Task uncertainty and communication during nursing shift handovers.

PubMed

Mayor, Eric; Bangerter, Adrian; Aribot, Myriam

2012-09-01

We explore variations in handover duration and communication in nursing units. We hypothesize that duration per patient is higher in units facing high task uncertainty. We expect both topics and functions of communication to vary depending on task uncertainty. Handovers are changing in modern healthcare organizations, where standardized procedures are increasingly advocated for efficiency and reliability reasons. However, redesign of handover should take environmental contingencies of different clinical unit types into account. An important contingency in institutions is task uncertainty, which may affect how communicative routines like handover are accomplished. Nurse unit managers of 80 care units in 18 hospitals were interviewed in 2008 about topics and functions of handover communication and duration in their unit. Interviews were content-analysed. Clinical units were classified into a theory-based typology (unit type) that gradually increases on task uncertainty. Quantitative analyses were performed. Unit type affected resource allocation. Unit types facing higher uncertainty had higher handover duration per patient. As expected, unit type also affected communication content. Clinical units facing higher uncertainty discussed fewer topics, discussing treatment and care and organization of work less frequently. Finally, unit type affected functions of handover: sharing emotions was less often mentioned in unit types facing higher uncertainty. Task uncertainty and its relationship with functions and topics of handover should be taken into account during the design of handover procedures. © 2011 Blackwell Publishing Ltd.

“It's like two worlds apart”: an analysis of vulnerable patient handover practices at discharge from hospital

PubMed Central

Groene, Raluca Oana; Orrego, Carola; Suñol, Rosa; Barach, Paul; Groene, Oliver

2012-01-01

Background Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. Objective To explore handover practices at discharge and to focus on the patients’ role in handovers and on the potential additional risks for vulnerable patients. Methods We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain. Results We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems. Conclusions Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment. PMID:23112285

IEEE 802.21 Assisted Seamless and Energy Efficient Handovers in Mixed Networks

NASA Astrophysics Data System (ADS)

Liu, Huaiyu; Maciocco, Christian; Kesavan, Vijay; Low, Andy L. Y.

Network selection is the decision process for a mobile terminal to handoff between homogeneous or heterogeneous networks. With multiple available networks, the selection process must evaluate factors like network services/conditions, monetary cost, system conditions, user preferences etc. In this paper, we investigate network selection using a cost function and information provided by IEEE 802.21. The cost function provides flexibility to balance different factors in decision making and our research is focused on improving both seamlessness and energy efficiency of handovers. Our solution is evaluated using real WiFi, WiMax, and 3G signal strength traces. The results show that appropriate networks were selected based on selection policies, handovers were triggered at optimal times to increase overall network connectivity as compared to traditional triggering schemes, while at the same time the energy consumption of multi-radio devices for both on-going operations as well as during handovers is optimized.

"WhatsApp"ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center.

PubMed

Khanna, Vishesh; Sambandam, Senthil N; Gul, Arif; Mounasamy, Varatharaj

2015-07-01

Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.

Supporting Seamless Mobility for P2P Live Streaming

PubMed Central

Kim, Eunsam; Kim, Sangjin; Lee, Choonhwa

2014-01-01

With advent of various mobile devices with powerful networking and computing capabilities, the users' demand to enjoy live video streaming services such as IPTV with mobile devices has been increasing rapidly. However, it is challenging to get over the degradation of service quality due to data loss caused by the handover. Although many handover schemes were proposed at protocol layers below the application layer, they inherently suffer from data loss while the network is being disconnected during the handover. We therefore propose an efficient application-layer handover scheme to support seamless mobility for P2P live streaming. By simulation experiments, we show that the P2P live streaming system with our proposed handover scheme can improve the playback continuity significantly compared to that without our scheme. PMID:24977171

Prediction-based association control scheme in dense femtocell networks.

PubMed

Sung, Nak Woon; Pham, Ngoc-Thai; Huynh, Thong; Hwang, Won-Joo; You, Ilsun; Choo, Kim-Kwang Raymond

2017-01-01

The deployment of large number of femtocell base stations allows us to extend the coverage and efficiently utilize resources in a low cost manner. However, the small cell size of femtocell networks can result in frequent handovers to the mobile user, and consequently throughput degradation. Thus, in this paper, we propose predictive association control schemes to improve the system's effective throughput. Our design focuses on reducing handover frequency without impacting on throughput. The proposed schemes determine handover decisions that contribute most to the network throughput and are proper for distributed implementations. The simulation results show significant gains compared with existing methods in terms of handover frequency and network throughput perspective.

Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center.

PubMed

Bauer, Natasha Johan

2016-01-01

Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association. A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Just over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient's age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. These findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the effects of these changes.

Knapsack - TOPSIS Technique for Vertical Handover in Heterogeneous Wireless Network

PubMed Central

2015-01-01

In a heterogeneous wireless network, handover techniques are designed to facilitate anywhere/anytime service continuity for mobile users. Consistent best-possible access to a network with widely varying network characteristics requires seamless mobility management techniques. Hence, the vertical handover process imposes important technical challenges. Handover decisions are triggered for continuous connectivity of mobile terminals. However, bad network selection and overload conditions in the chosen network can cause fallout in the form of handover failure. In order to maintain the required Quality of Service during the handover process, decision algorithms should incorporate intelligent techniques. In this paper, a new and efficient vertical handover mechanism is implemented using a dynamic programming method from the operation research discipline. This dynamic programming approach, which is integrated with the Technique to Order Preference by Similarity to Ideal Solution (TOPSIS) method, provides the mobile user with the best handover decisions. Moreover, in this proposed handover algorithm a deterministic approach which divides the network into zones is incorporated into the network server in order to derive an optimal solution. The study revealed that this method is found to achieve better performance and QoS support to users and greatly reduce the handover failures when compared to the traditional TOPSIS method. The decision arrived at the zone gateway using this operational research analytical method (known as the dynamic programming knapsack approach together with Technique to Order Preference by Similarity to Ideal Solution) yields remarkably better results in terms of the network performance measures such as throughput and delay. PMID:26237221

Knapsack--TOPSIS Technique for Vertical Handover in Heterogeneous Wireless Network.

