved professionals, reducing the technical failures and unnecessary exposure of patients to radiation, with substantial improvement in the final quality of mammography. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Calodney, Aaron K; Hirsch, Joshua A

2017-01-01

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs).Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category.

Cost analysis of the treatment of severe acute malnutrition in West Africa.

PubMed

Isanaka, Sheila; Menzies, Nicolas A; Sayyad, Jessica; Ayoola, Mudasiru; Grais, Rebecca F; Doyon, Stéphane

2017-10-01

We present an updated cost analysis to provide new estimates of the cost of providing community-based treatment for severe acute malnutrition, including expenditure shares for major cost categories. We calculated total and per child costs from a provider perspective. We categorized costs into three main activities (outpatient treatment, inpatient treatment, and management/administration) and four cost categories within each activity (personnel; therapeutic food; medical supplies; and infrastructure and logistical support). For each category, total costs were calculated by multiplying input quantities expended in the Médecins Sans Frontières nutrition program in Niger during a 12-month study period by 2015 input prices. All children received outpatient treatment, with 43% also receiving inpatient treatment. In this large, well-established program, the average cost per child treated was €148.86, with outpatient and inpatient treatment costs of €75.50 and €134.57 per child, respectively. Therapeutic food (44%, €32.98 per child) and personnel (35%, €26.70 per child) dominated outpatient costs, while personnel (56%, €75.47 per child) dominated in the cost of inpatient care. Sensitivity analyses suggested lowering prices of medical treatments, and therapeutic food had limited effect on total costs per child, while increasing program size and decreasing use of expatriate staff support reduced total costs per child substantially. Updated estimates of severe acute malnutrition treatment cost are substantially lower than previously published values, and important cost savings may be possible with increases in coverage/program size and integration into national health programs. These updated estimates can be used to suggest approaches to improve efficiency and inform national-level resource allocation. © 2016 John Wiley & Sons Ltd.

A successful turnaround in Dade County

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

Frank, H.

1988-10-01

When Dade County, Fla., decided to build a waste-to-energy plant, little did it known what a stink it would bring. Odor problems and seagulls plagued the neighborhood, emissions exceeded regulatory standards, and wind-blown garbage littered the facility. Maintenance costs rose and electricity sales never came close to its rated capacity. The residents called for a change, and they got it. After a new operator took over the plant, some of the problems were quickly solved. Other problems, which required substantial capital improvements to solve, were clearly identified. And after Dade County approved a new contract with $45 million in improvements,more » the facility is back on track to meeting the community's needs in an acceptable manner. The paper describes the original plant design, early problems, improved operation, present plant operation, and the Plant Rehabilitation Program.« less

Anion permselective membrane

NASA Technical Reports Server (NTRS)

Alexander, S.; Hodgdon, R. B.

1977-01-01

The objective of NAS 3-20108 was the development and evaluation of improved anion selective membranes useful as efficient separators in a redox power storage cell system being constructed. The program was divided into three parts, (a) optimization of the selected candidate membrane systems, (b) investigation of alternative membrane/polymer systems, and (c) characterization of candidate membranes. The major synthesis effort was aimed at improving and optimizing as far as possible each candidate system with respect to three critical membrane properties essential for good redox cell performance. Substantial improvements were made in 5 candidate membrane systems. The critical synthesis variables of cross-link density, monomer ratio, and solvent composition were examined over a wide range. In addition, eight alternative polymer systems were investigated, two of which attained candidate status. Three other alternatives showed potential but required further research and development. Each candidate system was optimized for selectivity.

Promoting Critical Reflection: An Evaluation of the Longer-Term Impact of a Substantial Faculty Development Program

ERIC Educational Resources Information Center

Calkins, Susanna; Harris, Muveddet

2017-01-01

For many faculty, critical reflection on teaching and learning requires space and time that is not readily available. For fifteen years, we have run a substantial year-long faculty development program designed to help participants: (1) reflect critically on their teaching and their students' learning; and (2) develop a project related to their…

Leveraging the trusted clinician: increasing retention in disease management through integrated program delivery.

PubMed

Frazee, Sharon Glave; Sherman, Bruce; Fabius, Raymond; Ryan, Pamela; Kirkpatrick, Patricia; Davis, Jeffery

2008-10-01

Disease management's (DM's) value largely depends on achieving and maintaining participation. Simply being enrolled in a program does not guarantee engaged participation by enrollees, a necessary factor to achieve the improved health outcomes and subsequent reduced health care costs that are the ultimate objective of DM. The objective of this study is to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, yields higher patient retention rates than traditional remote DM alone. An earlier study of the IDM protocol found that integrating a worksite-based primary care and pharmacy delivery system with traditional telephonic-based DM substantially increased contact, enrollment, and engagement rates compared to traditional stand-alone telephonic DM. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares participation rates at 6- and 12-month intervals as well as measures of continued retention in the DM program. The IDM protocol showed a significant improvement in participation persistence over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by "trusted clinicians at the workplace"trade mark with traditional telephonic-based DM not only increases contact and enrollment rates, but also results in higher patient engagement and retention. These improvements in participation are expected to result in improved outcomes for a larger proportion of the target population than traditional telephonic DM.

Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review.

PubMed

Ofman, Joshua J; Badamgarav, Enkhe; Henning, James M; Knight, Kevin; Gano, Anacleto D; Levan, Rebecka K; Gur-Arie, Shoval; Richards, Margaret S; Hasselblad, Vic; Weingarten, Scott R

2004-08-01

To assess the clinical and economic effects of disease management in patients with chronic diseases. Electronic databases were searched for English-language articles from 1987 to 2001. Articles were included if they used a systematic approach to care and evaluated patients with chronic disease, reported objective measurements of the processes or outcomes of care, and employed acceptable experimental or quasi-experimental study designs as defined by the Cochrane Effective Practice and Organization of Care Group. Two reviewers evaluated 16,917 titles and identified 102 studies that met the inclusion criteria. Identified studies represented 11 chronic conditions: depression, diabetes, rheumatoid arthritis, chronic pain, coronary artery disease, asthma, heart failure, back pain, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia. Disease management programs for patients with depression had the highest percentage of comparisons (48% [41/86]) showing substantial improvements in patient care, whereas programs for patients with chronic obstructive pulmonary disease (9% [2/22]) or chronic pain (8% [1/12]) appeared to be the least effective. Of the outcomes more frequently studied, disease management appeared to improve patient satisfaction (71% [12/17]), patient adherence (47% [17/36]), and disease control (45% [33/74]) most commonly and cost-related outcomes least frequently (11% to 16%). Disease management programs were associated with marked improvements in many different processes and outcomes of care. Few studies demonstrated a notable reduction in costs. Further research is needed to understand how disease management can most effectively improve the quality and cost of care for patients with chronic diseases.

A Web-Based Education Program for Colorectal Lesion Diagnosis with Narrow Band Imaging Classification.

PubMed

Aihara, Hiroyuki; Kumar, Nitin; Thompson, Christopher C

2018-04-19

An education system for narrow band imaging (NBI) interpretation requires sufficient exposure to key features. However, access to didactic lectures by experienced teachers is limited in the United States. To develop and assess the effectiveness of a colorectal lesion identification tutorial. In the image analysis pretest, subjects including 9 experts and 8 trainees interpreted 50 white light (WL) and 50 NBI images of colorectal lesions. Results were not reviewed with subjects. Trainees then participated in an online tutorial emphasizing NBI interpretation in colorectal lesion analysis. A post-test was administered and diagnostic yields were compared to pre-education diagnostic yields. Under the NBI mode, experts showed higher diagnostic yields (sensitivity 91.5% [87.3-94.4], specificity 90.6% [85.1-94.2], and accuracy 91.1% [88.5-93.7] with substantial interobserver agreement [κ value 0.71]) compared to trainees (sensitivity 89.6% [84.8-93.0], specificity 80.6% [73.5-86.3], and accuracy 86.0% [82.6-89.2], with substantial interobserver agreement [κ value 0.69]). The online tutorial improved the diagnostic yields of trainees to the equivalent level of experts (sensitivity 94.1% [90.0-96.6], specificity 89.0% [83.0-93.2], and accuracy 92.0% [89.3-94.7], p < 0.001 with substantial interobserver agreement [κ value 0.78]). This short, online tutorial improved diagnostic performance and interobserver agreement. © 2018 S. Karger AG, Basel.

Nuclear medicine and imaging research: Quantitative studies in radiopharmaceutical science

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

Copper, M.; Beck, R.N.

1991-06-01

During the past three years the program has undergone a substantial revitalization. There has been no significant change in the scientific direction of this grant, in which emphasis continues to be placed on developing new or improved methods of obtaining quantitative data from radiotracer imaging studies. However, considerable scientific progress has been made in the three areas of interest: Radiochemistry, Quantitative Methodologies, and Experimental Methods and Feasibility Studies, resulting in a sharper focus of perspective and improved integration of the overall scientific effort. Changes in Faculty and staff, including development of new collaborations, have contributed to this, as has acquisitionmore » of additional and new equipment and renovations and expansion of the core facilities. 121 refs., 30 figs., 2 tabs.« less

Migrant Home Attendants: Regulation and Practice in 7 Countries

PubMed Central

Garms-Homolová, Vjenka; Bentwich, Miriam

2013-01-01

We compared regulation and working and living conditions of foreign home attendants in 7 countries (Canada, Germany, Israel, Singapore, Spain, United Kingdom, United States). We conducted a literature search in the PSYCinfo, MEDLINE, and Google Scholar databases for 2002 to 2012. We found substantial between-country differences in the legal status of migrant caregivers and regulations regarding working and living conditions and drew 3 conclusions. Improving regulations will likely improve not only the well-being of foreign home attendants but also the care they provide. Countries in which many foreign home attendants work without specific legal entry programs should rethink their policies. Finally, requiring an employer’s recommendation to obtain permanent residency may constrain foreign workers from registering complaints or leaving suboptimal employment situations. PMID:24134377

Recommendations From the International Colorectal Cancer Screening Network on the Evaluation of the Cost of Screening Programs.

PubMed

Subramanian, Sujha; Tangka, Florence K L; Hoover, Sonja; Nadel, Marion; Smith, Robert; Atkin, Wendy; Patnick, Julietta

2016-01-01

Worldwide, colorectal cancer is the fourth leading cause of death from cancer and the incidence is projected to increase. Many countries are exploring the introduction of organized screening programs, but there is limited information on the resources required and guidance for cost-effective implementation. To facilitate the generating of the economics evidence base for program implementation, we collected and analyzed detailed program cost data from 5 European members of the International Colorectal Cancer Screening Network. The cost per person screened estimates, often used to compare across programs as an overall measure, varied significantly across the programs. In addition, there were substantial differences in the programmatic and clinical cost incurred, even when the same type of screening test was used. Based on these findings, several recommendations are provided to enhance the underlying methodology and validity of the comparative economic assessments. The recommendations include the need for detailed activity-based cost information, the use of a comprehensive set of effectiveness measures to adequately capture differences between programs, and the incorporation of data from multiple programs in cost-effectiveness models to increase generalizability. Economic evaluation of real-world colorectal cancer-screening programs is essential to derive valuable insights to improve program operations and ensure optimal use of available resources.

Optimization strategies for molecular dynamics programs on Cray computers and scalar work stations

NASA Astrophysics Data System (ADS)

Unekis, Michael J.; Rice, Betsy M.

1994-12-01

We present results of timing runs and different optimization strategies for a prototype molecular dynamics program that simulates shock waves in a two-dimensional (2-D) model of a reactive energetic solid. The performance of the program may be improved substantially by simple changes to the Fortran or by employing various vendor-supplied compiler optimizations. The optimum strategy varies among the machines used and will vary depending upon the details of the program. The effect of various compiler options and vendor-supplied subroutine calls is demonstrated. Comparison is made between two scalar workstations (IBM RS/6000 Model 370 and Model 530) and several Cray supercomputers (X-MP/48, Y-MP8/128, and C-90/16256). We find that for a scientific application program dominated by sequential, scalar statements, a relatively inexpensive high-end work station such as the IBM RS/60006 RISC series will outperform single processor performance of the Cray X-MP/48 and perform competitively with single processor performance of the Y-MP8/128 and C-9O/16256.

Health and productivity management: establishing key performance measures, benchmarks, and best practices.

PubMed

Goetzel, R Z; Guindon, A M; Turshen, I J; Ozminkowski, R J

2001-01-01

Major areas considered under the rubric of health and productivity management (HPM) in American business include absenteeism, employee turnover, and the use of medical, disability, and workers' compensation programs. Until recently, few normative data existed for most HPM areas. To meet the need for normative information in HPM, a series of Consortium Benchmarking Studies were conducted. In the most recent application of the study, 1998 HPM costs, incidence, duration, and other program data were collected from 43 employers on almost one million workers. The median HPM costs for these organizations were $9992 per employee, which were distributed among group health (47%), turnover (37%), unscheduled absence (8%), nonoccupational disability (5%), and workers' compensation programs (3%). Achieving "best-practice" levels of performance (operationally defined as the 25th percentile for program expenditures in each HPM area) would realize savings of $2562 per employee (a 26% reduction). The results indicate substantial opportunities for improvement through effective coordination and management of HPM programs. Examples of best-practice activities collated from on-site visits to "benchmark" organizations are also reviewed.

Message Passing and Shared Address Space Parallelism on an SMP Cluster

NASA Technical Reports Server (NTRS)

Shan, Hongzhang; Singh, Jaswinder P.; Oliker, Leonid; Biswas, Rupak; Biegel, Bryan (Technical Monitor)

2002-01-01

Currently, message passing (MP) and shared address space (SAS) are the two leading parallel programming paradigms. MP has been standardized with MPI, and is the more common and mature approach; however, code development can be extremely difficult, especially for irregularly structured computations. SAS offers substantial ease of programming, but may suffer from performance limitations due to poor spatial locality and high protocol overhead. In this paper, we compare the performance of and the programming effort required for six applications under both programming models on a 32-processor PC-SMP cluster, a platform that is becoming increasingly attractive for high-end scientific computing. Our application suite consists of codes that typically do not exhibit scalable performance under shared-memory programming due to their high communication-to-computation ratios and/or complex communication patterns. Results indicate that SAS can achieve about half the parallel efficiency of MPI for most of our applications, while being competitive for the others. A hybrid MPI+SAS strategy shows only a small performance advantage over pure MPI in some cases. Finally, improved implementations of two MPI collective operations on PC-SMP clusters are presented.

An isokinetic training program for reducing falls in a community-dwelling older adult: a case report.

PubMed

Beebe, Justin A; Hines, Roger W; McDaniel, Laura T; Shelden, Brenda L

2013-01-01

With the population older than 65 years, projected to double by the year 2030, falls in older adults are a substantial health concern. Muscle strength deficits are one of the multifactorial components linked to increased fall risk, and decreasing these deficits has been one of the goals of interventions designed to decrease fall risk. These interventions have traditionally focused on improving peak torque; however, recent research suggests that exercise protocols that focus on the rate of torque development (RTD) may be more effective in decreasing fall risk. This case report examines clinical outcomes following implementation of an isokinetic strengthening protocol coupled with a balance program designed to reduce fall risk in a community-dwelling older adult. The individual was a 70-year-old woman with a history of 3 falls over the past 8 months and no related medical etiology who had self-limited her activities because of fear of another fall. She was classified as having substantial risk for future falls because of fall history, increased fear of falling, and below age norms on the Berg Balance Scale (BBS), and the Timed Up and Go (TUG). The treatment program consisted of 12 weeks of high-intensity isokinetic knee extensor training, high challenge dynamic gait and balance activities, and core strengthening. The isokinetic protocol consisted of 4 sets of 10 concentric-only repetitions at speeds of 240°/sec and 300°/sec for a total of 8 work sets. Dynamic gait activities incorporating directional and obstacle drills, and rocker and balance boards were used for balance training activities. Progressive theraband exercises were used for core strengthening. As her home program, the participant was encouraged to return to line dancing twice per week. During the 12-week protocol, the participant completed two 90-minute therapy sessions and two 90-minute dance classes per week. After the 12 weeks of treatment, knee extensor peak torque at 150 ms improved on the right from 67.8 N to 107.1 N (57.9% increase), and on the left from 65.1 N to 97.6 N (49.9% increase). The BBS score improved from 45 to 52; and the TUG improved from 14.0 to 8.6 seconds. Both final scores exceeded fall risk cutoffs (BBS = 48; TUG = 13.5 seconds) and the change score exceeded minimal detectable change (BBS = 7; TUG 5.4 seconds). The treatment program produced improvements in knee extensor peak torque and RTD, but more importantly, the final scores on the clinical outcome measures placed the participant above established fall-risk cutoff scores. Although future research with increased numbers of participants and a control group should be conducted to confirm this study's results, these findings support the use of isokinetic training to reduce fall risk in older adults.

Challenges ahead: social and institutional factors influencing sustainable urban stormwater management in Australia.