PubMed

Malathy, E M; Muthuswamy, Vijayalakshmi

2015-01-01

In a heterogeneous wireless network, handover techniques are designed to facilitate anywhere/anytime service continuity for mobile users. Consistent best-possible access to a network with widely varying network characteristics requires seamless mobility management techniques. Hence, the vertical handover process imposes important technical challenges. Handover decisions are triggered for continuous connectivity of mobile terminals. However, bad network selection and overload conditions in the chosen network can cause fallout in the form of handover failure. In order to maintain the required Quality of Service during the handover process, decision algorithms should incorporate intelligent techniques. In this paper, a new and efficient vertical handover mechanism is implemented using a dynamic programming method from the operation research discipline. This dynamic programming approach, which is integrated with the Technique to Order Preference by Similarity to Ideal Solution (TOPSIS) method, provides the mobile user with the best handover decisions. Moreover, in this proposed handover algorithm a deterministic approach which divides the network into zones is incorporated into the network server in order to derive an optimal solution. The study revealed that this method is found to achieve better performance and QoS support to users and greatly reduce the handover failures when compared to the traditional TOPSIS method. The decision arrived at the zone gateway using this operational research analytical method (known as the dynamic programming knapsack approach together with Technique to Order Preference by Similarity to Ideal Solution) yields remarkably better results in terms of the network performance measures such as throughput and delay.

Prediction-based association control scheme in dense femtocell networks

PubMed Central

Pham, Ngoc-Thai; Huynh, Thong; Hwang, Won-Joo; You, Ilsun; Choo, Kim-Kwang Raymond

2017-01-01

The deployment of large number of femtocell base stations allows us to extend the coverage and efficiently utilize resources in a low cost manner. However, the small cell size of femtocell networks can result in frequent handovers to the mobile user, and consequently throughput degradation. Thus, in this paper, we propose predictive association control schemes to improve the system’s effective throughput. Our design focuses on reducing handover frequency without impacting on throughput. The proposed schemes determine handover decisions that contribute most to the network throughput and are proper for distributed implementations. The simulation results show significant gains compared with existing methods in terms of handover frequency and network throughput perspective. PMID:28328992

Effectiveness of a role-play simulation program involving the sbar technique: A quasi-experimental study.

PubMed

Yu, Mi; Kang, Kyung Ja

2017-06-01

Accurate, skilled communication in handover is of high priority in maintaining patients' safety. Nursing students have few chances to practice nurse-to-doctor handover in clinical training, and some have little knowledge of what constitutes effective handover or lack confidence in conveying information. This study aimed to develop a role-play simulation program involving the Situation, Background, Assessment, Recommendation technique for nurse-to-doctor handover; implement the program; and analyze its effects on situation, background, assessment, recommendation communication, communication clarity, handover confidence, and education satisfaction in nursing students. Non-equivalent control-group pretest-posttest quasi-experimental. A convenience sample of 62 senior nursing students from two Korean universities. The differences in SBAR communication, communication clarity, handover confidence, and education satisfaction between the control and intervention groups were measured before and after program participation. The intervention group showed higher Situation, Background, Assessment, Recommendation communication scores (t=-3.05, p=0.003); communication clarity scores in doctor notification scenarios (t=-5.50, p<0.001); and Situation, Background, Assessment, Recommendation education satisfaction scores (t=-4.94, p<0.001) relative to those of the control group. There was no significant difference in handover confidence between groups (t=-1.97, p=0.054). The role-play simulation program developed in this study could be used to promote communication skills in nurse-to-doctor handover and cultivate communicative competence in nursing students. Copyright © 2017. Published by Elsevier Ltd.

Is patient flow more efficient in Urgent Care Collaborations?

PubMed

van Gils-van Rooij, Elisabeth S J; Meijboom, Berthold R; Broekman, Sjoerd M; Yzermans, Christoffel J; de Bakker, Dingenus H

2018-02-01

Emergency Departments and out-of-hours General Practitioner services collaborate increasingly in Urgent Care Collaborations (UCCs) by sharing one combined entrance and joint triage. The aim of this study is to examine the difference between UCCs and providers who operate separately with respect to the efficiency of patient flow. This study had a cross-sectional observational design comparing three regions with UCC with three regions with usual care. Outcome measures were efficiency of patient flow, defined as a reducing length of stay (LOS), waiting time (WT) and the mean number of handovers. Data were obtained from electronic medical records. LOS (median 34:00 vs. 38:52 min) and WT (median 14:00 vs. 18:43 min) were statistically significantly longer in UCCs compared with usual care. This difference is mainly explained by the prolonged LOS and WT for consulting a General Practitioner. The mean number of interunit handovers was larger in UCCs. The results indicate that, on average, UCCs do not enhance the efficiency of patient flow. The median LOS and WT are longer in UCCs and more handovers occur in UCCs compared with usual care.

Improving Weekend Out Of hours Surgical Handover (WOOSH).

PubMed

Boyer, Melissa; Tappenden, Janine; Peter, Mark

2016-01-01

An effective surgical handover is imperative to optimise patient care and safety, whilst ensuring progression of clinical management and the delivery of an efficient service. The introduction of full-shift working, as a response to progressive implementation of the European Working Time Directive (EWTD), has placed the spotlight on patient and doctor safety. Effective handover between shifts is vital to protect patient safety and assist doctors with clinical governance. The weekend is a critical point where the transfer of patient care to the ongoing weekend team is efficient, thorough and informative, as this is a point in the patient journey where the patient is the most vulnerable. The weekend team is often not responsible for the management of the patient throughout the week and poor or incomplete information can have disastrous consequences on patient safety. (1,2,3) There is a general consensus and anecdotal evidence that this process is variable, occasionally unsafe or of poor quality, and can be improved. (4,5,6,7,8,9,10,11) However, no standardised format is deemed optimal or available. The aim therefore, was to design and implement a weekend handover proforma, in order to deliver a more efficient and safer system for patient care over the weekend without increasing junior doctor workload. The Weekend Out Of Hours Surgical Handover (WOOSH) form was designed following consultation with medical, nursing and allied health professionals. All staff were instructed how to complete the form, with pre- and post-intervention questionnaires undertaken. The results of the study enforce and advocate the permanent practice of the WOOSH form with 93.33% endorsing the permanent introduction of the form and 100% finding the form useful.

Enhanced Security and Pairing-free Handover Authentication Scheme for Mobile Wireless Networks

NASA Astrophysics Data System (ADS)

Chen, Rui; Shu, Guangqiang; Chen, Peng; Zhang, Lijun

2017-10-01

With the widely deployment of mobile wireless networks, we aim to propose a secure and seamless handover authentication scheme that allows users to roam freely in wireless networks without worrying about security and privacy issues. Given the open characteristic of wireless networks, safety and efficiency should be considered seriously. Several previous protocols are designed based on a bilinear pairing mapping, which is time-consuming and inefficient work, as well as unsuitable for practical situations. To address these issues, we designed a new pairing-free handover authentication scheme for mobile wireless networks. This scheme is an effective improvement of the protocol by Xu et al., which is suffer from the mobile node impersonation attack. Security analysis and simulation experiment indicate that the proposed protocol has many excellent security properties when compared with other recent similar handover schemes, such as mutual authentication and resistance to known network threats, as well as requiring lower computation and communication cost.

Template for success: using a resident-designed sign-out template in the handover of patient care.

PubMed

Clark, Clancy J; Sindell, Sarah L; Koehler, Richard P

2011-01-01

Report our implementation of a standardized handover process in a general surgery residency program. The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System. Nonprofit, tertiary referral teaching hospital. General surgery residents, residency faculty, patient care providers, and hospital administration. After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents. The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Team communication during patient handover from the operating room: more than facts and figures.

PubMed

Manser, Tanja; Foster, Simon; Flin, Rhona; Patey, Rona

2013-02-01

This study was aimed at examining team communication during postoperative handover and its relationship to clinicians' self-ratings of handover quality. Adverse events can often be traced back to inadequate communication during patient handover. Research and improvement efforts have mostly focused on the information transfer function of patient handover. However, the specific mechanisms between handover communication processes among teams of transferring and receiving clinicians and handover quality are poorly understood. We conducted a prospective, cross-sectional observation study using a taxonomy for handover behaviors developed on the basis of established approaches for analyzing teamwork in health care. Immediately after the observation, transferring and receiving clinicians rated the quality of the handover using a structured tool for handover quality assessment. Handover communication during 117 handovers in three postoperative settings and its relationship to clinicians' self-ratings of handover quality were analyzed with the use of correlation analyses and analyses of variance. We identified significantly different patterns of handover communication between clinical settings and across handover roles. Assessments provided during handover were related to higher ratings of handover quality overall and to all four dimensions of handover quality identified in this study. If assessment was lacking, we observed compensatory information seeking by the receiving team. Handover quality is more than the correct, complete transmission of patient information. Assessments, including predictions or anticipated problems, are critical to the quality of postoperative handover. The identification of communication behaviors related to high-quality handovers is necessary to effectively support the design and evaluation of handover improvement efforts.

Research of Ad Hoc Networks Access Algorithm

NASA Astrophysics Data System (ADS)

Xiang, Ma

With the continuous development of mobile communication technology, Ad Hoc access network has become a hot research, Ad Hoc access network nodes can be used to expand capacity of multi-hop communication range of mobile communication system, even business adjacent to the community, improve edge data rates. When the ad hoc network is the access network of the internet, the gateway discovery protocol is very important to choose the most appropriate gateway to guarantee the connectivity between ad hoc network and IP based fixed networks. The paper proposes a QoS gateway discovery protocol which uses the time delay and stable route to the gateway selection conditions. And according to the gateway discovery protocol, it also proposes a fast handover scheme which can decrease the handover time and improve the handover efficiency.

Improving cardiac operating room to intensive care unit handover using a standardised handover process.

PubMed

Gleicher, Yehoshua; Mosko, Jeffrey David; McGhee, Irene

2017-01-01

Handovers from the cardiovascular operating room (CVOR) to the cardiovascular intensive care unit (CVICU) are complex processes involving the transfer of information, equipment and responsibility, at a time when the patient is most vulnerable. This transfer is typically variable in structure, content and execution. This variability can lead to the omission and miscommunication of critical information leading to patient harm. We set out to improve the quality of patient handover from the CVOR to the CVICU by introducing a standardised handover protocol. This study is an interventional time-series study over a 4-month period at an adult cardiac surgery centre. A standardised handover protocol was developed using quality improvement methodologies. The protocol included a handover content checklist and introduction of a formal 'sterile cockpit' timeout. Implementation of the protocol was refined using monthly iterative Plan-Do-Study-Act. The primary outcome was the quality of handovers, measured by a Handover Score, comprising handover content, teamwork and patient care planning indicators. Secondary outcomes included handover duration, adherence to the standardised handover protocol and handover team satisfaction surveys. 37 handovers were observed (6 pre intervention and 31 post intervention). The mean handover score increased from 6.5 to 14.0 (maximum 18 points). Specific improvements included fewer handover interruptions and more frequent postoperative patient care planning. Average handover duration increased slightly from 2:40 to 2:57 min. Caregivers noted improvements in teamwork, content received and patient care planning. The majority (>95%) agreed that the intervention was a valuable addition to the CVOR to CVICU handover process. Implementation of a standardised handover protocol for postcardiac surgery patients was associated with fewer interruptions during handover, more reliable transfer of critical content and improved patient care planning.

One size fits all? Challenges faced by physicians during shift handovers in a hospital with high sender/recipient ratio

PubMed Central

Yang, Xi Jessie; Park, Taezoon; Siah, Tien Ho Kewin; Ang, Bee Leng Sophia; Donchin, Yoel

2015-01-01

INTRODUCTION The aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio. METHODS We adopted a multifaceted approach, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders’ and recipients’ verbal communication, and recipients’ handwritten notes) and handover environmental factors were analysed. The relationship between ‘to-do’ tasks and information transfer, handover quality and handover duration was examined using analysis of variance. RESULTS Verbal handovers for 152 patients were observed. Handwritten notes on 102 (67.1%) patients and handover quality ratings for 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of non-modifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication) allowed for interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location. CONCLUSION Handovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised. PMID:25532519

The importance of the verbal shift handover report: a multi-site case study.