PubMed

Brown, R R; Farrelly, M A

2009-01-01

In a time of climate uncertainty and drought in Australia, improved urban stormwater quality management practices are required not only for protecting waterway health, but also as a fit-for-purpose supply source. To conceive of urban stormwater as an environmental threat as well as a water supply source requires a substantial shift in our traditional linear supply and wastewater structures towards more hybrid and complex infrastructure systems. To understand what drives and limits treatment technology adoption for stormwater management, over 800 urban water professionals in three Australian capital cities completed an online questionnaire survey in November 2006. Using the conceptual framework of receptivity assessment, the results revealed the professional community to be highly associated with the importance of improving stormwater quality for receiving waterway health, yet they do not consider that politicians share this perspective by placing a substantially lower level of importance on stormwater quality management. Significant acquisition barriers within each city, including institutional arrangements, costs, responsibilities, and regulations and approvals processes were all identified as constraining more sustainable practices. Capacity building programs, fostering greater socio-political capital and developing key demonstration projects with training events are recommended as useful policy interventions for addressing current institutional impediments.

Caution on the use of liquid nitrogen traps in stable hydrogen isotope-ratio mass spectrometry

USGS Publications Warehouse

Coplen, T.B.; Qi, H.

2010-01-01

An anomalous stable hydrogen isotopic fractionation of 4 ??? in gaseous hydrogen has been correlated with the process of adding liquid nitrogen (LN2) to top off the dewar of a stainless-steel water trap on a gaseous hydrogen-water platinum equilibration system. Although the cause of this isotopic fractionation is unknown, its effect can be mitigated by (1) increasing the capacity of any dewars so that they do not need to be filled during a daily analytic run, (2) interspersing isotopic reference waters among unknowns, and (3) applying a linear drift correction and linear normalization to isotopic results with a program such as Laboratory Information Management System (LIMS) for Light Stable Isotopes. With adoption of the above guidelines, measurement uncertainty can be substantially improved. For example, the long-term (months to years) ??2H reproducibility (1?? standard deviation) of nine local isotopic reference waters analyzed daily improved substantially from about 1 ??? to 0.58 ???. This isotopically fractionating mechanism might affect other isotope-ratio mass spectrometers in which LN2 is used as a moisture trap for gaseous hydrogen. ?? This article not subject to U.S. Copyright. Published 2010 by the American Chemical Society.

Physicians' satisfaction with a collaborative disease management program for late-life depression in primary care.

PubMed

Levine, Stuart; Unützer, Jürgen; Yip, Judy Y; Hoffing, Marc; Leung, Moon; Fan, Ming-Yu; Lin, Elizabeth H B; Grypma, Lydia; Katon, Wayne; Harpole, Linda H; Langston, Christopher A

2005-01-01

This study describes physicians' satisfaction with care for patients with depression before and after the implementation of a primary care-based collaborative care program. Project Improving Mood, Promoting Access to Collaborative Treatment for late-life depression (IMPACT) is a multisite, randomized controlled trial comparing a primary care-based collaborative disease management program for late-life depression with care as usual. A total of 450 primary care physicians at 18 participating clinics participated in a satisfaction survey before and 12 months after IMPACT initiation. The preintervention survey focused on physicians' satisfaction with current mental health resources and ability to provide depression care. The postintervention survey repeated these and added questions about physician's experience with the IMPACT collaborative care model. Before intervention, about half (54%) of the participating physicians were satisfied with resources to treat patients with depression. After intervention, more than 90% reported the intervention as helpful in treating patients with depression and 82% felt that the intervention improved patients' clinical outcomes. Participating physicians identified proactive patient follow-up and patient education as the most helpful components of the IMPACT model. Physicians perceived a substantial need for improving depression treatment in primary care. They were very satisfied with the IMPACT collaborative care model for treating depressed older adults and felt that similar care management models would also be helpful for treating other chronic medical illnesses.

Adding Value to Total Joint Arthroplasty Care in an Academic Environment: The Utah Experience.

PubMed

Pelt, Christopher E; Anderson, Mike B; Erickson, Jill A; Gililland, Jeremy M; Peters, Christopher L

2018-06-01

Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models. The changes that occurred at our institution are described. Real-time data and knowledgeable personnel working behind the scenes, while physicians provide clinical care, help move clinical pathway redesigns. Engaged physicians are essential to the successful implementation of value creation and care pathway redesign that can lead to improvements in value. An investment of money and resources toward added infrastructure and personnel is often needed to realize large-scale improvements. Alignment of providers, payers, and hospital administration, including by means of gainsharing programs, can lead to improvements. Although significant care pathway redesign efforts may realize substantial initial cost savings, savings may be asymptotic in nature, which calls into question the likely sustainability of programs that incentivize or penalize payments based on historical targets. Copyright © 2018 Elsevier Inc. All rights reserved.

Evaluating the effectiveness of a post-license education program for young novice drivers in Belgium.

PubMed

Brijs, Kris; Cuenen, Ariane; Brijs, Tom; Ruiter, Robert A C; Wets, Geert

2014-05-01

The disproportionately large number of traffic accidents of young novice drivers highlights the need for an effective driver education program. The Goals for Driving Education (GDE) matrix shows that driver education must target both lower and higher levels of driver competences. Research has indicated that current education programs do not emphasize enough the higher levels, for example awareness and insight. This has raised the importance of insight programs. On the Road (OtR), a Flemish post-license driver education program, is such an insight program that aims to target these higher levels. The program focus is on risky driving behavior like speeding and drink driving. In addition, the program addresses risk detection and risk-related knowledge. The goal of the study was to do an effect evaluation of this insight program at immediate post-test and 2 months follow-up. In addition, the study aimed to generalize the results of this program to comparable programs in order to make usable policy recommendations. A questionnaire based on the Theory of Planned Behavior (TPB) was used in order to measure participants' safety consciousness of speeding and drink driving. Moreover, we focused on risk detection and risk-related knowledge. Participants (N=366) were randomly assigned to a baseline-follow-up group or a post-test-follow-up group. Regarding speeding and driving, we found OtR to have little effect on the TPB variables. Regarding risk detection, we found no significant effect, even though participants clearly needed substantial improvement when stepping into the program. Regarding risk-related knowledge, the program did result in a significant improvement at post-test and follow-up. It is concluded that the current program format is a good starting point, but that it requires further attention to enhance high level driving skills. Program developers are encouraged to work in a more evidence-based manner when they select target variables and methods to influence these variables. Copyright © 2014 Elsevier Ltd. All rights reserved.

Overview of C-2U FRC Experimental Program and Plans for C-2W

NASA Astrophysics Data System (ADS)

Gota, H.; Binderbauer, M. W.; Tajima, T.; Putvinski, S.; Tuszewski, M.; Dettrick, S.; Korepanov, S.; Smirnov, A.; Thompson, M. C.; Yang, X.; Cappello, M.; Ivanov, A. A.; TAE Team

2016-10-01

Tri Alpha Energy's experimental program has been focused on a demonstration of reliable field-reversed configuration (FRC) formation and sustainment, driven by fast ions via high-power neutral-beam (NB) injection. The world's largest compact-toroid experimental devices, C-2 and C-2U, have successfully produced a well-stabilized, sustainable FRC plasma state with NB injection (input power, PNB 10 + MW; 15 keV hydrogen) and end-on coaxial plasma guns. Remarkable improvements in confinement and stability of FRC plasmas have led to further improved fast-ion build up; thereby, an advanced beam-driven FRC state has been produced and sustained for up to 5 + ms (longer than all characteristic system time scales), only limited by hardware and electric supply constraints such as NB and plasma-gun power supplies. To further improve the FRC performance the C-2U device is being replaced by C-2W featuring higher injected NB power, longer pulse duration as well as enhanced edge-biasing systems and substantially upgraded divertors. Main C-2U experimental results and key features of C-2W will be presented. Tri Alpha Energy, Inc.

A macro-level fetal alcohol syndrome prevention program for Native Americans and Alaska Natives: description and evaluation.

PubMed

May, P A; Hymbaugh, K J

1989-11-01

Presented here are a detailed description and outcome evaluation of a comprehensive, macro-level Fetal Alcohol Syndrome prevention program for Native Americans and Alaska Natives. The program was designed to provide native communities throughout the United States with the knowledge, skills and strategies to initiate primary, secondary and tertiary prevention measures on their own. The key to the program was the training of a cadre of trainers/advocates in all local Native American and Alaska Native communities served by the Indian Health Service. These people were then supported and assisted in their efforts through a variety of means. Evaluation results of knowledge gained indicate that the local trainers had substantial success in imparting FAS information to a variety of audiences (prenatal groups, school children and community groups). Further, the evaluation samples also indicate that the knowledge was retained by the groups over time (2-4 months) and that there may have been some general diffusion of knowledge among peers in local communities. This program is presented in the hope that it will be replicated and improved upon by similar programs using this model as a base.

Oportunidades to reduce overweight and obesity in Mexico?

PubMed

Andalón, Mabel

2011-09-01

This paper investigates the causal effect of Oportunidades, a conditional cash-transfer program in Mexico, on overweight and obesity of adolescents living in poor rural areas. Affecting youth weight was not a goal of this program. However, health economics research suggests that the provision of schooling, health information sessions and sizable cash transfers to Oportunidades participants could have substantially changed their overweight and obesity rates. Exploiting an exogenous jump in program participation by means of a fuzzy Regression Discontinuity (RD) design, the evidence of this paper suggests that Oportunidades decreased obesity among participant women. The identified local average treatment effect (LATE) at the threshold for program eligibility suggests that female obesity would decrease if the program was expanded to cover slightly better-off households. The design of the program does not allow disentangling the causal pathways that contributed to the lower prevalence of obesity among women, but the effect likely resulted from increased access to information and schooling, improved dietary quality, increased monitoring of health outcomes and (possibly) increased physical activity. Suggestive evidence shows that teen pregnancy rates were higher among non-participants. Therefore, weight gain after childbirth might also explain higher obesity rates among non-participant females. Copyright © 2011 John Wiley & Sons, Ltd.

Message Passing vs. Shared Address Space on a Cluster of SMPs

NASA Technical Reports Server (NTRS)

Shan, Hongzhang; Singh, Jaswinder Pal; Oliker, Leonid; Biswas, Rupak

2000-01-01

The convergence of scalable computer architectures using clusters of PCs (or PC-SMPs) with commodity networking has become an attractive platform for high end scientific computing. Currently, message-passing and shared address space (SAS) are the two leading programming paradigms for these systems. Message-passing has been standardized with MPI, and is the most common and mature programming approach. However message-passing code development can be extremely difficult, especially for irregular structured computations. SAS offers substantial ease of programming, but may suffer from performance limitations due to poor spatial locality, and high protocol overhead. In this paper, we compare the performance of and programming effort, required for six applications under both programming models on a 32 CPU PC-SMP cluster. Our application suite consists of codes that typically do not exhibit high efficiency under shared memory programming. due to their high communication to computation ratios and complex communication patterns. Results indicate that SAS can achieve about half the parallel efficiency of MPI for most of our applications: however, on certain classes of problems SAS performance is competitive with MPI. We also present new algorithms for improving the PC cluster performance of MPI collective operations.

Effect of a group intervention for children and their parents who have cancer.

PubMed

Kobayashi, Mariko; Heiney, Sue P; Osawa, Kaori; Ozawa, Miwa; Matsushima, Eisuke

2017-10-01

Although support programs for children whose parents have cancer have been described and evaluated, formal research has not been conducted to document outcomes. We adapted a group intervention called CLIMB®, originally developed in the United States, and implemented it in Tokyo, Japan, for school-aged children and their parents with cancer. The purpose of this exploratory pilot study was to examine the feasibility, acceptability, and impact of the Japanese version of the CLIMB® Program on children's stress and parents' quality of life and psychosocial distress. We enrolled children and parents in six waves of replicate sets for the six-week group intervention. A total of 24 parents (23 mothers and 1 father) diagnosed with cancer and 38 school-aged children (27 girls and 11 boys) participated in our study. Intervention fidelity, including parent and child satisfaction with the program, was examined. The impact of the program was analyzed using a quasiexperimental within-subject design comparing pre- and posttest assessments of children and parents in separate analyses. Both children and parents experienced high levels of satisfaction with the program. Children's posttraumatic stress symptoms related to a parent's illness decreased after the intervention as measured by the Posttraumatic Stress Disorder-Reaction Index. No difference was found in children's psychosocial stress. The Functional Assessment of Chronic Illness Therapy scores indicated that parents' quality of life improved after the intervention in all domains except for physical well-being. However, no differences were found in parents' psychological distress and posttraumatic stress symptoms. Our results suggest that the group intervention using the CLIMB® Program relieved children's posttraumatic stress symptoms and improved parents' quality of life. The intervention proved the feasibility of delivering the program using manuals and training. Further research is needed to provide more substantiation for the benefits of the program.

The medical director and quality requirements in the dialysis facility.

PubMed

Schiller, Brigitte

2015-03-06

Four decades after the successful implementation of the ESRD program currently providing life-saving dialysis therapy to >430,000 patients, the definitions of and demands for a high-quality program have evolved and increased at the same time. Through substantial technological advances ESRD care improved, with a predominant focus on the technical aspects of care and the introduction of medications such as erythropoiesis-stimulating agents and active vitamin D for anemia and bone disease management. Despite many advances, the size of the program and the increasingly older and multimorbid patient population have contributed to continuing challenges for providing consistently high-quality care. Medicare's Final Rule of the Conditions for Coverage (April 2008) define the medical director of the dialysis center as the leader of the interdisciplinary team and the person ultimately accountable for quality, safety, and care provided in the center. Knowledge and active leadership with a hands-on approach in the quality assessment and performance improvement process (QAPI) is essential for the achievement of high-quality outcomes in dialysis centers. A collaborative approach between the dialysis provider and medical director is required to optimize outcomes and deliver evidence-based quality care. In 2011 the Centers for Medicare & Medicaid Services introduced a pay-for-performance program-the ESRD quality incentive program (QIP)- with yearly varying quality metrics that result in payment reductions in subsequent years when targets are not achieved during the performance period. Success with the QIP requires a clear understanding of the structure, metrics, and scoring methods. Information on achievement and nonachievement is publicly available, both in facilities (through the facility performance score card) and on public websites (including Medicare's Dialysis Facility Compare). By assuming the leadership role in the quality program of dialysis facilities, the medical director is given an important opportunity to improve patients' lives and effect true change in a patient population dealing with a very challenging chronic disease. This article in the series on the role of the medical director summarizes the medical director's specific role in the quality improvement process in the dialysis facility and the associated requirements and programs, including QAPI and QIP. Copyright © 2015 by the American Society of Nephrology.

Aeroelastic modeling of rotor blades with spanwise variable elastic axis offset: Classic issues revisited and new formulations

NASA Technical Reports Server (NTRS)

Bielawa, Richard L.

1988-01-01

In response to a systematic methodology assessment program directed to the aeroelastic stability of hingeless helicopter rotor blades, improved basic aeroelastic reformulations and new formulations relating to structural sweep were achieved. Correlational results are presented showing the substantially improved performance of the G400 aeroelastic analysis incorporating these new formulations. The formulations pertain partly to sundry solutions to classic problem areas, relating to dynamic inflow with vortex-ring state operation and basic blade kinematics, but mostly to improved physical modeling of elastic axis offset (structural sweep) in the presence of nonlinear structural twist. Specific issues addressed are an alternate modeling of the delta EI torsional excitation due to compound bending using a force integration approach, and the detailed kinematic representation of an elastically deflected point mass of a beam with both structural sweep and nonlinear twist.

Measuring participant rurality in Web-based interventions.

PubMed

Danaher, Brian G; Hart, L Gary; McKay, H Garth; Severson, Herbert H

2007-08-31

Web-based health behavior change programs can reach large groups of disparate participants and thus they provide promise of becoming important public health tools. Data on participant rurality can complement other demographic measures to deepen our understanding of the success of these programs. Specifically, analysis of participant rurality can inform recruitment and social marketing efforts, and facilitate the targeting and tailoring of program content. Rurality analysis can also help evaluate the effectiveness of interventions across population groupings. We describe how the RUCAs (Rural-Urban Commuting Area Codes) methodology can be used to examine results from two Randomized Controlled Trials of Web-based tobacco cessation programs: the ChewFree.com project for smokeless tobacco cessation and the Smokers' Health Improvement Program (SHIP) project for smoking cessation. Using RUCAs methodology helped to highlight the extent to which both Web-based interventions reached a substantial percentage of rural participants. The ChewFree program was found to have more rural participation which is consistent with the greater prevalence of smokeless tobacco use in rural settings as well as ChewFree's multifaceted recruitment program that specifically targeted rural settings. Researchers of Web-based health behavior change programs targeted to the US should routinely include RUCAs as a part of analyzing participant demographics. Researchers in other countries should examine rurality indices germane to their country.

Comprehensive, Individualized, Person-Centered Management of Community-Residing Persons with Moderate-to-Severe Alzheimer Disease: A Randomized Controlled Trial.