PubMed

Randell, Rebecca; Wilson, Stephanie; Woodward, Peter

2011-11-01

Shift handover is seen as a key tool in ensuring continuity of care yet a number of studies have highlighted the role of shift handovers in adverse events. This, combined with the increased frequency of shift handovers, has led to interest in providing technological support for handover to enhance safety. The aim of this paper is to describe current practices for the conduct of shift handovers and to use this as a basis for considering the role that technology could play in supporting handover. A multi-site case study of handover was conducted. Data included observations of 15 medical shift handovers and 33 nursing shift handovers across three case sites. The findings highlight the way in which the verbal shift handover report is practically focused, displaying the healthcare professional's ability to know what information is required and where further explanation is needed. As well as supporting teaching and team cohesion, shift handover can provide an opportunity to reflect on the previous shift and for discussion with patients and their families. The benefits provided by a face to face handover suggest that technology should focus on supporting rather than replacing the verbal shift handover report, providing a flexible solution that allows handover participants to gather more information as it is required. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Improving the quality of handover by addressing handover culture and introducing a new, multi-disciplinary, team-based handover meeting.

PubMed

Walton, Henry; Munro, Wendy

2015-01-01

Handover is a "major preventable cause of patient harm"[1] and this project aims to improve the quality of night handover within a teaching hospitals general medicine department, resulting in the safe transfer of patient care to the night team. Quality of handover was assessed both qualitatively, via structured qualitative interviews with trainees and a baseline survey assessing doctor's opinions of night handover, and quantitatively through the collection of a data set during regular observation of night handover. The initial intervention instituted a new handover meeting with a set time and new location and invited the night nurse practitioner to attend. A prompt card, standardised documentation, defined leadership, and an attendance register were also introduced. Successive PDSA cycles introduced technology to the intervention, enabled the nurse night practitioners to actually attend and re-branded the prompt card as an agenda. Results show a sustained reduction in length of handover from 70 minutes (n=7) to 34 minutes (n=13) post-intervention as well as a reduction in the number of distractions occurring during each handover from a mean of 14 to a mean of 8.5. An improved quality of handover was also demonstrated with an overall increase in the percentage of task handovers containing hospital number, an admitting diagnosis, comorbidities and a time allocated for the task to be performed of at least 10%. When trainees were surveyed post-implementation they unanimously identified the new handover system as safer than the previous handover process (n=30). This project demonstrates that replacing an ad-hoc system of handover with a multi-disciplinary, team based approach to handover improves handover quality. In addition it provides a useful guide to introducing a new handover meeting to a department and contains useful lessons on how to combat cultural barriers to change within a department.

A before-after study of multidisciplinary Out-of-Hours handover: combining management and frontline efforts to create sustainable improvement.

PubMed

Pennell, Christopher; Flynn, Lorna; Boulton, Belinda; Hughes, Tracey; Walker, Graham; McCulloch, Peter

2017-04-01

The importance of implementation strategy in systems improvement is increasingly recognized and both 'bottom-up' and 'top-down' approaches have significant barriers. A trial of a combined approach involving frontline and managerial staff therefore seems merited. We attempted to improve handover using a Human Factors-based approach integrated with a combined 'top and bottom' implementation strategy. A before-after study was conducted across 9 months. The study was set in a 236 bed district general hospital. Participants included any member of staff involved in Out of Hours handover. Existing processes were analysed using Human Factors methods. Changes made were based on this analysis and developed via facilitation between management and frontline staff. These included creating a single multidisciplinary handover, changing the venue, standardizing the meeting structure, developing an standard operating procedure for identifying unwell patients for handover and creating a clinical coordinator role. Meeting attendance, duration, start time efficiency, the type of patients handed over and the transfer of important information were measured pre- and post-intervention. We found improvement in handover start time (P = 0.002, r = 0) and multidisciplinary participation (P = 0.002, r = -0.534). Handover of unwell patients improved, but not significantly. Communication of plan (P < 0.001, r = 0.14) and pending tasks (P < 0.001, r = 0.30) improved, but diagnosis (P = 0.233, r = -0.05), history (P = 0.482, r = -0.03) and comorbidities (P = 0.19, r = -0.05) did not. The changes produced greater multidisciplinary participation, a broader focus and improved communication of plans and tasks outstanding. The 'top and bottom' implementation approach appeared valuable. Management involvement was essential for significant changes, while frontline staff involvement facilitated the design of context-specific practical solutions with staff buy-in. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Clinical handover of patients arriving by ambulance to the emergency department - a literature review.

PubMed

Bost, Nerolie; Crilly, Julia; Wallis, Marianne; Patterson, Elizabeth; Chaboyer, Wendy

2010-10-01

To provide a critical review of research on clinical handover between the ambulance service and emergency department (ED) in hospitals. Data base and hand searches were conducted using the keywords ambulance, handover, handoff, emergency department, emergency room, ER, communication, and clinical handover. Data were extracted, summarised and critically assessed to provide evidence of current clinical handover processes. From 252 documents, eight studies fitted the inclusion criteria of clinical handover and the ambulance to ED patient transfer. Three themes were identified in the review: (1) important information may be missed during clinical handover; (2) structured handovers that include both written and verbal components may improve information exchange; (3) multidisciplinary education about the clinical handover process may encourage teamwork, a shared common language and a framework for minimum patient information to be transferred from the ambulance service to the hospital ED. Knowledge gaps exist concerning handover information, consequences of poor handover, transfer of responsibility, staff perception of handovers, staff training and evaluation of recommended strategies to improve clinical handover. Evidence of strategies being implemented and further research is required to examine the ongoing effects of implementing the strategies. Copyright © 2009 Elsevier Ltd. All rights reserved.

Surgical handover in an era of reduced working hours: an audit of current practice.

PubMed

Shafiq-ur-Rehman; Mehmood, Sajid; Ahmed, Jamil; Razzaq, Muhammad Haroon; Khan, Shakeeb; Perry, Eugene Phillip

2012-06-01

To examine the current practice of handover and to record trainees' assessment of handover process. An audit study. Department of General Surgery, Scarborough General Hospital, Scarborough, United Kingdom, from January to April 2010. A paper-based questionnaire containing instruments pertaining to handover guidelines was disseminated to trainees on surgical on-call rota at the hospital. Trainees' responses regarding handover process including information transferred, designated location, duration, structure, senior supervision, awareness of guidelines, formal training, and rating of current handover practice were analysed. A total of 42 questionnaires were returned (response rate = 100%). The trainees included were; registrars 21% (n=9), core surgical trainees 38 % (n=16), and foundation trainees 41% (n=17). Satisfactory compliance (> 80% handover sessions) to RCS guidelines was observed for only five out of nine components. Ninety-five percent of hand over sessions took place at a designated place and two-third lasted less than 20-minutes. Computer generated handover sheet 57% (n=24) was the most commonly practised method of handover. Specialist registrar 69 % (n=29) remained the supervising person in majority of handover sessions. None of the respondents received formal teaching or training in handover, whereas only half of them 48% (n=20) were aware of handover guidelines. Twenty-one percent of the trainees expressed dissatisfaction with the current practice of handover. Current practice of surgical handover lacks structure despite a fair degree of compliance to RCS handover guidelines. A computerised-sheet based structured handover process, subjected to regular audit, would ensure patient safety and continuity of care.

Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey.

PubMed

Spooner, Amy J; Aitken, Leanne M; Chaboyer, Wendy

2017-11-15

There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

A New Ticket-Based Authentication Mechanism for Fast Handover in Mesh Network.

PubMed

Lai, Yan-Ming; Cheng, Pu-Jen; Lee, Cheng-Chi; Ku, Chia-Yi

2016-01-01

Due to the ever-growing popularity mobile devices of various kinds have received worldwide, the demands on large-scale wireless network infrastructure development and enhancement have been rapidly swelling in recent years. A mobile device holder can get online at a wireless network access point, which covers a limited area. When the client leaves the access point, there will be a temporary disconnection until he/she enters the coverage of another access point. Even when the coverages of two neighboring access points overlap, there is still work to do to make the wireless connection smoothly continue. The action of one wireless network access point passing a client to another access point is referred to as the handover. During handover, for security concerns, the client and the new access point should perform mutual authentication before any Internet access service is practically gained/provided. If the handover protocol is inefficient, in some cases discontinued Internet service will happen. In 2013, Li et al. proposed a fast handover authentication mechanism for wireless mesh network (WMN) based on tickets. Unfortunately, Li et al.'s work came with some weaknesses. For one thing, some sensitive information such as the time and date of expiration is sent in plaintext, which increases security risks. For another, Li et al.'s protocol includes the use of high-quality tamper-proof devices (TPDs), and this unreasonably high equipment requirement limits its applicability. In this paper, we shall propose a new efficient handover authentication mechanism. The new mechanism offers a higher level of security on a more scalable ground with the client's privacy better preserved. The results of our performance analysis suggest that our new mechanism is superior to some similar mechanisms in terms of authentication delay.

A New Ticket-Based Authentication Mechanism for Fast Handover in Mesh Network

PubMed Central

Lai, Yan-Ming; Cheng, Pu-Jen; Lee, Cheng-Chi; Ku, Chia-Yi

2016-01-01

Due to the ever-growing popularity mobile devices of various kinds have received worldwide, the demands on large-scale wireless network infrastructure development and enhancement have been rapidly swelling in recent years. A mobile device holder can get online at a wireless network access point, which covers a limited area. When the client leaves the access point, there will be a temporary disconnection until he/she enters the coverage of another access point. Even when the coverages of two neighboring access points overlap, there is still work to do to make the wireless connection smoothly continue. The action of one wireless network access point passing a client to another access point is referred to as the handover. During handover, for security concerns, the client and the new access point should perform mutual authentication before any Internet access service is practically gained/provided. If the handover protocol is inefficient, in some cases discontinued Internet service will happen. In 2013, Li et al. proposed a fast handover authentication mechanism for wireless mesh network (WMN) based on tickets. Unfortunately, Li et al.’s work came with some weaknesses. For one thing, some sensitive information such as the time and date of expiration is sent in plaintext, which increases security risks. For another, Li et al.’s protocol includes the use of high-quality tamper-proof devices (TPDs), and this unreasonably high equipment requirement limits its applicability. In this paper, we shall propose a new efficient handover authentication mechanism. The new mechanism offers a higher level of security on a more scalable ground with the client’s privacy better preserved. The results of our performance analysis suggest that our new mechanism is superior to some similar mechanisms in terms of authentication delay. PMID:27171160

Exploring Socio-Technical Insights for Safe Nursing Handover.

PubMed

Wong, Ming Chao; Yee, Kwang Chien; Turner, Paul

2017-01-01

Current efforts to improve nursing handover frequently use prescriptive approaches based on research evidence of handover issues within a single nursing ward or nursing specialty. Despite reported handover improvement, few studies adequately consider the transferability of results to other nursing handover environments or acknowledge the unique attributes that supported sustained improvement. With the increasing diffusion of electronic tools it has become even more critical to ensure that socio-technical issues that may impact on the quality and safety of nursing handovers are identified. This paper describes a qualitative research project that examined nursing handover in three different wards - General Medicine, General Surgery and Department of Emergency Medicine in a tertiary teaching hospital. Through conduct of a detailed analysis of nursing handover processes, this paper highlights the similarities and differences in the handover among the three different wards and presents five key socio-technical insights to support safe nursing handover.

A Novel RSSI Prediction Using Imperialist Competition Algorithm (ICA), Radial Basis Function (RBF) and Firefly Algorithm (FFA) in Wireless Networks

PubMed Central

Goudarzi, Shidrokh; Haslina Hassan, Wan; Abdalla Hashim, Aisha-Hassan; Soleymani, Seyed Ahmad; Anisi, Mohammad Hossein; Zakaria, Omar M.