PubMed

Reisberg, Barry; Shao, Yongzhao; Golomb, James; Monteiro, Isabel; Torossian, Carol; Boksay, Istvan; Shulman, Melanie; Heller, Sloane; Zhu, Zhaoyin; Atif, Ayesha; Sidhu, Jaskirat; Vedvyas, Alok; Kenowsky, Sunnie

2017-01-01

The aim was to examine added benefits of a Comprehensive, Individualized, Person-Centered Management (CI-PCM) program to memantine treatment. This was a 28-week, clinician-blinded, randomized, controlled, parallel-group study, with a similar study population, similar eligibility criteria, and a similar design to the memantine pivotal trial of Reisberg et al. [N Engl J Med 2003;348:1333-1341]. Twenty eligible community-residing Alzheimer disease (AD) subject-caregiver dyads were randomized to the CI-PCM program (n = 10) or to usual community care (n = 10). Primary outcomes were the New York University Clinician's Interview-Based Impression of Change Plus Caregiver Input (NYU-CIBIC-Plus), assessed by one clinician set, and an activities of daily living inventory, assessed by a separate clinician set at baseline and at weeks 4, 12, and 28. Primary outcomes showed significant benefits of the CI-PCM program at all post-baseline evaluations. Improvement on the NYU-CIBIC-Plus in the management group at 28 weeks was 2.9 points over the comparator group. The memantine 2003 trial showed an improvement of 0.3 points on this global measure in memantine-treated versus placebo-randomized subjects at 28 weeks. Hence, globally, the management program intervention benefits were 967% greater than memantine treatment alone. These results are approximately 10 times those usually observed with both nonpharmacological and pharmacological treatments and indicate substantial benefits with the management program for advanced AD persons. © 2017 S. Karger AG, Basel.

Investigating Star-Gas Correlation and Evolution in the 100pc Cygnus X Complex

NASA Astrophysics Data System (ADS)

Gutermuth, Robert

We request support to pursue a substantial refinement of the ongoing characterizations of star and gas surface density in nearby star forming regions by engaging in a focused study of the Cygnus X star forming complex. The substantial physical size of the region and high spatial dynamic range of its surveys enables us to achieve the following science goals: - Characterize the distributions of gas and stellar column densities in a large, nearby starforming complex and integrate those values over successively larger physical scales in order to gauge the effect of varying physical resolution on the measured star-gas correlation. - Validate integrated 24 ¼m luminosity as a method of estimating star formation rate surface density using a region in which the substantial number of known forming members should ensure that the IMF is statistically well-sampled. - Validate 12CO luminosity as a method of estimating molecular gas column density against 13CO column density. tegrated 24 micron and radio continuum luminosity. To achieve these goals, we will perform substantial improvement and expansion of the Cygnus X Spitzer (and 2MASS) Legacy Survey point source catalog using UKIRT Infrared Deep Sky Survey (UKIDSS) near-IR data and WISE mid-IR data. From this catalog, we will produce a comprehensive census of young stellar objects (YSOs) with IR-excess emission over the numerical bulk of the stellar mass function (0.2 2 M ). This YSO catalog is expected to be considerably larger than the entire YSO census of the nearest kiloparsec. Both the point source and YSO catalogs will be contributed to the Infrared Science Archive (IRSA) to facilitate community access to these improved data products. In addition, we will provide a star formation surface density map derived from the MIPS 24 micron map of Cygnus X from the Spitzer Legacy Survey and gas column density maps derived from 12CO and 13CO data from the Exeter-Five College Radio Astronomy Observatory Cygnus Survey. The proposed program will bring to maturity a major new scientific result from the combination of data from several NASA program investments (Spitzer Legacy, WISE, & 2MASS) and some external archives (UKIDSS GPS, Exeter-FCRAO XGRS) that we have shown above add considerable value to the scientific interpretation of the data from the NASA archive. The improvement in effective sensitivity to low mass YSOs from the Cygnus X Legacy Survey source catalog and our targeted science investigation to examine the star-gas correlation (and any deviation that may correlate with local YSO evolutionary age) are relevant to the NASA Astrophysics Theme, Cosmic Origins, which aspires to unveil how the universe developed to the current day configuration of galaxies, stars and planets and the conditions necessary for life.

Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial.

PubMed

Hurley, M V; Walsh, N E; Mitchell, H; Nicholas, J; Patel, A

2012-02-01

Chronic joint pain is a major cause of pain and disability. Exercise and self-management have short-term benefits, but few studies follow participants for more than 6 months. We investigated the long-term (up to 30 months) clinical and cost effectiveness of a rehabilitation program combining self-management and exercise: Enabling Self-Management and Coping of Arthritic Knee Pain Through Exercise (ESCAPE-knee pain). In this pragmatic, cluster randomized, controlled trial, 418 people with chronic knee pain (recruited from 54 primary care surgeries) were randomized to usual care (pragmatic control) or the ESCAPE-knee pain program. The primary outcome was physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function), with a clinically meaningful improvement in physical function defined as a ≥15% change from baseline. Secondary outcomes included pain, psychosocial and physiologic variables, costs, and cost effectiveness. Compared to usual care, ESCAPE-knee pain participants had large initial improvements in function (mean difference in WOMAC function -5.5; 95% confidence interval [95% CI] -7.8, -3.2). These improvements declined over time, but 30 months after completing the program, ESCAPE-knee pain participants still had better physical function (difference in WOMAC function -2.8; 95% CI -5.3, -0.2); lower community-based health care costs (£-47; 95% CI £-94, £-7), medication costs (£-16; 95% CI £-29, £-3), and total health and social care costs (£-1,118; 95% CI £-2,566, £-221); and a high probability (80-100%) of being cost effective. Clinical and cost benefits of ESCAPE-knee pain were still evident 30 months after completing the program. ESCAPE-knee pain is a more effective and efficient model of care that could substantially improve the health, well-being, and independence of many people, while reducing health care costs. Copyright © 2012 by the American College of Rheumatology.

Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians.

PubMed

Thomas, David C; Johnston, Bree; Dunn, Kathel; Sullivan, Gail M; Brett, Belle; Matzko, Marilyn; Levine, Sharon A

2006-10-01

Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.

COMSKIL Communication Training in Oncology-Adaptation to German Cancer Care Settings.

PubMed

Hartung, Tim J; Kissane, David; Mehnert, Anja

2018-01-01

Medical communication is a skill which can be learned and taught and which can substantially improve treatment outcomes, especially if patients' communication preferences are taken into account. Here, we give an overview of communication training research and outline the COMSKIL program as a state-of-the-art communication skills training in oncology. COMSKIL has a solid theoretical foundation and teaches core elements of medical communication in up to ten fully operationalized modules. These address typical situations ranging from breaking bad news to responding to difficult emotions, shared decision-making, and communicating via interpreters.

Atmospheric Effects of Subsonic Aircraft: Interim Assessment Report of the Advanced Subsonic Technology Program

NASA Technical Reports Server (NTRS)

Friedl, Randall R. (Editor)

1997-01-01

This first interim assessment of the subsonic assessment (SASS) project attempts to summarize concisely the status of our knowledge concerning the impacts of present and future subsonic aircraft fleets. It also highlights the major areas of scientific uncertainty, through review of existing data bases and model-based sensitivity studies. In view of the need for substantial improvements in both model formulations and experimental databases, this interim assessment cannot provide confident numerical predictions of aviation impacts. However, a number of quantitative estimates are presented, which provide some guidance to policy makers.

Large-Scale Demonstration of Liquid Hydrogen Storage with Zero Boiloff for In-Space Applications

NASA Technical Reports Server (NTRS)

Hastings, L. J.; Bryant, C. B.; Flachbart, R. H.; Holt, K. A.; Johnson, E.; Hedayat, A.; Hipp, B.; Plachta, D. W.

2010-01-01

Cryocooler and passive insulation technology advances have substantially improved prospects for zero-boiloff cryogenic storage. Therefore, a cooperative effort by NASA s Ames Research Center, Glenn Research Center, and Marshall Space Flight Center (MSFC) was implemented to develop zero-boiloff concepts for in-space cryogenic storage. Described herein is one program element - a large-scale, zero-boiloff demonstration using the MSFC multipurpose hydrogen test bed (MHTB). A commercial cryocooler was interfaced with an existing MHTB spray bar mixer and insulation system in a manner that enabled a balance between incoming and extracted thermal energy.

[Health effects of living habits].

PubMed

Vuori, Ilkka

2015-01-01

Single healthy living habits such as non-smoking and regular physical activity decrease the risk of common non-communicable diseases, unsuccessful aging and premature death to a small to moderate degree. Their cumulative effects are, however, large. Only a small minority of people adhere well to all healthy living habits or even the healthiest ones. Consequently, the population attributable fractions of major public health problems due to unhealthy lifestyles are large. Substantial improvement of public health calls for policies and programs to influence the root causes of the lifestyles in the multiple environments and systems where they are developed, maintained, and changed.

Policy analysis for prenatal genetic diagnosis.

PubMed

Thompson, M; Milunsky, A

1979-01-01

Consideration of the analytic difficulties faced in estimating the benefits and costs of prenatal genetic diagnosis, coupled with a brief review of existing benefit-cost studies, leads to the conclusion that public subsidy of prenatal testing can yield benefits substantially in excess of costs. The practical obstacles to such programs include the attitudes of prospective parents, a lack of knowledge, monetary barriers, inadequately organized medical resources, and the political issue of abortion. Policy analysis can now nevertheless formulate principles and guide immediate actions to improve present utilization of prenatal testing and to facilitate possible future expansion of these diagnostic techniques.

34 CFR 692.41 - What standards may a State use to determine substantial financial need?

Code of Federal Regulations, 2011 CFR

2011-07-01

... financial need? 692.41 Section 692.41 Education Regulations of the Offices of the Department of Education... Students Under the Leap Program? § 692.41 What standards may a State use to determine substantial financial need? (a) A State determines whether a student has substantial financial need on the basis of criteria...

34 CFR 692.41 - What standards may a State use to determine substantial financial need?

Code of Federal Regulations, 2010 CFR

2010-07-01

... financial need? 692.41 Section 692.41 Education Regulations of the Offices of the Department of Education... Under the Leap Program? § 692.41 What standards may a State use to determine substantial financial need? (a) A State determines whether a student has substantial financial need on the basis of criteria it...

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

Kuypers, Marshall A.; Lambert, Gregory Joseph; Moore, Thomas W.

Chronic infection with Hepatitis C virus (HCV) results in cirrhosis, liver cancer and death. As the nations largest provider of care for HCV, US Veterans Health Administration (VHA) invests extensive resources in the diagnosis and treatment of the disease. This report documents modeling and analysis of HCV treatment dynamics performed for the VHA aimed at improving service delivery efficiency. System dynamics modeling of disease treatment demonstrated the benefits of early detection and the role of comorbidities in disease progress and patient mortality. Preliminary modeling showed that adherence to rigorous treatment protocols is a primary determinant of treatment success. In depthmore » meta-analysis revealed correlations of adherence and various psycho-social factors. This initial meta-analysis indicates areas where substantial improvement in patient outcomes can potentially result from VA programs which incorporate these factors into their design.« less

Outcomes of an enhancement study with additional psychoeducational sessions for healthy siblings of a child with cancer during inpatient family-oriented rehabilitation.

PubMed

Niemitz, Mandy; Goldbeck, Lutz

2018-03-01

Chronic illness of a child puts healthy children of the family at risk of distress. Previous studies have demonstrated that healthy children's psychological symptoms can be reduced when the child knows more about the disease. So far, there is limited evidence of the effectiveness of psychoeducational interventions for healthy children. To compare the effectiveness of an inpatient family-oriented rehabilitation program with vs without additional psychoeducational sessions for healthy children of families with children with cancer. We performed a controlled study in 4 German family-oriented rehabilitation clinics. The outcomes of n = 73 healthy children (mean age: M = 9.55; SD = 3.14; range: 4-18), who participated in 5 additional psychoeducational sessions, were compared with the outcomes of n = 111 healthy children (mean age: M = 8.85; SD = 3.28; range: 4-17), who underwent the usual inpatient rehabilitation program. Primary outcomes were the healthy children's cancer-specific knowledge and their emotional symptoms. Secondary outcomes were family satisfaction and quality of life. Intention-to-treat analyses showed that both groups improved significantly from preintervention to postintervention. Improvements comprised knowledge about cancer (F(1,174) = 11.03, p < 0.001), self-reported emotional symptoms (F(1,135) = 31.68, p < 0.001), and parent-proxy-reported emotional symptoms (F(1,179) = 37.07, p < 0.001). The additional psycho-educational program did not significantly enhance the outcomes. The same pattern of significant improvement in both conditions emerged for all secondary outcomes. The immediate effects of the intervention persisted until 2 months after discharge from the rehabilitation program. Inpatient family-oriented rehabilitation is effective in improving multiple psychosocial outcomes of healthy children in families which have a child with cancer. Additional psycho-educational sessions did not show any substantial additional improvement. Copyright © 2017 John Wiley & Sons, Ltd.

Pharmacist-driven antimicrobial stewardship program in an institution without infectious diseases physician support.

PubMed

Waters, C Dustin

2015-03-15

Improved drug-utilization and cost outcomes achieved by a pharmacist-led antimicrobial stewardship program (ASP) are described. Pharmacists may be tasked to lead ASP development and implementation with little or no support from an infectious diseases (ID) physician and other hospital personnel whose involvement on ASP teams is recommended (e.g., clinical microbiologists, infection control specialists, hospital epidemiologists). Several years ago, Intermountain Healthcare's 325-bed McKay-Dee Hospital in Utah implemented an ASP led by an antimicrobial stewardship pharmacist. In addition to reviewing patient profiles and meeting with physicians to discuss cases daily (Monday-Friday), the pharmacist was available to provide afterhours phone consultations; support was provided by an infection prevention nurse, two physician ASP champions, the pharmacy leadership, pharmacy informatics and hospital laboratory personnel, and the chief medical officer. In the program's first 33 months, the pharmacist made a total of 2,457 interventions or recommendations, with an acceptance rate of 91.8%. Comparison of selected outcomes during one-year periods before and after ASP implementation indicated substantial decreases in the utilization of four commonly used antimicrobial agents and classes (carbapenems, daptomycin, echinocandins, and levofloxacin) in the postimplementation period, with a significant decline in the average length of stay for community-acquired pneumonia (mean ± S.D., 2.69 ± 0.10 days versus 3.40 ± 0.23 days; p = 0.03). Two years after ASP implementation, annual cost savings attributed to the program were estimated at $355,000. In the absence of ID physician support and oversight, the pharmacist-led ASP achieved substantial reductions in antimicrobial utilization and associated expenditures. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Cognitive workload reduction in hospital information systems : Decision support for order set optimization.

PubMed

Gartner, Daniel; Zhang, Yiye; Padman, Rema

2018-06-01

Order sets are a critical component in hospital information systems that are expected to substantially reduce physicians' physical and cognitive workload and improve patient safety. Order sets represent time interval-clustered order items, such as medications prescribed at hospital admission, that are administered to patients during their hospital stay. In this paper, we develop a mathematical programming model and an exact and a heuristic solution procedure with the objective of minimizing physicians' cognitive workload associated with prescribing order sets. Furthermore, we provide structural insights into the problem which lead us to a valid lower bound on the order set size. In a case study using order data on Asthma patients with moderate complexity from a major pediatric hospital, we compare the hospital's current solution with the exact and heuristic solutions on a variety of performance metrics. Our computational results confirm our lower bound and reveal that using a time interval decomposition approach substantially reduces computation times for the mathematical program, as does a K -means clustering based decomposition approach which, however, does not guarantee optimality because it violates the lower bound. The results of comparing the mathematical program with the current order set configuration in the hospital indicates that cognitive workload can be reduced by about 20.2% by allowing 1 to 5 order sets, respectively. The comparison of the K -means based decomposition with the hospital's current configuration reveals a cognitive workload reduction of about 19.5%, also by allowing 1 to 5 order sets, respectively. We finally provide a decision support system to help practitioners analyze the current order set configuration, the results of the mathematical program and the heuristic approach.

Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials.