2016-01-01

This study aims to design a vertical handover prediction method to minimize unnecessary handovers for a mobile node (MN) during the vertical handover process. This relies on a novel method for the prediction of a received signal strength indicator (RSSI) referred to as IRBF-FFA, which is designed by utilizing the imperialist competition algorithm (ICA) to train the radial basis function (RBF), and by hybridizing with the firefly algorithm (FFA) to predict the optimal solution. The prediction accuracy of the proposed IRBF–FFA model was validated by comparing it to support vector machines (SVMs) and multilayer perceptron (MLP) models. In order to assess the model’s performance, we measured the coefficient of determination (R2), correlation coefficient (r), root mean square error (RMSE) and mean absolute percentage error (MAPE). The achieved results indicate that the IRBF–FFA model provides more precise predictions compared to different ANNs, namely, support vector machines (SVMs) and multilayer perceptron (MLP). The performance of the proposed model is analyzed through simulated and real-time RSSI measurements. The results also suggest that the IRBF–FFA model can be applied as an efficient technique for the accurate prediction of vertical handover. PMID:27438600

A Novel RSSI Prediction Using Imperialist Competition Algorithm (ICA), Radial Basis Function (RBF) and Firefly Algorithm (FFA) in Wireless Networks.

PubMed

Goudarzi, Shidrokh; Haslina Hassan, Wan; Abdalla Hashim, Aisha-Hassan; Soleymani, Seyed Ahmad; Anisi, Mohammad Hossein; Zakaria, Omar M

2016-01-01

This study aims to design a vertical handover prediction method to minimize unnecessary handovers for a mobile node (MN) during the vertical handover process. This relies on a novel method for the prediction of a received signal strength indicator (RSSI) referred to as IRBF-FFA, which is designed by utilizing the imperialist competition algorithm (ICA) to train the radial basis function (RBF), and by hybridizing with the firefly algorithm (FFA) to predict the optimal solution. The prediction accuracy of the proposed IRBF-FFA model was validated by comparing it to support vector machines (SVMs) and multilayer perceptron (MLP) models. In order to assess the model's performance, we measured the coefficient of determination (R2), correlation coefficient (r), root mean square error (RMSE) and mean absolute percentage error (MAPE). The achieved results indicate that the IRBF-FFA model provides more precise predictions compared to different ANNs, namely, support vector machines (SVMs) and multilayer perceptron (MLP). The performance of the proposed model is analyzed through simulated and real-time RSSI measurements. The results also suggest that the IRBF-FFA model can be applied as an efficient technique for the accurate prediction of vertical handover.

Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care.

PubMed

Ramasubbu, Benjamin; Stewart, Emma; Spiritoso, Rosalba

2017-02-01

To audit the quality and safety of the current doctor-to-doctor handover of patient information in our Cardiothoracic Intensive Care Unit. If deficient, to implement a validated handover tool to improve the quality of the handover process. In Cycle 1 we observed the verbal handover and reviewed the written handover information transferred for 50 consecutive patients in St George's Hospital Cardiothoracic Intensive Care Unit. For each patient's handover, we assessed whether each section of the Identification, Situation, Background, Assessment, Recommendations tool was used on a scale of 0-2. Zero if no information in that category was transferred, one if the information was partially transferred and two if all relevant information was transferred. Each patient's handover received a score from 0 to 10 and thus, each cycle a total score of 0-500. Following the implementation of the Identification, Situation, Background, Assessment, Recommendations handover tool in our Intensive Care Unit in Cycle 2, we re-observed the handover process for another 50 consecutive patients hence, completing the audit cycle. There was a significant difference between the total scores from Cycle 1 and 2 (263/500 versus 457/500, p < 0.001). The median handover score for Cycle 1 was 5/10 (interquartile range 4-6). The median handover score for Cycle 2 was 9/10 (interquartile range 9-10). Patient handover scores increased significantly between Cycle 1 and 2, U = 13.5, p < 0.001. The introduction of a standardised handover template (Identification, Situation, Background, Assessment, Recommendations tool) has improved the quality and safety of the doctor-to-doctor handover of patient information in our Intensive Care Unit.

Exploring perinatal shift-to-shift handover communication and process: an observational study.

PubMed

Poot, Else P; de Bruijne, Martine C; Wouters, Maurice G A J; de Groot, Christianne J M; Wagner, Cordula

2014-04-01

Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety in perinatal care. SA refers to knowing what is going on around. Adequate handover communication and process may support situation assessment, a precursor of SA. This study describes current practices and opinions of perinatal handover to identify potential improvements. Structured direct observations of shift-to-shift patient handovers (n = 70) in an academic perinatal setting were used to measure handover communication (presence and order of levels of SA: current situation, background, assessment and recommendation) and process (duration, interruptions/distractions, eye contact, active inquiry and reading information back). Afterwards, receivers' opinions of handover communication (n = 51) were measured by means of a questionnaire. All levels of SA were present in 7% of handovers, the current situation in 86%, the background in 99%, an assessment in 24% and a recommendation in 46%. In 77% of handovers the background was mentioned first, followed by the current situation. Forty-four per cent of handovers took 2 minutes or more per patient. In 52% distractions occurred, in 43% there was no active inquiry, in 32% no eye contact and in 97% information was not read back. The overall mean of the receivers' opinions of handover communication was 4.1 (standard deviation ± 0.7; scale 1-5, where 5 is excellent). Perinatal handovers are currently at risk for inadequate situation assessment because of variability and limitations in handover communication and process. However, receivers' opinions of handover communication were very positive, indicating a lack of awareness of patient safety threats during handover. Therefore, the staff's awareness of current limitations should be raised, for example through video reflection or simulation training. © 2013 John Wiley & Sons, Ltd.

Investigation of a New Handover Approach in LTE and WiMAX

PubMed Central

Hindia, Mohammad Nour; Reza, Ahmed Wasif; Noordin, Kamarul Ariffin

2014-01-01

Nowadays, one of the most important challenges in heterogeneous networks is the connection consistency between the mobile station and the base stations. Furthermore, along the roaming process between the mobile station and the base station, the system performance degrades significantly due to the interferences from neighboring base stations, handovers to inaccurate base station and inappropriate technology selection. In this paper, several algorithms are proposed to improve mobile station performance and seamless mobility across the long-term evolution (LTE) and Worldwide Interoperability for Microwave Access (WiMAX) technologies, along with a minimum number of redundant handovers. Firstly, the enhanced global positioning system (GPS) and the novel received signal strength (RSS) prediction approaches are suggested to predict the target base station accurately. Then, the multiple criteria with two thresholds algorithm is proposed to prioritize the selection between LTE and WiMAX as the target technology. In addition, this study also covers the intercell and cochannel interference reduction by adjusting the frequency reuse ratio 3 (FRR3) to work with LTE and WiMAX. The obtained results demonstrate high next base station prediction efficiency and high accuracy for both horizontal and vertical handovers. Moreover, the received signal strength is kept at levels higher than the threshold, while maintaining low connection cost and delay within acceptable levels. In order to highlight the combination of the proposed algorithms' performance, it is compared with the existing RSS and multiple criteria handover decision algorithms. PMID:25379524

Investigation of a new handover approach in LTE and WiMAX.