PubMed

Peikes, Deborah; Chen, Arnold; Schore, Jennifer; Brown, Randall

2009-02-11

Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care, patient adherence, and communication. To determine whether care coordination programs reduced hospitalizations and Medicare expenditures and improved quality of care for chronically ill Medicare beneficiaries. Eligible fee-for-service Medicare patients (primarily with congestive heart failure, coronary artery disease, and diabetes) who volunteered to participate between April 2002 and June 2005 in 15 care coordination programs (each received a negotiated monthly fee per patient from Medicare) were randomly assigned to treatment or control (usual care) status. Hospitalizations, costs, and some quality-of-care outcomes were measured with claims data for 18 309 patients (n = 178 to 2657 per program) from patients' enrollment through June 2006. A patient survey 7 to 12 months after enrollment provided additional quality-of-care measures. Nurses provided patient education and monitoring (mostly via telephone) to improve adherence and ability to communicate with physicians. Patients were contacted twice per month on average; frequency varied widely. Hospitalizations, monthly Medicare expenditures, patient-reported and care process indicators. Thirteen of the 15 programs showed no significant (P<.05) differences in hospitalizations; however, Mercy had 0.168 fewer hospitalizations per person per year (90% confidence interval [CI], -0.283 to -0.054; 17% less than the control group mean, P=.02) and Charlestown had 0.118 more hospitalizations per person per year (90% CI, 0.025-0.210; 19% more than the control group mean, P=.04). None of the 15 programs generated net savings. Treatment group members in 3 programs (Health Quality Partners [HQP], Georgetown, Mercy) had monthly Medicare expenditures less than the control group by 9% to 14% (-$84; 90% CI, -$171 to $4; P=.12; -$358; 90% CI, -$934 to $218; P=.31; and -$112; 90% CI, -$231 to $8; P=.12; respectively). Savings offset fees for HQP and Georgetown but not for Mercy; Georgetown was too small to be sustainable. These programs had favorable effects on none of the adherence measures and only a few of many quality of care indicators examined. Viable care coordination programs without a strong transitional care component are unlikely to yield net Medicare savings. Programs with substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care. clinicaltrials.gov Identifier: NCT00627029.

24 CFR 881.208 - Financing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... DEVELOPMENT (SECTION 8 HOUSING ASSISTANCE PROGRAMS, SECTION 202 DIRECT LOAN PROGRAM, SECTION 202 SUPPORTIVE...) SECTION 8 HOUSING ASSISTANCE PAYMENTS PROGRAM FOR SUBSTANTIAL REHABILITATION Definitions and Other... insurance programs under the National Housing Act; and (3) Financing by tax-exmpt bonds or other obligations...

Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategies.

PubMed

Lapa, Teresa A; Madeira, Filipa M; Viana, Joaquim S; Pinto-Gouveia, José

2017-02-01

Anesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.

Family-based risk reduction of obesity and metabolic syndrome: an overview and outcomes of the Idaho Partnership for Hispanic Health.

PubMed

Schwartz, Rachel; Powell, Linda; Keifer, Matthew

2013-01-01

Mexican American women have the highest incidence of metabolic syndrome among all U.S. demographic groups. This paper details an innovative approach to reducing the risks for metabolic syndrome among Hispanic families in rural Idaho. Compañeros en Salud (CeS) is a promotora-led wellness program and community-based participatory research project from the Idaho Partnership for Hispanic Health. As behavior change is the first line of prevention and treatment of obesity and metabolic syndrome, the program aimed to improve nutrition and physical activity behaviors as well as increase community support and infrastructure for healthy living. CeS has demonstrated substantial improvement in health outcomes, with statistically significant reductions in weight, BMI, metabolic syndrome risk, A1c, glucose, blood pressure, and cholesterol, from pre-intervention to post-intervention and/or pre-intervention to one-year follow-up. These outcomes suggest the CeS model as a promising best practice for effecting individual and family-level physiologic and behavioral outcomes for obesity prevention.

Compiling the space shuttle wind tunnel data base: An exercise in technical and managerial innovators

NASA Technical Reports Server (NTRS)

Kemp, N. D.

1983-01-01

Engineers evaluating Space Shuttle flight data and performance results are using a massive data base of wind tunnel test data. A wind tunnel test data base of the magnitude attained is a major accomplishment. The Apollo program spawned an automated wind tunnel data analysis system called SADSAC developed by the Chrysler Space Division. An improved version of this system renamed DATAMAN was used by Chrysler to document analyzed wind tunnel data and data bank the test data in standardized formats. These analysis documents, associated computer graphics and standard formatted data were disseminated nationwide to the Shuttle technical community. These outputs became the basis for substantiating and certifying the flight worthiness of the Space Shuttle and for improving future designs. As an aid to future programs this paper documents the lessons learned in compiling the massive wind tunnel test data base for developing the Space Shuttle. In particular, innovative managerial and technical concepts evolved in the course of conceiving and developing this successful DATAMAN system and the methods and organization for applying the system are presented.

The PEREGRINETM program: using physics and computer simulation to improve radiation therapy for cancer

NASA Astrophysics Data System (ADS)

Hartmann Siantar, Christine L.; Moses, Edward I.

1998-11-01

When using radiation to treat cancer, doctors rely on physics and computer technology to predict where the radiation dose will be deposited in the patient. The accuracy of computerized treatment planning plays a critical role in the ultimate success or failure of the radiation treatment. Inaccurate dose calculations can result in either insufficient radiation for cure, or excessive radiation to nearby healthy tissue, which can reduce the patient's quality of life. This paper describes how advanced physics, computer, and engineering techniques originally developed for nuclear weapons and high-energy physics research are being used to predict radiation dose in cancer patients. Results for radiation therapy planning, achieved in the Lawrence Livermore National Laboratory (LLNL) 0143-0807/19/6/005/img2 program show that these tools can give doctors new insights into their patients' treatments by providing substantially more accurate dose distributions than have been available in the past. It is believed that greater accuracy in radiation therapy treatment planning will save lives by improving doctors' ability to target radiation to the tumour and reduce suffering by reducing the incidence of radiation-induced complications.

Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior.

PubMed

Tang, Yan; Chang, Chung-Chou H; Lave, Judith R; Gellad, Walid F; Huskamp, Haiden A; Donohue, Julie M

2016-03-01

Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. Using 2011 data from Pennsylvania's Medicaid program, IMS Health's HCOSTM database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to 10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians' prescribing behavior and indicate that even among specialties regularly prescribing a therapeutic category, some physicians rely heavily on a small number of agents. Health systems may need to offer educational interventions to clinicians in order to improve their ability to tailor treatment decisions to the needs of individual patients. Future studies should examine the impact of the diversity of antipsychotic prescribing to determine whether more diversified prescribing improves patient adherence and outcomes.

The Health IT Regional Extension Center Program: evolution and lessons for health care transformation.

PubMed

Lynch, Kimberly; Kendall, Mat; Shanks, Katherine; Haque, Ahmed; Jones, Emily; Wanis, Maggie G; Furukawa, Michael; Mostashari, Farzad

2014-02-01

Assess the Regional Extension Center (REC) program's progress toward its goal of supporting over 100,000 providers in small, rural, and underserved practices to achieve meaningful use (MU) of an electronic health record (EHR). Data collected January 2010 through June 2013 via monitoring and evaluation of the 4-year REC program. Descriptive study of 62 REC programs. Primary data collected from RECs were merged with nine other datasets, and descriptive statistics of progress by practice setting and penetration of targeted providers were calculated. RECs recruited almost 134,000 primary care providers (PCPs), or 44 percent of the nation's PCPs; 86 percent of these were using an EHR with advanced functionality and almost half (48 percent) have demonstrated MU. Eighty-three percent of Federally Qualified Health Centers and 78 percent of the nation's Critical Access Hospitals were participating with an REC. RECs have made substantial progress in assisting PCPs with adoption and MU of EHRs. This infrastructure supports small practices, community health centers, and rural and public hospitals to use technology for care delivery transformation and improvement. © Health Research and Educational Trust.

Computerisation of general practice in the Republic of Croatia: experience gained in general practice use.

PubMed

Bergman-Marković, Biserka; Katić, Milica; Kern, Josipa

2007-01-01

Well-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/systems employed within the family medicine frame, and the frame of evaluation of available and commonly-exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs). The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation.

The HIV care continuum: no partial credit given.

PubMed

McNairy, Margaret L; El-Sadr, Wafaa M

2012-09-10

Despite significant scale-up of HIV care and treatment across the world, overall effectiveness of HIV programs is severely undermined by attrition of patients across the HIV care continuum, both in resource-rich and resource-limited settings. The care continuum has four essential steps: linkage from testing to enrollment in care, determination of antiretroviral therapy (ART) eligibility, ART initiation, and adherence to medications to achieve viral suppression. In order to substantially improve health outcomes for the individual and potentially for prevention of transmission to others, each of the steps of the entire care continuum must be achieved. This will require the adoption of interventions that address the multiplicity of barriers and social contexts faced by individuals and populations across each step, a reconceptualization of services to maximize engagement in care, and ambitious evaluation of program performance using all-or-none measurement.

Evaluation of Bikers Against Child Abuse (BACA) program: A community intervention for child abuse victims.

PubMed

Ray, Dee C; Lilly, J P; Gallina, Nancy; MacIan, Paula; Wilson, Brittany

2017-12-01

Children who have experienced physical abuse benefit from a multitude of community interventions including support programs to address emotional and behavioral stability. This pilot study evaluated the services of Bikers Against Child Abuse (BACA), a community of bikers lending intervention to abused children, using a pre/post exploratory design. Participants (N=154) were children who had been referred by parents/guardians for current or past physical and/or sexual abuse. Parents/guardians of children were interviewed four times over a course of one year. Results indicated children demonstrated substantial improvements in their overall levels of emotional distress, conduct concerns, hyperactivity, and behavioral and emotional functioning. Overall, results support the premise that services provided by BACA may serve as a unique intervention for children who have experienced abuse. Copyright © 2017 Elsevier Ltd. All rights reserved.

Simple solution to the medical instrumentation software problem

NASA Astrophysics Data System (ADS)

Leif, Robert C.; Leif, Suzanne B.; Leif, Stephanie H.; Bingue, E.

1995-04-01

Medical devices now include a substantial software component, which is both difficult and expensive to produce and maintain. Medical software must be developed according to `Good Manufacturing Practices', GMP. Good Manufacturing Practices as specified by the FDA and ISO requires the definition and compliance to a software processes which ensures quality products by specifying a detailed method of software construction. The software process should be based on accepted standards. US Department of Defense software standards and technology can both facilitate the development and improve the quality of medical systems. We describe the advantages of employing Mil-Std-498, Software Development and Documentation, and the Ada programming language. Ada provides the very broad range of functionalities, from embedded real-time to management information systems required by many medical devices. It also includes advanced facilities for object oriented programming and software engineering.

Chemical vapor infiltration of TiB{sub 2} fibrous composites

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

Besmann, T.M.

1997-04-01

This program is designed to develop a Hall-Heroult aluminum smelting cathode with substantially improved properties. The carbon cathodes in current use require significant anode-to-cathode spacing in order to prevent shorting, causing significant electrical inefficiencies. This is due to the non-wettability of carbon by aluminum which causes instability in the cathodic aluminum pad. It is suggested that a fiber reinforced-TiB{sub 2} matrix composite would have the requisite wettability, strength, strain-to-failure, cost, and lifetime to solve this problem. The approach selected to fabricate such a cathode material is chemical vapor infiltration (CVI). This process produces high purity matrix TiB{sub 2} without damagingmore » the relatively fragile fibers. The program is designed to evaluate potential fiber reinforcements, fabricate test specimens, and scale the process to provide demonstration components.« less

Automotive Stirling engine development program. [fuel economy assessment

NASA Technical Reports Server (NTRS)

Kitzner, E. W.

1978-01-01

The Ford/DOE automotive Stirling engine development program is directed towards establishing the technological and developmental base that would enable a decision on whether an engineering program should be directed at Stirling engine production. The fuel economy assessment aims to achieve, with a high degree of confidence, the ERDA proposal estimate of 20.6 MPG (gasoline) for a 4500 lb 1WC Stirling engine passenger car. The current M-H fuel economy projection for the 170 HP Stirling engine is 15.7 MPG. The confidence level for this projection is 32%. A confidence level of 29% is projected for a 22.1 MPG estimate. If all of the planned analyses and test work is accomplished at the end of the one year effort, and the projected improvements are substantiated, the confidence levels would rise to 59% for the 20.6 MPG projection and 54% for the 22.1 MPG projection. Progress achieved thus far during the fuel economy assessment is discussed.

A Formative Evaluation of Two Evidence-Based Psychotherapies for PTSD In VA Residential Treatment Programs

PubMed Central

Cook, Joan M.; O’Donnell, Casey; Dinnen, Stephanie; Bernardy, Nancy; Rosenheck, Robert; Desai, Rani

2013-01-01

Thirty-eight U.S. Department of Veterans Affairs (VA) residential treatment programs for posttraumatic stress disorder (PTSD) participated in a formative evaluation of their programmatic services, including evidenced-based treatments (EBTs), between July 2008 and March 2011. Face-to-face qualitative interviews were conducted with over 250 staff by an independent psychologist along with on-site participant observations. This evaluation coincided with a national VA dissemination initiative to train providers in two EBTs for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). A substantial proportion of eligible (based on professional background) residential treatment providers received training in PE (37.4%) or CPT (64.2%), with 9.5% completing case consultation or becoming national trainers in each therapy respectively. In semi-structured interviews, providers reported that their clinical programs had adopted these EBTs at varying levels ranging from no adoption to every patient receiving the full protocol. Suggestions for improving the adoption of PE and CPT are noted, including distilling manualized treatments to essential common elements. PMID:23417875

The Urban Ecology Institute's field studies program: utilizing urban areas for experiential learning and ecological research

NASA Astrophysics Data System (ADS)

Starry, O.

2005-05-01

The Urban Ecology Institute (UEI) promotes the stewardship of healthy urban ecosystems by improving science and civic education for middle and high school youth and by working with urban communities to protect and transform natural resources. Established in 1999, UEI's field studies program engages over 1000 youth in the greater Boston area. A substantial component of this program involves water quality monitoring. We have recently adapted protocols from published leaf breakdown studies for incorporation into the UEI water quality curriculum. A 2004 pilot study of these leaf breakdown activities, conducted at four sites, compared rates of red maple breakdown to those of Norway maple, a potentially invasive urban street tree. Preliminary data from this successful pilot study suggest that leaf litter inputs from the two different tree species have varying effects on stream ecosystem function. We present this study as an example of how urban areas can be utilized for both ecological research and inclusive experiential learning through which science and mathematic knowledge can be effectively communicated.

Efficacy of a novel swallowing exercise program for chronic dysphagia in long-term head and neck cancer survivors.

PubMed

Kraaijenga, Sophie A C; Molen, Lisette van der; Stuiver, Martijn M; Takes, Robert P; Al-Mamgani, Abrahim; Brekel, Michiel W M van den; Hilgers, Frans J M

2017-10-01

The efficacy of rehabilitative exercises for chronic dysphagia treatment in head and neck cancer survivors has not been studied extensively and is ambiguous. A prospective clinical phase II study using an intensive strength training program was carried out in 17 head and neck cancer survivors with chronic dysphagia. Both swallow and nonswallow exercises were performed for 6-8 weeks with a newly developed tool allowing for progressive muscle overload, including chin tuck, jaw opening, and effortful swallow exercises. Outcome parameters were feasibility, compliance, and parameters for effect. Feasibility in terms of the program completion rate was 88%. Compliance with the exercises was 97%. After the training period, chin tuck, jaw opening, and anterior tongue strength had substantially improved. All but 1 patient reported to benefit from the exercises. Feasibility and compliance were high. Some objective and subjective effects of progressive load on muscle strength and swallowing function could be demonstrated. © 2017 Wiley Periodicals, Inc.

24 CFR 9.152 - Program accessibility: alterations of Property Disposition Program multifamily housing facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... of Property Disposition Program multifamily housing facilities. 9.152 Section 9.152 Housing and Urban... URBAN DEVELOPMENT § 9.152 Program accessibility: alterations of Property Disposition Program multifamily housing facilities. (a) Substantial alteration. If the agency undertakes alterations to a PDP multifamily...

24 CFR 9.152 - Program accessibility: alterations of Property Disposition Program multifamily housing facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... of Property Disposition Program multifamily housing facilities. 9.152 Section 9.152 Housing and Urban... URBAN DEVELOPMENT § 9.152 Program accessibility: alterations of Property Disposition Program multifamily housing facilities. (a) Substantial alteration. If the agency undertakes alterations to a PDP multifamily...

78 FR 75362 - Notice of Issuance of Final Determination Concerning Docave Computer Software

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-11

... in whole or in part of materials from another country or instrumentality, it has been substantially... programming of a foreign PROM (Programmable Read-Only Memory chip) in the United States substantially...

Disparities between resident and attending surgeon perceptions of intraoperative teaching.

PubMed

Butvidas, Lynn D; Anderson, Cheryl I; Balogh, Daniel; Basson, Marc D

2011-03-01

This study aimed to assess attending surgeon and resident recall of good and poor intraoperative teaching experiences and how often these experiences occur at present. By web-based survey, we asked US surgeons and residents to describe their best and worst intraoperative teaching experiences during training and how often 26 common intraoperative teaching behaviors occur in their current environment. A total of 346 residents and 196 surgeons responded (51 programs; 26 states). Surgeons and residents consistently identified trainee autonomy, teacher confidence, and communication as positive, while recalling negatively contemptuous, arrogant, accusatory, or uncommunicative teachers. Residents described intraoperative teaching behaviors by faculty as substantially less frequent than faculty self-reports. Neither sex nor seniority explained these results, although women reported communicative behaviors more frequently than men. Although veteran surgeons and current trainees agree on what constitutes effective and ineffective teaching in the operating room, they disagree on how often these behaviors occur, leaving substantial room for improvement. Published by Elsevier Inc.

NEUTRONIC REACTOR CORE

DOEpatents

Thomson, W.B.; Corbin, A. Jr.

1961-07-18

An improved core for a gas-cooled power reactor which admits gas coolant at high temperatures while affording strong integral supporting structure and efficient moderation of neutrons is described. The multiplicities of fuel elements constituting the critical amassment of fissionable material are supported and confined by a matrix of metallic structure which is interspersed therebetween. Thermal insulation is interposed between substantially all of the metallic matrix and the fuel elements; the insulation then defines the principal conduit system for conducting the coolant gas in heat-transfer relationship with the fuel elements. The metallic matrix itseif comprises a system of ducts through which an externally-cooled hydrogeneous liquid, such as water, is circulated to serve as the principal neutron moderant for the core and conjointly as the principal coolant for the insulated metallic structure. In this way, use of substantially neutron transparent metals, such as aluminum, becomes possible for the supporting structure, despite the high temperatures of the proximate gas. The Aircraft Nuclear Propulsion program's "R-1" reactor design is a preferred embodiment.

Parallelized reliability estimation of reconfigurable computer networks

NASA Technical Reports Server (NTRS)

Nicol, David M.; Das, Subhendu; Palumbo, Dan

1990-01-01

A parallelized system, ASSURE, for computing the reliability of embedded avionics flight control systems which are able to reconfigure themselves in the event of failure is described. ASSURE accepts a grammar that describes a reliability semi-Markov state-space. From this it creates a parallel program that simultaneously generates and analyzes the state-space, placing upper and lower bounds on the probability of system failure. ASSURE is implemented on a 32-node Intel iPSC/860, and has achieved high processor efficiencies on real problems. Through a combination of improved algorithms, exploitation of parallelism, and use of an advanced microprocessor architecture, ASSURE has reduced the execution time on substantial problems by a factor of one thousand over previous workstation implementations. Furthermore, ASSURE's parallel execution rate on the iPSC/860 is an order of magnitude faster than its serial execution rate on a Cray-2 supercomputer. While dynamic load balancing is necessary for ASSURE's good performance, it is needed only infrequently; the particular method of load balancing used does not substantially affect performance.

Changing educational inequalities in India in the context of affirmative action.

PubMed

Desai, Sonalde; Kulkarni, Veena

2008-05-01

Indian society suffers from substantial inequalities in education, employment, and income based on caste and ethnicity. Compensatory or positive discrimination policies reserve 15% of the seats in institutions of higher education and state and central government jobs for people of the lowest caste, the Scheduled Caste; 7.5% of the seats are reserved for the Scheduled Tribe. These programs have been strengthened by improved enforcement and increased funding in the 1990s. This positive discrimination has also generated popular backlash and on-the-ground sabotage of the programs. This paper examines the changes in educational attainment between various social groups for a period of nearly 20 years to see whether educational inequalities have declined over time. We use data from a large national sample survey of over 100,000 households for each of the four survey years--1983, 1987-1988, 1993-1994, and 1999-2000--and focus on the educational attainment of children and young adults aged 6-29. Our results show a declining gap between dalits, adivasis, and others in the odds of completing primary school. Such improvement is not seen for Muslims, a minority group that does not benefit from affirmative action. We find little improvement in inequality at the college level. Further, we do not find evidence that upper-income groups, the so-called creamy layer of dalits and adivasis, disproportionately benefit from the affirmative action programs at the expense of their lower-income counterparts.

Changing Educational Inequalities in India in the Context of Affirmative Action

PubMed Central

DESAI, SONALDE; KULKARNI, VEENA

2008-01-01

Indian society suffers from substantial inequalities in education, employment, and income based on caste and ethnicity. Compensatory or positive discrimination policies reserve 15% of the seats in institutions of higher education and state and central government jobs for people of the lowest caste, the Scheduled Caste; 7.5% of the seats are reserved for the Scheduled Tribe. These programs have been strengthened by improved enforcement and increased funding in the 1990s. This positive discrimination has also generated popular backlash and on-the-ground sabotage of the programs. This paper examines the changes in educational attainment between various social groups for a period of nearly 20 years to see whether educational inequalities have declined over time. We use data from a large national sample survey of over 100,000 households for each of the four survey years—1983, 1987–1988, 1993–1994, and 1999–2000—and focus on the educational attainment of children and young adults aged 6–29. Our results show a declining gap between dalits, adivasis, and others in the odds of completing primary school. Such improvement is not seen for Muslims, a minority group that does not benefit from affirmative action. We find little improvement in inequality at the college level. Further, we do not find evidence that upper-income groups, the so-called creamy layer of dalits and adivasis, disproportionately benefit from the affirmative action programs at the expense of their lower-income counterparts. PMID:18613480

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

Looney, J.H.; Im, C.J.

Under the sponsorship of DOE/METC, UCC Research completed a program in 1984 concerned with the development, testing, and manufacture of an ultra-clean coal-water mixture fuel using the UCC two-stage physical beneficiation and coal-water mixture preparation process. Several gallons of ultra-clean coal-water slurry produced at the UCC Research pilot facility was supplied to DOE/METC for combustion testing. The finalization of this project resulted in the presentation of a conceptual design and economic analysis of an ultra-clean coal-water mixture processing facility sufficient in size to continuously supply fuel to a 100 MW turbine power generation system. Upon completion of the above program,more » it became evident that substantial technological and economic improvement could be realized through further laboratory and engineering investigation of the UCC two-stage physical beneficiation process. Therefore, as an extension to the previous work, the purpose of the present program was to define the relationship between the controlling technical parameters as related to coal-water slurry quality and product price, and to determine the areas of improvement in the existing flow-scheme, associated cost savings, and the overall effect of these savings on final coal-water slurry price. Contents of this report include: (1) introduction; (2) process refinement (improvement of coal beneficiation process, different source coals and related cleanability, dispersants and other additives); (3) coal beneficiation and cost parametrics summary; (4) revised conceptual design and economic analysis; (5) operating and capital cost reduction; (6) conclusion; and (7) appendices. 24 figs., 12 tabs.« less

Federal agency biodefense funding, FY2012-FY2013.

PubMed

Franco, Crystal; Sell, Tara Kirk

2012-06-01

Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. Earlier articles in this series have analyzed civilian biodefense funding by the federal government for fiscal years (FY) 2001 through proposed funding for FY2012. This article updates those figures with budgeted amounts for FY2013, specifically analyzing the budgets and allocations for civilian biodefense at the Departments of Health and Human Services, Defense, Homeland Security, Agriculture, Commerce, and State; the Environmental Protection Agency; and the National Science Foundation. As in previous years, our analysis indicates that the majority (>90%) of the "biodefense" programs included in the FY2013 budget have both biodefense and non-biodefense goals and applications-that is, programs to improve infectious disease research, public health and hospital preparedness, and disaster response more broadly. Programs that focus solely on biodefense represent a small proportion (<10%) of our analysis, as the federal agencies continue to prioritize all-hazards preparedness. For FY2013, the federal budget for programs focused solely on civilian biodefense totals $574.2 million, and the budget for programs with multiple goals and applications, including biodefense, is $4.96 billion, for an overall total of $5.54 billion.

Self-care management of Thai Buddhists and Muslims with type 2 diabetes after an empowerment education program.

PubMed

Lundberg, Pranee C; Thrakul, Supunnee

2018-04-23

The aim of the present study was to explore self-care management of Thai Buddhists and Muslims with type 2 diabetes and inadequate blood glucose levels, after they had been subjected to a 6-month diabetes empowerment education program. Twenty-seven participants (male and female) were selected through purposive convenience sampling for an explorative qualitative study. Semistructured focus group interviews with four open-ended questions were used to study the participants' self-care behavior at the beginning and the end of the program, and the data obtained were subjected to content analysis. At the end, one third of the participants had been able to reduce their blood glucose to acceptable levels. Most of the others had achieved reduced but irregular blood glucose levels; however, some did not achieve any reduction. Diet was the most difficult problem, and economic difficulties, incorrect knowledge, and misleading beliefs were barriers. In conclusion, an empowerment education program can substantially improve the outcome of self-care management for many people with type 2 diabetes. In the planning of such programs, barriers should be taken into account. © 2018 John Wiley & Sons Australia, Ltd.

Developing a smoking cessation program for Turkish-speaking migrants in Switzerland: novel findings and promising effects.

PubMed

Schnoz, Domenic; Schaub, Michael; Schwappach, David L; Salis Gross, Corina

2011-02-01

Recent studies show that smoking prevalence in the Turkish-speaking migrant population in Switzerland is substantially higher than in the general population. A specific group treatment for Turkish-speaking migrants was developed and tested in order to provide the migrant population with equal access to smoking cessation programs and to improve the migration-sensitive quality of such programs by sociocultural targeting. The evaluation of the program included quantitative (questionnaires t1 and t2 and follow-up by telephone) and qualitative methods (participant observation and semi-structured interviews). The results showed that 37.7% of the 61 participants were smoke free at the 12-month follow-up. The factors of being in a partnership and using nicotine replacement products during the program were positively associated with successful cessation. We also demonstrated the importance of "strong ties" (strong relationships between participants) and the sensitivity of the program to sociocultural (e.g., social aspects of smoking in Turkish culture, which were addressed in relapse prevention), socioeconomic (e.g., low financial resources, which were addressed by providing the course for free), and migration-specific (e.g., underdeveloped access to smoking cessation programs, which was addressed using outreach strategy for recruiting) issues. Overall, the smoking cessation program was successfully tested and is now becoming implemented as a regular service of the Swiss Public Health Program for Tobacco Prevention (by the Swiss Association for Smoking Prevention).

ELMO Bumpy Square proposal

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

Dory, R.A.; Uckan, N.A.; Ard, W.B.

The ELMO Bumpy Square (EBS) concept consists of four straight magnetic mirror arrays linked by four high-field corner coils. Extensive calculations show that this configuration offers major improvements over the ELMO Bumpy Torus (EBT) in particle confinement, heating, transport, ring production, and stability. The components of the EBT device at Oak Ridge National Laboratory can be reconfigured into a square arrangement having straight sides composed of EBT coils, with new microwave cavities and high-field corners designed and built for this application. The elimination of neoclassical convection, identified as the dominant mechanism for the limited confinement in EBT, will give themore » EBS device substantially improved confinement and the flexibility to explore the concepts that produce this improvement. The primary goals of the EBS program are twofold: first, to improve the physics of confinement in toroidal systems by developing the concepts of plasma stabilization using the effects of energetic electrons and confinement optimization using magnetic field shaping and electrostatic potential control to limit particle drift, and second, to develop bumpy toroid devices as attractive candidates for fusion reactors. This report presents a brief review of the physics analyses that support the EBS concept, discussions of the design and expected performance of the EBS device, a description of the EBS experimental program, and a review of the reactor potential of bumpy toroid configurations. Detailed information is presented in the appendices.« less

An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study

PubMed Central

2012-01-01

Background Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. Methods/design This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients’ supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. Discussion Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the intervention program will be (cost)effective, substantial improvements in work productivity might be obtained among workers with RA at lower costs. Results are expected in 2015. Trial registration number NTR2886 PMID:22747949

An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study.

PubMed

van Vilsteren, Myrthe; Boot, Cécile R L; Steenbeek, Romy; van Schaardenburg, Dirkjan; Voskuyl, Alexandre E; Anema, Johannes R

2012-07-02

Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients' supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the intervention program will be (cost)effective, substantial improvements in work productivity might be obtained among workers with RA at lower costs. Results are expected in 2015. NTR2886.

The Wind Forecast Improvement Project (WFIP). A Public-Private Partnership Addressing Wind Energy Forecast Needs

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

Wilczak, James M.; Finley, Cathy; Freedman, Jeff

The Wind Forecast Improvement Project (WFIP) is a public-private research program, the goals of which are to improve the accuracy of short-term (0-6 hr) wind power forecasts for the wind energy industry and then to quantify the economic savings that accrue from more efficient integration of wind energy into the electrical grid. WFIP was sponsored by the U.S. Department of Energy (DOE), with partners that include the National Oceanic and Atmospheric Administration (NOAA), private forecasting companies (WindLogics and AWS Truepower), DOE national laboratories, grid operators, and universities. WFIP employed two avenues for improving wind power forecasts: first, through the collectionmore » of special observations to be assimilated into forecast models to improve model initial conditions; and second, by upgrading NWP forecast models and ensembles. The new observations were collected during concurrent year-long field campaigns in two high wind energy resource areas of the U.S. (the upper Great Plains, and Texas), and included 12 wind profiling radars, 12 sodars, 184 instrumented tall towers and over 400 nacelle anemometers (provided by private industry), lidar, and several surface flux stations. Results demonstrate that a substantial improvement of up to 14% relative reduction in power root mean square error (RMSE) was achieved from the combination of improved NOAA numerical weather prediction (NWP) models and assimilation of the new observations. Data denial experiments run over select periods of time demonstrate that up to a 6% relative improvement came from the new observations. The use of ensemble forecasts produced even larger forecast improvements. Based on the success of WFIP, DOE is planning follow-on field programs.« less

The Rate of Return to the High/Scope Perry Preschool Program.

PubMed

Heckman, James J; Moon, Seong Hyeok; Pinto, Rodrigo; Savelyev, Peter A; Yavitz, Adam

2010-02-01

This paper estimates the rate of return to the High/Scope Perry Preschool Program, an early intervention program targeted toward disadvantaged African-American youth. Estimates of the rate of return to the Perry program are widely cited to support the claim of substantial economic benefits from preschool education programs. Previous studies of the rate of return to this program ignore the compromises that occurred in the randomization protocol. They do not report standard errors. The rates of return estimated in this paper account for these factors. We conduct an extensive analysis of sensitivity to alternative plausible assumptions. Estimated annual social rates of return generally fall between 7-10 percent, with most estimates substantially lower than those previously reported in the literature. However, returns are generally statistically significantly different from zero for both males and females and are above the historical return on equity. Estimated benefit-to-cost ratios support this conclusion.

The Rate of Return to the High/Scope Perry Preschool Program

PubMed Central

Heckman, James J.; Moon, Seong Hyeok; Pinto, Rodrigo; Savelyev, Peter A.; Yavitz, Adam

2010-01-01

This paper estimates the rate of return to the High/Scope Perry Preschool Program, an early intervention program targeted toward disadvantaged African-American youth. Estimates of the rate of return to the Perry program are widely cited to support the claim of substantial economic benefits from preschool education programs. Previous studies of the rate of return to this program ignore the compromises that occurred in the randomization protocol. They do not report standard errors. The rates of return estimated in this paper account for these factors. We conduct an extensive analysis of sensitivity to alternative plausible assumptions. Estimated annual social rates of return generally fall between 7–10 percent, with most estimates substantially lower than those previously reported in the literature. However, returns are generally statistically significantly different from zero for both males and females and are above the historical return on equity. Estimated benefit-to-cost ratios support this conclusion. PMID:21804653

10 CFR 4.503 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... COMMISSION NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL...

Effects of enhanced foster care on the long-term physical and mental health of foster care alumni.

PubMed

Kessler, Ronald C; Pecora, Peter J; Williams, Jason; Hiripi, Eva; O'Brien, Kirk; English, Diana; White, James; Zerbe, Richard; Downs, A Chris; Plotnick, Robert; Hwang, Irving; Sampson, Nancy A

2008-06-01

Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth. To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni. We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni. A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed. Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs. Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni. Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Programs to Increase High School Completion

PubMed Central

Hahn, Robert A.; Knopf, John A.; Wilson, Sandra Jo; Truman, Benedict I.; Milstein, Bobby; Johnson, Robert L.; Fielding, Jonathan E.; Muntaner, Carles J.M.; Jones, Camara Phyllis; Fullilove, Mindy T.; Moss, Regina Davis; Uefffng, Erin; Hunt, Pete C.