PubMed

Hindia, Mohammad Nour; Reza, Ahmed Wasif; Noordin, Kamarul Ariffin

2014-01-01

Nowadays, one of the most important challenges in heterogeneous networks is the connection consistency between the mobile station and the base stations. Furthermore, along the roaming process between the mobile station and the base station, the system performance degrades significantly due to the interferences from neighboring base stations, handovers to inaccurate base station and inappropriate technology selection. In this paper, several algorithms are proposed to improve mobile station performance and seamless mobility across the long-term evolution (LTE) and Worldwide Interoperability for Microwave Access (WiMAX) technologies, along with a minimum number of redundant handovers. Firstly, the enhanced global positioning system (GPS) and the novel received signal strength (RSS) prediction approaches are suggested to predict the target base station accurately. Then, the multiple criteria with two thresholds algorithm is proposed to prioritize the selection between LTE and WiMAX as the target technology. In addition, this study also covers the intercell and cochannel interference reduction by adjusting the frequency reuse ratio 3 (FRR3) to work with LTE and WiMAX. The obtained results demonstrate high next base station prediction efficiency and high accuracy for both horizontal and vertical handovers. Moreover, the received signal strength is kept at levels higher than the threshold, while maintaining low connection cost and delay within acceptable levels. In order to highlight the combination of the proposed algorithms' performance, it is compared with the existing RSS and multiple criteria handover decision algorithms.

An Optimized Handover Scheme with Movement Trend Awareness for Body Sensor Networks

PubMed Central

Sun, Wen; Zhang, Zhiqiang; Ji, Lianying; Wong, Wai-Choong

2013-01-01

When a body sensor network (BSN) that is linked to the backbone via a wireless network interface moves from one coverage zone to another, a handover is required to maintain network connectivity. This paper presents an optimized handover scheme with movement trend awareness for BSNs. The proposed scheme predicts the future position of a BSN user using the movement trend extracted from the historical position, and adjusts the handover decision accordingly. Handover initiation time is optimized when the unnecessary handover rate is estimated to meet the requirement and the outage probability is minimized. The proposed handover scheme is simulated in a BSN deployment area in a hospital environment in UK. Simulation results show that the proposed scheme reduces the outage probability by 22% as compared with the existing hysteresis-based handover scheme under the constraint of acceptable handover rate. PMID:23736852

Clinical handover as an interactive event: informational and interactional communication strategies in effective shift-change handovers.

PubMed

Eggins, Suzanne; Slade, Diana

2012-01-01

Clinical handover -- the transfer between clinicians of responsibility and accountability for patients and their care (AMA 2006) -- is a pivotal and high-risk communicative event in hospital practice. Studies focusing on critical incidents, mortality, risk and patient harm in hospitals have highlighted ineffective communication -- including incomplete and unstructured clinical handovers -- as a major contributing factor (NSW Health 2005; ACSQHC 2010). In Australia, as internationally, Health Departments and hospital management have responded by introducing standardised handover communication protocols. This paper problematises one such protocol - the ISBAR tool - and argues that the narrow understanding of communication on which such protocols are based may seriously constrain their ability to shape effective handovers. Based on analysis of audio-recorded shift-change clinical handovers between medical staff we argue that handover communication must be conceptualised as inherently interactive and that attempts to describe, model and teach handover practice must recognise both informational and interactive communication strategies. By comparing the communicative performance of participants in authentic handover events we identify communication strategies that are more and less likely to lead to an effective handover and demonstrate the importance of focusing close up on communication to improve the quality and safety of healthcare interactions.

Information environments for supporting consistent registrar medical handover.

PubMed

Alem, Leila; Joseph, Michele; Kethers, Stefanie; Steele, Cathie; Wilkinson, Ross

This study was two-fold in nature. Initially, it examined the information environment and the use of customary information tools to support medical handovers in a large metropolitan teaching hospital on four weekends (i.e. Friday night to Monday morning). Weekend medical handovers were found to involve sequences of handovers where patients were discussed at the discretion of the doctor handing over; no reliable discussion of all patients of concern occurred at any one handover, with few information tools being used; and after a set of weekend handovers, there was no complete picture on a Monday morning without an analysis of all patient progress notes. In a subsequent case study, three information tools specifically designed as intervention that attempted to enrich the information environment were evaluated. Results indicate that these tools did support greater continuity in who was discussed but not in what was discussed at handover. After the intervention, if a doctor discussed a patient at handover, that patient was more likely to be discussed at subsequent handovers. However, the picture at Monday morning remained fragmentary. The results are discussed in terms of the complexities inherent in the handover process.

Assessing intern handover processes.

PubMed

Habicht, Robert; Block, Lauren; Silva, Kathryn Novello; Oliver, Nora; Wu, Albert; Feldman, Leonard

2016-06-01

New standards for resident work hours set in 2011 changed the landscape of patient care in teaching hospitals, and resulted in new challenges for US residency training programmes to overcome. One such challenge was a dramatic increase in the number of patient handovers performed by residents. As a result, there is a renewed focus for clinical teachers to develop educational strategies to optimise the patient handover process and improve the quality of patient care and safety. In order to investigate current gaps in resident handovers, we examined the handover processes performed by medicine interns at two academic medical centres in Baltimore, Maryland, USA. We used trained observers to collect data on whether handovers were conducted face to face, with questions asked, in private locations, with written documentation, and without distractions or interruptions. Results were analysed using chi-square tests, and adjusted for clustering at the observer and intern levels. Interns successfully conducted handovers face to face (99.5%), asked questions (85.3%), used private locations (91%), included written handover documentation (95.8%) and did not experience distractions for the majority of the time (87.7%); however, interruptions were pervasive, occurring 41.3 per cent of the time. In order to investigate current gaps in resident handovers, we examined the handover processes performed by medicine interns Interns conducted patient handovers face to face, with questions asked, in private locations, with written documentation and without distractions the majority of the time; however, interruptions during the handover process were common. Exploring gaps at the individual programme level is a critical first step to develop effective teaching strategies to optimise handovers in residency. © 2015 John Wiley & Sons Ltd.