2015-01-01

Context High school completion (HSC) is an established predictor of long-term morbidity and mortality. U.S. rates of HSC are substantially lower among students from low-income families and most racial/ethnic minority populations than students from high-income families and the non-Hispanic white population. This systematic review assesses the effectiveness of programs to increase HSC and the potential of these programs to improve lifelong health among at-risk students. Evidence acquisition A search located a meta-analysis (search period 1985–2010/2011) on the effects of programs to increase HSC or General Educational Development (GED) diploma receipt; the meta-analysis was concordant with Community Guide definitions and methodologic standards. Programs were assessed separately for the general student population (152 studies) and students who were parents or pregnant (15 studies). A search for studies published between 2010 and August 2012 located ten more recent studies, which were assessed for consistency with the meta-analysis. Analyses were conducted in 2013. Evidence synthesis The review focused on the meta-analysis. Program effectiveness was measured as the increased rate of HSC (or GED receipt) by the intervention group compared with controls. All assessed program types were effective in increasing HSC in the general student population: vocational training, alternative schooling, social–emotional skills training, college-oriented programming, mentoring and counseling, supplemental academic services, school and class restructuring, multiservice packages, attendance monitoring and contingencies, community service, and case management. For students who had children or were pregnant, attendance monitoring and multiservice packages were effective. Ten studies published after the search period for the meta-analysis were consistent with its findings. Conclusions There is strong evidence that a variety of HSC programs can improve high school or GED completion rates. Because many programs are targeted to high-risk students and communities, they are likely to advance health equity. PMID:25818117

Data envelopment analysis in service quality evaluation: an empirical study

NASA Astrophysics Data System (ADS)

Najafi, Seyedvahid; Saati, Saber; Tavana, Madjid

2015-09-01

Service quality is often conceptualized as the comparison between service expectations and the actual performance perceptions. It enhances customer satisfaction, decreases customer defection, and promotes customer loyalty. Substantial literature has examined the concept of service quality, its dimensions, and measurement methods. We introduce the perceived service quality index (PSQI) as a single measure for evaluating the multiple-item service quality construct based on the SERVQUAL model. A slack-based measure (SBM) of efficiency with constant inputs is used to calculate the PSQI. In addition, a non-linear programming model based on the SBM is proposed to delineate an improvement guideline and improve service quality. An empirical study is conducted to assess the applicability of the method proposed in this study. A large number of studies have used DEA as a benchmarking tool to measure service quality. These models do not propose a coherent performance evaluation construct and consequently fail to deliver improvement guidelines for improving service quality. The DEA models proposed in this study are designed to evaluate and improve service quality within a comprehensive framework and without any dependency on external data.

Extravehicular Mobility Unit Penetration Probability from Micrometeoroids and Orbital Debris: Revised Analytical Model and Potential Space Suit Improvements

NASA Technical Reports Server (NTRS)

Chase, Thomas D.; Splawn, Keith; Christiansen, Eric L.

2007-01-01

The NASA Extravehicular Mobility Unit (EMU) micrometeoroid and orbital debris protection ability has recently been assessed against an updated, higher threat space environment model. The new environment was analyzed in conjunction with a revised EMU solid model using a NASA computer code. Results showed that the EMU exceeds the required mathematical Probability of having No Penetrations (PNP) of any suit pressure bladder over the remaining life of the program (2,700 projected hours of 2 person spacewalks). The success probability was calculated to be 0.94, versus a requirement of >0.91, for the current spacesuit s outer protective garment. In parallel to the probability assessment, potential improvements to the current spacesuit s outer protective garment were built and impact tested. A NASA light gas gun was used to launch projectiles at test items, at speeds of approximately 7 km per second. Test results showed that substantial garment improvements could be made, with mild material enhancements and moderate assembly development. The spacesuit s PNP would improve marginally with the tested enhancements, if they were available for immediate incorporation. This paper discusses the results of the model assessment process and test program. These findings add confidence to the continued use of the existing NASA EMU during International Space Station (ISS) assembly and Shuttle Operations. They provide a viable avenue for improved hypervelocity impact protection for the EMU, or for future space suits.

Protecting water and wastewater infrastructure from cyber attacks

NASA Astrophysics Data System (ADS)

Panguluri, Srinivas; Phillips, William; Cusimano, John

2011-12-01

Multiple organizations over the years have collected and analyzed data on cyber attacks and they all agree on one conclusion: cyber attacks are real and can cause significant damages. This paper presents some recent statistics on cyber attacks and resulting damages. Water and wastewater utilities must adopt countermeasures to prevent or minimize the damage in case of such attacks. Many unique challenges are faced by the water and wastewater industry while selecting and implementing security countermeasures; the key challenges are: 1) the increasing interconnection of their business and control system networks, 2) large variation of proprietary industrial control equipment utilized, 3) multitude of cross-sector cyber-security standards, and 4) the differences in the equipment vendor's approaches to meet these security standards. The utilities can meet these challenges by voluntarily selecting and adopting security standards, conducting a gap analysis, performing vulnerability/risk analysis, and undertaking countermeasures that best meets their security and organizational requirements. Utilities should optimally utilize their limited resources to prepare and implement necessary programs that are designed to increase cyber-security over the years. Implementing cyber security does not necessarily have to be expensive, substantial improvements can be accomplished through policy, procedure, training and awareness. Utilities can also get creative and allocate more funding through annual budgets and reduce dependence upon capital improvement programs to achieve improvements in cyber-security.

Engaging High School Science Teachers in Field-Based Seismology Research: Opportunities and Challenges

NASA Astrophysics Data System (ADS)

Long, M. D.

2015-12-01

Research experiences for secondary school science teachers have been shown to improve their students' test scores, and there is a substantial body of literature about the effectiveness of RET (Research Experience for Teachers) or SWEPT (Scientific Work Experience Programs for Teachers) programs. RET programs enjoy substantial support, and several opportunities for science teachers to engage in research currently exist. However, there are barriers to teacher participation in research projects; for example, laboratory-based projects can be time consuming and require extensive training before a participant can meaningfully engage in scientific inquiry. Field-based projects can be an effective avenue for involving teachers in research; at its best, earth science field work is a fun, highly immersive experience that meaningfully contributes to scientific research projects, and can provide a payoff that is out of proportion to a relatively small time commitment. In particular, broadband seismology deployments provide an excellent opportunity to provide teachers with field-based research experience. Such deployments are labor-intensive and require large teams, with field tasks that vary from digging holes and pouring concrete to constructing and configuring electronics systems and leveling and orienting seismometers. A recently established pilot program, known as FEST (Field Experiences for Science Teachers) is experimenting with providing one week of summer field experience for high school earth science teachers in Connecticut. Here I report on results and challenges from the first year of the program, which is funded by the NSF-CAREER program and is being run in conjunction with a temporary deployment of 15 seismometers in Connecticut, known as SEISConn (Seismic Experiment for Imaging Structure beneath Connecticut). A small group of teachers participated in a week of field work in August 2015 to deploy seismometers in northern CT; this experience followed a visit of the PI to the classroom of one of the teacher participants during spring 2015 to give a series of talks on Connecticut earthquakes and geology. This presentation will focus on the challenges and opportunities of running small, PI-driven, field-based RET programs.

Influence of financial incentive programs in sustaining wildlife values

Treesearch

Thomas J. Straka; Michael A. Kilgore; Michael G. Jacobson; John L. Greene; Steven E. Daniels

2007-01-01

Conservation incentive programs have substantial impacts on the nation’s forests and wildlife habitat. There are eight major conservation incentive programs. The Forest Stewardship Program (FSP) provides forest landowner assistance by focusing on resource management plans embodying multi-resource stewardship principles. The Forest Land Enhancement Program (FLEP) is the...

The landscape of services for drug users in Yogyakarta, Indonesia.

PubMed

Morrison, Chris; Kurniasih, Yacinta; Barton, Greg

2012-01-01

Drug use has increased rapidly in Indonesia since the late 1990s. The formal drug treatment sector has grown within the bounds of available government funding; however, there is also a substantial informal sector which provides a range of services for current and former users. While information regarding the former is available from the provincial and national governments, there are few sources that detail the latter. The aim of the current study, therefore, is to document the drug treatment services in one Indonesian city, Yogyakarta. This qualitative study utilised nine key informant interviews with drug treatment workers from nine government and non-government treatment services. Transcripts were analysed thematically. There exists a patchwork of enthusiastic yet under-resourced non-government services that complement the government rehabilitation and withdrawal programs in Yogyakarta. The focus of most such services is on abstinence (including several faith-based residential rehabilitation programs); however, some harm reduction programs have emerged in recent years. Under-utilisation is a feature of many non-government services, and all respondents acknowledged a significant gap in service coordination. Yogyakarta has a drug treatment sector in which most major treatment types are represented, and there appears to be potential for growth within many organisations. Nevertheless, the number and reach of the services are limited by a lack of resources and collaboration, and there are substantial cultural barriers to improving inter-organisational coordination. This study suggests that Yogyakarta and greater Indonesia may benefit from greater service coordination facilitated by local government. © 2011 Australasian Professional Society on Alcohol and other Drugs.

[Determinants of health and health policy. Part 3. From intervention of quality of life].

PubMed

Zácek, A

2000-03-29

Effectiveness of outputs of a qualified intervention can be valued by several positive criteria corresponding to the "quality of life" conception, which is based on the feeling of the health and contentment. The finding that great differences in the income among different social groups in conditions of the liberal market society correlate with several health and social problems brought about to the hypothesis that the decrease of the differences in the income, accompanied by strengthening of various forms of the social cohesion, civic solidarity, legitimate equality, and ethical justice may substantially improve the health status of the population. The hypothesis has been verified in many epidemiological studies and found to be valid enough for the health policy and far-seeing economy. Analytics of the World Bank recommend to governments primary invest into the health of socially week groups in order to decrease their poverty and to keep social conciliation. World Health Organization (WHO) sets in its new program for Europe called "21 Goals for the 21st Century" that differences in the health status among the European states should diminish till 2020 by one third and within the countries by one quarter at least. Both goals should be achieved by a substantial improvement of the health status of the ill-adapted social groups and by significant improvement of those socioeconomical conditions which may have adverse effects namely on the differences in incomes, education and opportunities for employment.

The impact of patient advocacy: the University of California-San Francisco experience.

PubMed

Carroll, Peter R

2004-11-01

Although the principal goals of health care advocacy are to raise awareness of specific issues and make them national priorities, it is important that physicians should recognize that advocacy is a multidimensional phenomenon. In 1997 a group of scientists, administrators, clinicians and patients met to discuss individual goals, needs and areas of mutual interest in the areas of prostate cancer care and research. A formal advocacy group was established and advocates were integrated into the administration and planning process in specific areas of the clinical and research program. In an effort to quantitate and communicate the impact of this group we assessed outcomes in the last 5 years in 4 areas matched to group interests and priorities, namely research, clinical trials, patient services and philanthropy. Improvements in all assessed metrics were noted (18% to 1,796%), most substantially in the areas of research grants (286%) and philanthropy (1,796%). The highlight of the collaborative effort was the awarding of the University of California-San Francisco Prostate Cancer SPORE, which included a highly rated, formal advocacy core. Advocates initiated at least 25 new initiatives to improve patient services in the areas of access to care, patient education, psychosocial support, outreach, etc. Since the initiation of a prostate cancer advocacy effort at our institution, substantial and quantitative improvements in several key metrics have been identified. Although an exact cause and effect cannot be stated with certainty, it seems likely. The successful collaboration was based on a multidimensional patient advocacy effort.

Addressing challenges of training a new generation of clinician-innovators through an interdisciplinary medical technology design program: Bench-to-Bedside.

PubMed

Loftus, Patrick D; Elder, Craig T; D'Ambrosio, Troy; Langell, John T

2015-01-01

Graduate medical education has traditionally focused on training future physicians to be outstanding clinicians with basic and clinical science research skills. This focus has resulted in substantial knowledge gains, but a modest return on investment based on direct improvements in clinical care. In today's shifting healthcare landscape, a number of important challenges must be overcome to not only improve the delivery of healthcare, but to prepare future physicians to think outside the box, focus on and create healthcare innovations, and navigate the complex legal, business and regulatory hurdles of bringing innovation to the bedside. We created an interdisciplinary and experiential medical technology design competition to address these challenges and train medical students interested in moving new and innovative clinical solutions to the forefront of medicine. Medical students were partnered with business, law, design and engineering students to form interdisciplinary teams focused on developing solutions to unmet clinical needs. Over the course of six months teams were provided access to clinical and industry mentors, $500 prototyping funds, development facilities, and non-mandatory didactic lectures in ideation, design, intellectual property, FDA regulatory requirements, prototyping, market analysis, business plan development and capital acquisition. After four years of implementation, the program has supported 396 participants, seen the development of 91 novel medical devices, and launched the formation of 24 new companies. From our perspective, medical education programs that develop innovation training programs and shift incentives from purely traditional basic and clinical science research to also include high-risk innovation will see increased student engagement in improving healthcare delivery and an increase in the quality and quantity of innovative solutions to medical problems being brought to market.

Evaluation of Laparoscopic Curricula in American Urology Residency Training: A 5-Year Update.

PubMed

Clements, Matthew B; Morrison, Kasey Y; Schenkman, Noah S

2016-03-01

Medical simulation offers the advantage of improving resident skill and comfort without impacting patient care. Five years ago, we identified trends in the use of robotic and laparoscopic simulation in 2008 and 2009 at American urology residency training programs. We seek to identify the changes in the use of simulators and the presence of formal curricula in the wake of technological advances and changes in graduate medical education. Attendees of the American Urological Association (AUA) Basic Sciences Course, mostly in their second or third year of residency, were surveyed on the availability and use of laparoscopic/robotic simulators at their program, the presence of a formal curriculum, and a Likert scale questionnaire regarding face and content validity. Over a 5-year period, the availability of virtual reality robotic simulators substantially increased from 14% to nearly 60% availability in 2013. Despite this increase, the frequency of simulator use remained unchanged (p = 0.40) and the reported presence of formal curricula decreased from 41% to 34.8%. There was no significant difference in simulator use between residents in programs with or without laparoscopic/robotic curricula (p = 0.95). There was also a decrease in the percentage of residents who felt official laparoscopic curricula (93%-81%) and simulators (82%-74%) should be involved in resident education. In the past 5 years, despite evidence supporting benefits from simulator use and increasing availability, self-reported resident use has remained unchanged and the reporting of presence of laparoscopic/robotic curricula has decreased. With more dedicated investment in formal curricula, residency training programs may receive greater returns on their simulator investments, improve resident skills and comfort, and ultimately improve the quality of patient care.

10 CFR 1040.63 - Discrimination prohibited.

Code of Federal Regulations, 2010 CFR

2010-01-01

... subjected to discrimination under any program or activity that receives Federal financial assistance from... or substantially impairing accomplishment of the objectives of the recipient's program or activity... subjecting them to discrimination under any program or activity that receives Federal financial assistance...

Implementation of Age-Specific Services for Transition-Age Youths in California.

PubMed

Ojeda, Victoria D; Hiller, Sarah P; Hurst, Samantha; Jones, Nev; McMenamin, Sara; Burgdorf, James; Gilmer, Todd P

2016-09-01

This study examined the implementation of age-specific services for transition-age youths in California under the Mental Health Services Act (MHSA). This study employed a sequential, exploratory mixed-methods design. Qualitative interviews with 39 mental health service area administrators in California were analyzed to develop an understanding of how the MHSA has facilitated the development of youth-specific programs or services. A quantitative survey of 180 youth-focused programs was also used to describe the range of services that were implemented, the use of evidence-based and promising practices, and the role of youths in the design, planning, delivery, and evaluation of services. Administrators described the MHSA as providing a programmatic focus and financial support for youth-specific services, outlining a stakeholder process to create buy-in and develop a vision for services, and emphasizing the role of youths in service delivery and planning. Youth-specific programs implemented a diverse array of services, including general medical care; employment and education support; housing placement and support; and family, mentoring, and social support. Programs described implementing evidence-based and promising practices and involving youths in service planning, implementation, or quality improvement activities. The MHSA has had a substantial impact on the landscape of youth-specific services in California by expanding both the number of programs and the diversity in types of services and by promoting the engagement of youths in the planning and delivery of services. Additional efforts are necessary to determine the extent to which youth-specific services yield greater improvements in youths' outcomes compared with services designed for adults.

Family intervention in Indigenous communities: emergent issues in conducting outcome research.

PubMed

Turner, Karen; Sanders, Matthew

2007-01-01

Indigenous children and youth are at greater risk of emotional and behavioural problems than non-Indigenous youth, with family life stresses and parenting style identified as common risk factors. There is substantial evidence that parenting programs can improve family relationships and improve child outcomes, however little research has focused on Indigenous communities. Our team is conducting research to evaluate a culturally sensitive adaptation of a mainstream intervention, the Group Triple P---Positive Parenting Program, for Indigenous families. This paper shares some of the insights into research and clinical issues gained as non-Indigenous researchers working with urban, rural and remote Indigenous communities. The experience of the research team and feedback from practitioners and parents have been drawn on for this discussion. Parenting programs need to be sensitive to the political and cultural context in which parenting takes place, flexibly incorporate cultural practices and expectations, and develop an evidence base of outcomes for families in diverse communities. As research is needed to evaluate the acceptability and effectiveness of these programs, culturally sensitive research practices are also necessary and the value of program evaluation and its benefit to the community must be clear. Community acceptance of the research process and the intervention itself is vital and may be influenced by community perceptions, current priorities, and local issues. If our overall aim is to increase the skilled health and mental health workforce in Indigenous communities and their use of evidence-based interventions, ongoing collaborative relationships between research institutions and service providers will serve to further this aim.

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia.

PubMed

Chew, Derek P; Carter, Robert; Rankin, Bree; Boyden, Andrew; Egan, Helen

2010-05-01

The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model. A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented. Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program's ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis. Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.

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

Peters, R.H.; Clingan, M.R.; Randolph, R.F.

The U.S. Bureau of Mines has prepared the report on strategies for maintaining high job attendance among underground coal miners because high absenteeism is a threat to miners' safety and seriously hampers productivity. A substantial number of research studies on the effectiveness of various strategies for reducing absenteeism among the employees of nonmining industries have been reported in the literature. These strategies have aimed at improving job attendance through one or more of the following: improving employment procedures, overcoming problems that adversely affect one's ability to attend work, and increasing miners' motivation to attend work. Many of these strategies appearmore » applicable to the mining industry and are reviewed in the first half of the report. The second half of the report describes how one could develop and implement a program for maintaining high attendance at underground coal mines.« less

41 CFR 101-6.204-2 - Specific discriminatory actions prohibited.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REGULATIONS 6.2-Nondiscrimination in Programs Receiving Federal Financial Assistance § 101-6.204-2 Specific... under the program (including the opportunity to participate in the program as an employee but only to... defeating or substantially impairing accomplishment of the objectives of the program as respect individuals...

Financial impact of divorce on children and their families.

PubMed

Teachman, J D; Paasch, K M

1994-01-01

This article reviews the evidence pertaining to the financial impact of divorce on children and their families. While there is some variance as to the degree of change, the preponderance of evidence suggests that women and children experience substantial financial declines upon divorce while divorced men's relative income remains stable or even increases. Given this decline in women and children's economic status, the impact of public assistance programs is next considered followed by a discussion of child support and property settlements. The authors then present a discussion of roadblocks to economic recovery and recommend policies to improve the financial status of divorced mothers with children.

Exploring the potential of short-baseline physics at Fermilab

NASA Astrophysics Data System (ADS)

Miranda, O. G.; Pasquini, Pedro; Tórtola, M.; Valle, J. W. F.

2018-05-01

We study the capabilities of the short-baseline neutrino program at Fermilab to probe the unitarity of the lepton mixing matrix. We find the sensitivity to be slightly better than the current one. Motivated by the future DUNE experiment, we have also analyzed the potential of an extra liquid Argon near detector in the LBNF beamline. Adding such a near detector to the DUNE setup will substantially improve the current sensitivity on nonunitarity. This would help to remove C P degeneracies due to the new complex phase present in the neutrino mixing matrix. We also study the sensitivity of our proposed setup to light sterile neutrinos for various configurations.

National environmental observing system to mitigate the effects of nuclear-biological-chemical (NBC) attacks: strategic and tactical

NASA Astrophysics Data System (ADS)

Fleming, Rex J.

2003-09-01

The challenge of obtaining an adequate environmental support system to help mitigate the effects of various terrorist generated plumes is articulated and a fiscally responsible solution is presented. A substantially improved national system of upper air data observing systems serves as a powerful information source prior to a terrorist event. A mobile tactical observing system for measuring the environment and for measuring the composition and intensity of the plume is implemented immediately following an event. Only proven and tested technologies are used. Program costs, benefits for the fight against terrorism, and multiple benefits to other aspects of the economy are summarized.

Training for older adults.

PubMed

Hautier, C; Bonnefoy, M

2007-07-01

Aging is associated with a reduction in physical fitness, with loss of muscular force and endurance. Physical activity has been demonstrated to provide substantial health benefits and to maintain functional independence and improve quality of life in older adults. Resistance training has a significant effect on muscle mass and force whereas endurance training increases oxygen transport and consumption capacities. This article presents training methods used in the literature and their associated effects in order to adapt training protocols to older populations. To maximise benefits from adoption of a program to which the patient can adhere for long time, it is important to tailor the exercise prescription to the individual.

Efficacy of a short cognitive training program in patients with multiple sclerosis

PubMed Central

Pérez-Martín, María Yaiza; González-Platas, Montserrat; Eguía-del Río, Pablo; Croissier-Elías, Cristina; Jiménez Sosa, Alejandro

2017-01-01

Background Cognitive impairment is a common feature in multiple sclerosis (MS) and may have a substantial impact on quality of life. Evidence about the effectiveness of neuropsychological rehabilitation is still limited, but current data suggest that computer-assisted cognitive training improves cognitive performance. Objective The objective of this study was to evaluate the efficacy of combined computer-assisted training supported by home-based neuropsychological training to improve attention, processing speed, memory and executive functions during 3 consecutive months. Methods In this randomized controlled study blinded for the evaluators, 62 MS patients with clinically stable disease and mild-to-moderate levels of cognitive impairment were randomized to receive a computer-assisted neuropsychological training program (n=30) or no intervention (control group [CG]; n=32). The cognitive assessment included the Brief Repeatable Battery of Neuropsychological Test. Other secondary measures included subjective cognitive impairment, anxiety and depression, fatigue and quality of life measures. Results The treatment group (TG) showed significant improvements in measures of verbal memory, working memory and phonetic fluency after intervention, and repeated measures analysis of covariance revealed a positive effect in most of the functions. The control group (CG) did not show changes. The TG showed a significant reduction in anxiety symptoms and significant improvement in quality of life. There were no improvements in fatigue levels and depressive symptoms. Conclusion Cognitive intervention with a computer-assisted training supported by home training between face-to-face sessions is a useful tool to treat patients with MS and improve functions such as verbal memory, working memory and phonetic fluency. PMID:28223806

The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families

PubMed Central

Shah, Prakesh S.; McDonald, Sarah D.; Barrett, Jon; Synnes, Anne; Robson, Kate; Foster, Jonathan; Pasquier, Jean-Charles; Joseph, K.S.; Piedboeuf, Bruno; Lacaze-Masmonteil, Thierry; O'Brien, Karel; Shivananda, Sandesh; Chaillet, Nils; Pechlivanoglou, Petros

2018-01-01

Background: Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. Methods: Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. Interpretation: These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates. PMID:29348260

The impact of disease management on outcomes and cost of care: a study of low-income asthma patients.

PubMed

Rossiter, L F; Whitehurst-Cook, M Y; Small, R E; Shasky, C; Bovbjerg, V E; Penberthy, L; Okasha, A; Green, J; Ibrahim, I A; Yang, S; Lee, K

2000-01-01

An asthma disease management program designed specifically for low-income patients experiencing significant adverse events can improve health outcomes substantially, while lowering costs. The Virginia Health Outcomes Partnership aimed to help physicians in a fee-for-service primary care case management program manage asthma in Medicaid recipients. Approximately one-third of physicians treating asthma in an area designated as the intervention community volunteered to participate in training on disease management and communication skills. This large-scale study discovered that the rate of emergency visit claims for patients of participating physicians who received feedback reports dropped an average of 41% from the same quarter a year earlier, compared to only 18% for comparison community physicians. Although only a third of the intervention community physicians participated in the training, emergency visit rates for all intervention community physicians nonetheless declined by 6% relative to the comparison community among moderate-to-severe asthma patients when data for participating and nonparticipating physicians were combined. At the same time, the dispensing of some reliever drugs recommended for asthma increased 25% relative to the comparison community. A cost-effectiveness analysis projected direct savings to Medicaid of $3 to $4 for every incremental dollar spent providing disease management support to physicians. The results of this study demonstrate the potential this program offers, especially for Medicaid programs in other states that want to improve the care of their primary care case management networks and, at the same time, manage costs.

The Diabetes Management Education Program in South Texas: An Economic and Clinical Impact Analysis.

PubMed

Kash, Bita A; Lin, Szu-Hsuan; Baek, Juha; Ohsfeldt, Robert L

2017-01-01

Diabetes is a major chronic disease that can lead to serious health problems and high healthcare costs without appropriate disease management and treatment. In the United States, the number of people diagnosed with diabetes and the cost for diabetes treatment has dramatically increased over time. To improve patients' self-management skills and clinical outcomes, diabetes management education (DME) programs have been developed and operated in various regions. This community case study explores and calculates the economic and clinical impacts of expanding a model DME program into 26 counties located in South Texas. The study sample includes 355 patients with type 2 diabetes and a follow-up hemoglobin A1c level measurement among 1,275 individuals who participated in the DME program between September 2012 and August 2013. We used the Gilmer's cost differentials model and the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine methodology to predict 3-year healthcare cost savings and 10-year clinical benefits of implementing a DME program in the selected 26 Texas counties. Changes in estimated 3-year cost and the estimated treatment effect were based on baseline hemoglobin A1c level. An average 3-year reduction in medical treatment costs per program participant was $2,033 (in 2016 dollars). The total healthcare cost savings for the 26 targeted counties increases as the program participation rate increases. The total projected cost saving ranges from $12 million with 5% participation rate to $185 million with 75% participation rate. A 10-year outlook on additional clinical benefits associated with the implementation and expansion of the DME program at 60% participation is estimated to result in approximately 4,838 avoided coronary heart disease cases and another 392 cases of avoided strokes. The implementation of this model DME program in the selected 26 counties would contribute to substantial healthcare cost savings and clinical benefits. Organizations that provide DME services may benefit from reduction in medical treatment costs and improvement in clinical outcomes for populations with diabetes.

The Nutritional Impact of the Dairy Price Support Program.

ERIC Educational Resources Information Center

Heien, Dale; Wessells, Cathy Roheim

1988-01-01

Examined the impact of the dairy price support program and its resulting higher prices on nutrition intake, especially calcium. A demand system emphasizing dairy products was estimated. Concluded that nutrient intake would increase substantially if the program was terminated. (JOW)

5 CFR 900.704 - Discrimination prohibited.

Code of Federal Regulations, 2010 CFR

2010-01-01

... objectives of the recipient's program with respect to handicapped persons, or (iii) That perpetuate the... substantially impairing the accomplishment of the objectives of the program or activity with respect to... REGULATIONS (CONTINUED) INTERGOVERNMENTAL PERSONNEL ACT PROGRAMS Nondiscrimination on the Basis of Handicap in...

Effect of a six-week walking program on work place activity limitations among adults with arthritis.

PubMed

Nyrop, Kirsten A; Charnock, Brian L; Martin, Kathryn R; Lias, Jennifer; Altpeter, Mary; Callahan, Leigh F

2011-12-01

To conduct an exploratory evaluation of the impact of the Arthritis Foundation's evidence-based Walk With Ease (WWE) program on work place activity limitations of adults with self-reported or doctor-diagnosed arthritis. WWE participants who were self-identified as "employed" completed the Workplace Activity Limitation Scale (WALS) at 6-week (postintervention; n = 94) and 1-year followup (n = 69). Paired t-tests were used to determine whether reduced work place limitations were reported at 6 weeks and maintained at 1-year followup. Participants were on average age 55 years, 88% women, and 61% white. The mean body mass index was 32 kg/m2 , and 81% had more than a high school education. Overall WALS scores improved significantly from a mean ± SD of 6.7 ± 3.99 at baseline to 5.5 ± 4.20 at 6-week followup (P < 0.001, effect size 0.30). Improvements were maintained at 1-year followup, i.e., no change from 6-week followup (P = 0.87). Work place activities reported by participants as "some" or "a lot" of difficulty at baseline, i.e., "crouch/bend/kneel/work in awkward positions," "stand for long periods," and "lift/carry/move objects," showed some of the highest improvements at 6 weeks. "Concentrate/keep your mind on the job" also improved significantly, although it was not rated as a substantial difficulty at baseline. Our study provides encouraging evidence that WWE, a brief, low-cost, and easy-to-do community-based walking program, may provide both immediate and sustained benefits for people with self-reported arthritis who also report a range of work place limitations related to their arthritis symptoms. Copyright © 2011 by the American College of Rheumatology.

Enhanced Recovery After Surgery: A Review.

PubMed

Ljungqvist, Olle; Scott, Michael; Fearon, Kenneth C

2017-03-01

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.

Improving the outcomes of children affected by parental substance abuse: a review of randomized controlled trials

PubMed Central

Calhoun, Stacy; Conner, Emma; Miller, Melodi; Messina, Nena

2015-01-01

Substance abuse is a major public health concern that impacts not just the user but also the user’s family. The effect that parental substance abuse has on children has been given substantial attention over the years. Findings from the literature suggest that children of substance-abusing parents have a high risk of developing physical and mental health and behavioral problems. A number of intervention programs have been developed for parents who have a substance abuse problem. There have also been a number of interventions that have been developed for children who have at least one parent with a substance abuse problem. However, it remains unclear how we can best mitigate the negative effects that parental substance abuse has on children due to the scarcity of evaluations that utilize rigorous methodologies such as experimental designs. The purpose of this study is to review randomized controlled trials of intervention programs targeting parents with substance abuse problems and/or children with at least one parent with a substance abuse problem in order to identify programs that show some promise in improving the behavioral and mental health outcomes of children affected by parental substance abuse. Four randomized controlled trials that met our eligibility criteria were identified using major literature search engines. The findings from this review suggest that interventions that focus on improving parenting practices and family functioning may be effective in reducing problems in children affected by parental substance abuse. However, further research utilizing rigorous methodologies are needed in order to identify other successful interventions that can improve the outcomes of these children long after the intervention has ended. PMID:25670915

Fifteen years of sector-wide approach (SWAp) in Bangladesh health sector: an assessment of progress

PubMed Central

Ahsan, Karar Zunaid; Streatfield, Peter Kim; Ijdi, Rashida -E-; Escudero, Gabriela Maria; Khan, Abdul Waheed; Reza, M M

2016-01-01

The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh embarked on a sector-wide approach (SWAp) modality for the health, nutrition and population (HNP) sector in 1998. This programmatic shift initiated a different set of planning disciplines and practices along with institutional changes in the MOHFW. Over the years, the SWAp modality has evolved in Bangladesh as the MOHFW has learnt from its implementation and refined the program design. This article explores the progress made, both in terms of achievement of health outcomes and systems strengthening results, since the implementation of the SWAp for Bangladesh’s health sector. Secondary analyses of survey data from 1993 to 2011 as well as a literature review of published and grey literature on health SWAp in Bangladesh was conducted for this assessment. Results of the assessment indicate that the MOHFW made substantial progress in health outcomes and health systems strengthening. SWAps facilitated the alignment of funding and technical support around national priorities, and improved the government’s role in program design as well as in implementation and development partner coordination. Notable systemic improvements have taken place in the country systems with regards to monitoring and evaluation, procurement and service provision, which have improved functionality of health facilities to provide essential care. Implementation of the SWAp has, therefore, contributed to an accelerated improvement in key health outcomes in Bangladesh over the last 15 years. The health SWAp in Bangladesh offers an example of a successful adaptation of such an approach in a complex administrative structure. Based on the lessons learned from SWAp implementation in Bangladesh, the MOHFW needs to play a stronger stewardship and regulatory role to reap the full benefits of a SWAp in its subsequent programming. PMID:26582744

Rotavirus vaccines

PubMed Central

Yen, Catherine; Tate, Jacqueline E; Hyde, Terri B; Cortese, Margaret M; Lopman, Benjamin A; Jiang, Baoming; Glass, Roger I; Parashar, Umesh D

2014-01-01

Rotavirus is the leading cause of severe diarrhea among children <5 years worldwide. Currently licensed rotavirus vaccines have been efficacious and effective, with many countries reporting substantial declines in diarrheal and rotavirus-specific morbidity and mortality. However, the full public health impact of these vaccines has not been realized. Most countries, including those with the highest disease burden, have not yet introduced rotavirus vaccines into their national immunization programs. Research activities that may help inform vaccine introduction decisions include (1) establishing effectiveness, impact, and safety for rotavirus vaccines in low-income settings; (2) identifying potential strategies to improve performance of oral rotavirus vaccines in developing countries, such as zinc supplementation; and (3) pursuing alternate approaches to oral vaccines, such as parenteral immunization. Policy- and program-level barriers, such as financial implications of new vaccine introductions, should be addressed to ensure that countries are able to make informed decisions regarding rotavirus vaccine introduction. PMID:24755452

Problem-based learning in laboratory medicine resident education: a satisfaction survey.

PubMed

Lepiller, Quentin; Solis, Morgane; Velay, Aurélie; Gantner, Pierre; Sueur, Charlotte; Stoll-Keller, Françoise; Barth, Heidi; Fafi-Kremer, Samira

2017-04-01

Theoretical knowledge in biology and medicine plays a substantial role in laboratory medicine resident education. In this study, we assessed the contribution of problem-based learning (PBL) to improve the training of laboratory medicine residents during their internship in the department of virology, Strasbourg University Hospital, France. We compared the residents' satisfaction regarding an educational program based on PBL and a program based on lectures and presentations. PBL induced a high level of satisfaction (100%) among residents compared to lectures and presentations (53%). The main advantages of this technique were to create a situational interest regarding virological problems, to boost the residents' motivation and to help them identify the most relevant learning objectives in virology. However, it appears pertinent to educate the residents in appropriate bibliographic research techniques prior to PBL use and to monitor their learning by regular formative assessment sessions.

Role of Retinopathy of Prematurity (ROP) Tertiary Centers of Excellence in Capacity-building.

PubMed

Rani, Padmaja Kumari; Balakrishnanan, D; Padhi, T R; Jalali, Subhadra

2016-11-07

Tertiary Centres of Excellence in India have been at the forefront of the efforts against Retinopathy of Prematurity (ROP) - associated blindness. The epidemic of blindness from ROP; however, has now spread rapidly into large parts of interiors of developing countries due to improved newborn care facilities. Due to their knowledge and experience of more than a decade, these centres of excellence, both from child care and Ophthalmology care, now need to come forward in substantial measures and need to be supported by funds and programs so that concerns of neonatal eye-health, training, screening, prevention and treatment can get integrated and embedded into newborn critical care and health programs. This will protect newborn preterm survivors from losing the potentially good vision that they are born with, reduce the rapidly rising blindness epidemic, and also protect staff from potential high-value litigations.

An overview of autonomous rendezvous and docking system technology development

NASA Astrophysics Data System (ADS)

Nelson, Kurt D.

The Centaur upper stage was selected for an airborne avionics modernization program. The parts used in the existing avionics units were obsolete. Continued use of existing hardware would require substantial redesign, yet would result in the use of outdated hardware. Out of date processes, with very expensive and labor intensive technologies, were being used for manufacturing. The Atlas/Centaur avionics were to be procured at a fairly high rate that demanded the use of modern components. The new avionics also reduce size, weight, power, and parts count with a dramatic improvement in reliability. Finally, the cost leverage derived from upgrading the avionics as opposed to any other subsystem for the existing Atlas/Centaur was a very large consideration in the upgrade decision. The upgrade program is a multiyear effort that began in 1989. It includes telemetry, guidance and navigation, control electronics, thrust vector control, and redundancy levels.

Energy Efficient Engine exhaust mixer model technology report addendum; phase 3 test program

NASA Technical Reports Server (NTRS)

Larkin, M. J.; Blatt, J. R.

1984-01-01

The Phase 3 exhaust mixer test program was conducted to explore the trends established during previous Phases 1 and 2. Combinations of mixer design parameters were tested. Phase 3 testing showed that the best performance achievable within tailpipe length and diameter constraints is 2.55 percent better than an optimized separate flow base line. A reduced penetration design achieved about the same overall performance level at a substantially lower level of excess pressure loss but with a small reduction in mixing. To improve reliability of the data, the hot and cold flow thrust coefficient analysis used in Phases 1 and 2 was augmented by calculating percent mixing from traverse data. Relative change in percent mixing between configurations was determined from thrust and flow coefficient increments. The calculation procedure developed was found to be a useful tool in assessing mixer performance. Detailed flow field data were obtained to facilitate calibration of computer codes.

Reintegration of child soldiers in Burundi: a tracer study

PubMed Central

2012-01-01

Background Substantial attention and resources are aimed at the reintegration of child soldiers, yet rigorous evaluations are rare. Methods This tracer study was conducted among former child soldiers (N=452) and never-recruited peers (N=191) who participated in an economic support program in Burundi. Socio-economic outcome indicators were measured retrospectively for the period before receiving support (T1; 2005–06); immediately afterwards (T2; 2006–07); and at present (T3; 2010). Participants also rated present functional impairment and mental health indicators. Results Participants reported improvement on all indicators, especially economic opportunity and social integration. At present no difference existed between both groups on any of the outcome indicators. Socio-economic functioning was negatively related with depression- and, health complaints and positively with intervention satisfaction. Conclusion The present study demonstrates promising reintegration trajectories of former child soldiers after participating in a support program. PMID:23095403

Practical applications of new research information in the practice of bovine embryo transfer.

PubMed

Looney, C R; Pryor, J H

2010-01-01

For more than 40 years, practitioners have sought to improve all aspects of commercial bovine embryo transfer. The development of new technologies for this industry has been substantial, with recent focus on cryopreservation techniques and the in vitro production of embryos fertilised with sexed spermatozoa. When these and other new technologies are developed, the following questions remain: (1) is said technology regulated or does it require licensing; and (2) is it applicable and, if so, is it financially feasible? Computer access to published research and the advancement of data software programs conducive to the industry for data procurement have been essential for helping practitioners answer these questions by enhancing their ability to analyse and apply data. The focus of the present paper is to aid commercial embryo transfer practitioners in determining new technologies that are available and whether they can be implemented effectively, benefiting their programs.

Social Skills Training for Adolescents With Intellectual Disabilities: A School-Based Evaluation.

PubMed

O'Handley, Roderick D; Ford, W Blake; Radley, Keith C; Helbig, Kate A; Wimberly, Joy K

2016-07-01

Individuals with intellectual disabilities (ID) often demonstrate impairments in social functioning, with deficits becoming more apparent during adolescence. This study evaluated the effects of the Superheroes Social Skills program, a program that combines behavioral skills training and video modeling to teach target social skills, on accurate demonstration of three target social skills in adolescents with ID. Skills taught in the present study include Expressing Wants and Needs, Conversation, and Turn Taking. Four adolescents with ID participated in a 3-week social skills intervention, with the intervention occurring twice per week. A multiple baseline across skills design was used to determine the effect of the intervention on social skill accuracy in both a training and generalization setting. All participants demonstrated substantial improvements in skill accuracy in both settings, with teacher ratings of social functioning further suggesting generalization of social skills to nontraining settings. © The Author(s) 2016.

The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization

PubMed Central

Baicker, Katherine; Chernew, Michael; Robbins, Jacob

2013-01-01

More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial – offsetting more than 10% of increased payments to Medicare Advantage plans. PMID:24308880

Hazardous Waste Worker Education

PubMed Central

McQuiston, Thomas H.; Coleman, Paula; Wallerstein, Nina B.; Marcus, Alfred C.; Morawetz, John S.; Ortlieb, David W.

2014-01-01

This study illustrates how a union education center successfully integrated adult empowerment education principles into the teaching methods and curriculum of a health and safety training program. The 12-month follow-up phone survey involved 481 local union respondents each representing a separate plant site and a group of 50 manager trainees. The evaluation shows that the training manual continued to be used by more than 70% of respondents, more than 70% taught coworkers, more than 50% of union trainees went on to train their managers, and more than 90% identified problems at work and sought and obtained changes in programs, training, or equipment. More than 20% reported that major spills had occurred following training. The majority stated that the handling of the spills improved. More than 80% stated that the training better prepared them for their health and safety duties. The managers’ data substantially supported union members’ reports. PMID:7884572

12 CFR 794.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... UNION ADMINISTRATION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES...

29 CFR 4907.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... PROCEDURES ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY...

22 CFR 711.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE OVERSEAS PRIVATE INVESTMENT...

47 CFR 1.1803 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... having, a mental or physical impairment that substantially limits one or more major life activities. (4...; (ii) Has a physical or mental impairment that substantially limits major life activities only as a... on the Basis of Disability In Programs or Activities Conducted By the Federal Communications...

The Impacts of Water Conservation Strategies on Water Use: Four Case Studies.

PubMed

Tsai, Yushiou; Cohen, Sara; Vogel, Richard M

2011-08-01

We assessed impacts on water use achieved by implementation of controlled experiments relating to four water conservation strategies in four towns within the Ipswich watershed in Massachusetts. The strategies included (1) installation of weather-sensitive irrigation controller switches (WSICS) in residences and municipal athletic fields; (2) installation of rainwater harvesting systems in residences; (3) two outreach programs: (a) free home indoor water use audits and water fixture retrofit kits and (b) rebates for low-water-demand toilets and washing machines; and (4) soil amendments to improve soil moisture retention at a municipal athletic field. The goals of this study are to summarize the effectiveness of the four water conservation strategies and to introduce nonparametric statistical methods for evaluating the effectiveness of these conservation strategies in reducing water use. It was found that (1) the municipal WSICS significantly reduced water use; (2) residences with high irrigation demand were more likely than low water users to experience a substantial demand decrease when equipped with the WSICS; (3) rainwater harvesting provided substantial rainwater use, but these volumes were small relative to total domestic water use and relative to the natural fluctuations in domestic water use; (4) both the audits/retrofit and rebate programs resulted in significant water savings; and (5) a modeling approach showed potential water savings from soil amendments in ball fields.

The Impacts of Water Conservation Strategies on Water Use: Four Case Studies1

PubMed Central

Tsai, Yushiou; Cohen, Sara; Vogel, Richard M

2011-01-01

We assessed impacts on water use achieved by implementation of controlled experiments relating to four water conservation strategies in four towns within the Ipswich watershed in Massachusetts. The strategies included (1) installation of weather-sensitive irrigation controller switches (WSICS) in residences and municipal athletic fields; (2) installation of rainwater harvesting systems in residences; (3) two outreach programs: (a) free home indoor water use audits and water fixture retrofit kits and (b) rebates for low-water-demand toilets and washing machines; and (4) soil amendments to improve soil moisture retention at a municipal athletic field. The goals of this study are to summarize the effectiveness of the four water conservation strategies and to introduce nonparametric statistical methods for evaluating the effectiveness of these conservation strategies in reducing water use. It was found that (1) the municipal WSICS significantly reduced water use; (2) residences with high irrigation demand were more likely than low water users to experience a substantial demand decrease when equipped with the WSICS; (3) rainwater harvesting provided substantial rainwater use, but these volumes were small relative to total domestic water use and relative to the natural fluctuations in domestic water use; (4) both the audits/retrofit and rebate programs resulted in significant water savings; and (5) a modeling approach showed potential water savings from soil amendments in ball fields. PMID:22457572

Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study.

PubMed

Cantrell, Jennifer; Shelley, Donna

2009-12-17

Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care. The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26) and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement. Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers. Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific staff members, and supported by internal systems that ensure adequate tracking and follow up of smokers. Ongoing staff training and patient self-management techniques are also needed to ease the introduction of new programs and increase their acceptability to smokers.

Computer Programs for Library Operations; Results of a Survey Conducted Between Fall 1971 and Spring 1972.

ERIC Educational Resources Information Center

Liberman, Eva; And Others

Many library operations involving large data banks lend themselves readily to computer operation. In setting up library computer programs, in changing or expanding programs, cost in programming and time delays could be substantially reduced if the programmers had access to library computer programs being used by other libraries, providing similar…

49 CFR 21.5 - Discrimination prohibited.

Code of Federal Regulations, 2010 CFR

2010-10-01

... defeating or substantially impairing accomplishment of the objectives of the program with respect to... program receiving Federal financial assistance include any service, financial aid, or other benefit... financial assistance to a program to which this part applies is to provide employment, a recipient or other...

43 CFR 17.203 - Discrimination prohibited.

Code of Federal Regulations, 2010 CFR

2010-10-01

... under any program or activity which receives Federal financial assistance. (b) Discriminatory actions... substantially impairing the accomplishment of the objectives of the program or activity with respect to... ASSISTED PROGRAMS OF THE DEPARTMENT OF THE INTERIOR Nondiscrimination on the Basis of Handicap § 17.203...

24 CFR 594.23 - Approval and certification procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES JOHN HEINZ NEIGHBORHOOD DEVELOPMENT PROGRAM Award and... to challenge in a substantial manner the certifications made by the applicant pursuant to § 594.30... that tends to challenge in a substantial manner an applicant's certification, HUD may require further...

41 CFR 51-10.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

13 CFR 136.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... having, a mental or physical impairment that substantially limits one or more major life activities. (4...) Has a physical or mental impairment that substantially limits major life activities only as a result... THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE SMALL BUSINESS ADMINISTRATION § 136...

5 CFR 1207.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... NONDISCRIMINATION ON THE BASIS OF DISABILITY IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE MERIT SYSTEMS PROTECTION...

32 CFR 1699.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY SELECTIVE SERVICE SYSTEM § 1699...

5 CFR 723.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the...) ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE OFFICE OF...

20 CFR 365.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... mental or physical impairment that substantially limits one or more major life activities. (4) Is... physical or mental impairment that substantially limits major life activities only as a result of the... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE RAILROAD RETIREMENT BOARD...

Review of the magnetic fusion program by the 1986 ERAB Fusion Panel

NASA Astrophysics Data System (ADS)

Davidson, Ronald C.

1987-09-01

The 1986 ERAB Fusion Panel finds that fusion energy continues to be an attractive energy source with great potential for the future, and that the magnetic fusion program continues to make substantial technical progress. In addition, fusion research advances plasma physics, a sophisticated and useful branch of applied science, as well as technologies important to industry and defense. These factors fully justify the substantial expenditures by the Department of Energy in fusion research and development (R&D). The Panel endorses the overall program direction, strategy, and plans, and recognizes the importance and timeliness of proceeding with a burning plasma experiment, such as the proposed Compact Ignition Tokamak (CIT) experiment.

Retention in care among HIV-infected patients in resource-limited settings: emerging insights and new directions.

PubMed

Geng, Elvin H; Nash, Denis; Kambugu, Andrew; Zhang, Yao; Braitstein, Paula; Christopoulos, Katerina A; Muyindike, Winnie; Bwana, Mwebesa Bosco; Yiannoutsos, Constantin T; Petersen, Maya L; Martin, Jeffrey N

2010-11-01

In resource-limited settings--where a massive scale-up of HIV services has occurred in the last 5 years--both understanding the extent of and improving retention in care presents special challenges. First, retention in care within the decentralizing network of services is likely higher than existing estimates that account only for retention in clinic, and therefore antiretroviral therapy services may be more effective than currently believed. Second, both magnitude and determinants of patient retention vary substantially and therefore encouraging the conduct of locally relevant epidemiology is needed to inform programmatic decisions. Third, socio-structural factors such as program characteristics, transportation, poverty, work/child care responsibilities, and social relations are the major determinants of retention in care, and therefore interventions to improve retention in care should focus on implementation strategies. Research to assess and improve retention in care for HIV-infected patients can be strengthened by incorporating novel methods such as sampling-based approaches and a causal analytic framework.

Protocols for Molecular Modeling with Rosetta3 and RosettaScripts

PubMed Central

2016-01-01

Previously, we published an article providing an overview of the Rosetta suite of biomacromolecular modeling software and a series of step-by-step tutorials [Kaufmann, K. W., et al. (2010) Biochemistry 49, 2987–2998]. The overwhelming positive response to this publication we received motivates us to here share the next iteration of these tutorials that feature de novo folding, comparative modeling, loop construction, protein docking, small molecule docking, and protein design. This updated and expanded set of tutorials is needed, as since 2010 Rosetta has been fully redesigned into an object-oriented protein modeling program Rosetta3. Notable improvements include a substantially improved energy function, an XML-like language termed “RosettaScripts” for flexibly specifying modeling task, new analysis tools, the addition of the TopologyBroker to control conformational sampling, and support for multiple templates in comparative modeling. Rosetta’s ability to model systems with symmetric proteins, membrane proteins, noncanonical amino acids, and RNA has also been greatly expanded and improved. PMID:27490953

Tai Chi and balance control.

PubMed

Wong, Alice M K; Lan, Ching

2008-01-01

Balance function begins to decline from middle age on, and poor balance function increases the risk of fall and injury. Suitable exercise training may improve balance function and prevent accidental falls. The coordination of visual, proprioceptive, vestibular and musculoskeletal system is important to maintain balance. Balance function can be evaluated by functional balance testing and sensory organization testing. Tai Chi Chuan (TC) is a popular conditioning exercise in the Chinese community, and recent studies substantiate that TC is effective in balance function enhancement and falls prevention. In studies utilizing functional balance testing, TC may increase the duration of one-leg standing and the distance of functional reach. In studies utilizing sensory organization testing, TC improves static and dynamic balance, especially in more challenging sensory perturbed condition. Therefore, TC may be prescribed as an alternative exercise program for elderly subjects or balance-impaired patients. Participants can choose to perform a complete set of TC or selected movements according to their needs. In conclusion, TC may improve balance function and is appropriate for implementation in the community.

Monitoring of health and demographic outcomes in poor urban settlements: evidence from the Nairobi Urban Health and Demographic Surveillance System.

PubMed

Emina, Jacques; Beguy, Donatien; Zulu, Eliya M; Ezeh, Alex C; Muindi, Kanyiva; Elung'ata, Patricia; Otsola, John K; Yé, Yazoumé

2011-06-01

The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor.

Improving Access to Hospice Care: Informing the Debate

PubMed Central

CARLSON, MELISSA D.A.; MORRISON, R. SEAN; BRADLEY, ELIZABETH H.

2015-01-01

The most frequently cited policy solution for improving access to hospice care for patients and families is to expand hospice eligibility criteria under the Medicare Hospice Benefit. However, the substantial implications of such a policy change have not been fully articulated or evaluated. This paper seeks to identify and describe the implications of expanding Medicare Hospice Benefit eligibility on the nature of hospice care, the cost of hospice care to the Medicare program, and the very structure of hospice and palliative care delivery in the United States. The growth in hospice has been dramatic and the central issue facing policymakers and the hospice industry is defining the appropriate target population for hospice care. As policymakers and the hospice industry discuss the future of hospice and potential changes to the Medicare Hospice Benefit, it is critical to clearly delineate the options—and the implications and challenges of each option—for improving access to hospice care for patients and families. PMID:18363486