Clinical handover practices in maternity services in Ireland: A qualitative descriptive study.

PubMed

Fealy, Gerard; Munroe, Deirdre; Riordan, Fiona; Croke, Eilish; Conroy, Celine; McNamara, Martin; Shannon, Michael

2016-08-01

the objective was to examine and describe clinical handover practices in Irish maternity services. the study design incorporated interviews and focus group discussions with a purposive sample of healthcare practitioners working in Irish maternity services. five maternity hospitals and fourteen co-located maternity units. midwives, obstetricians and other healthcare professionals, specifically physiotherapists and radiologists, midwifery students and health care assistants working in maternity services. the study participants provided nuanced and differentiated accounts of clinical handover practices, which indicated a general absence of formal policy and training on clinical handover and the practice of midwifery and medical teams holding separate clinical handovers based on their separate, respective needs for transferring information and clinical responsibility. Participants spoke of barriers to effective clinical handover, including unsuitable environments, lack of dedicated time and fatigue during duty shift clinical handover, lack of supportive information technology (IT) infrastructure, and resistance of some staff to the adoption of new technologies to support clinical handover. whether internal and external to clinical handover events, the barriers to effective clinical handover represent threats to patient safety and quality of care, since effective clinical handover is essential to the provision of safe quality care. clear and effective communication between collaborating professionals within maternity teams is essential. Copyright © 2016 Elsevier Ltd. All rights reserved.

Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover.

PubMed

Pickering, Brian W; Hurley, Killian; Marsh, Brian

2009-11-01

To use a handover assessment tool for identifying patient information corruption and objectively evaluating interventions designed to reduce handover errors and improve medical decision making. The continuous monitoring, intervention, and evaluation of the patient in modern intensive care unit practice generates large quantities of information, the platform on which medical decisions are made. Information corruption, defined as errors of distortion/omission compared with the medical record, may result in medical judgment errors. Identifying these errors may lead to quality improvements in intensive care unit care delivery and safety. Handover assessment instrument development study divided into two phases by the introduction of a handover intervention. Closed, 17-bed, university-affiliated mixed surgical/medical intensive care unit. Senior and junior medical members of the intensive care unit team. Electronic handover page. Study subjects were asked to recall clinical information commonly discussed at handover on individual patients. The handover score measured the percentage of information correctly retained for each individual doctor-patient interaction. The clinical intention score, a subjective measure of medical judgment, was graded (1-5) by three blinded intensive care unit experts. A total of 137 interactions were scored. Median (interquartile range) handover scores for phases 1 and 2 were 79.07% (67.44-84.50) and 83.72% (76.16-88.37), respectively. Score variance was reduced by the handover intervention (p < .05). Increasing median handover scores, 68.60 to 83.72, were associated with increases in clinical intention scores from 1 to 5 (chi-square = 23.59, df = 4, p < .0001). When asked to recall clinical information discussed at handover, medical members of the intensive care unit team provide data that are significantly corrupted compared with the medical record. Low subjective clinical judgment scores are significant associated with low handover scores. The handover/clinical intention scores may, therefore, be useful screening tools for intensive care unit system vulnerability to medical error. Additionally, handover instruments can identify interventions that reduce system vulnerability to error and may be used to guide quality improvements in handover practice.

Fuzzy Logic-based Intelligent Scheme for Enhancing QoS of Vertical Handover Decision in Vehicular Ad-hoc Networks

NASA Astrophysics Data System (ADS)

Azzali, F.; Ghazali, O.; Omar, M. H.

2017-08-01

The design of next generation networks in various technologies under the “Anywhere, Anytime” paradigm offers seamless connectivity across different coverage. A conventional algorithm such as RSSThreshold algorithm, that only uses the received strength signal (RSS) as a metric, will decrease handover performance regarding handover latency, delay, packet loss, and handover failure probability. Moreover, the RSS-based algorithm is only suitable for horizontal handover decision to examine the quality of service (QoS) compared to the vertical handover decision in advanced technologies. In the next generation network, vertical handover can be started based on the user’s convenience or choice rather than connectivity reasons. This study proposes a vertical handover decision algorithm that uses a Fuzzy Logic (FL) algorithm, to increase QoS performance in heterogeneous vehicular ad-hoc networks (VANET). The study uses network simulator 2.29 (NS 2.29) along with the mobility traffic network and generator to implement simulation scenarios and topologies. This helps the simulation to achieve a realistic VANET mobility scenario. The required analysis on the performance of QoS in the vertical handover can thus be conducted. The proposed Fuzzy Logic algorithm shows improvement over the conventional algorithm (RSSThreshold) in the average percentage of handover QoS whereby it achieves 20%, 21% and 13% improvement on handover latency, delay, and packet loss respectively. This is achieved through triggering a process in layer two and three that enhances the handover performance.

A tailored e-learning program to improve handover in the chain of emergency care: a pre-test post-test study.

PubMed

Ebben, Remco H A; van Grunsven, Pierre M; Moors, Marie Louise; Aldenhoven, Peter; de Vaan, Jordan; van Hout, Roger; van Achterberg, Theo; Vloet, Lilian C M

2015-04-16

To standardize patient handover in the chain of emergency care a handover guideline was developed. The main guideline recommendation is to use the DeMIST model (Demographics, Mechanism of Injury/illness, Injury/Illness, Signs, Treatment given) to structure pre-hospital notification and handover. To benefit from the new guideline, guideline adherence is necessary. As adherence to guidelines in emergency care settings is variable, there is a need to systematically implement the new guideline. For implementation of the guideline we developed a e-learning program tailored to influencing factors. The aim of the study was to evaluate the effectiveness of this e-learning program to improve emergency care professionals' adherence to the handover guideline during pre-hospital notification and handover in the chain of emergency medical service (EMS), emergency medical dispatch (EMD), and emergency department (ED). A prospective pre-test post-test study was conducted. The intervention was a tailored e-learning program that was offered to ambulance crew and emergency medical dispatchers (n=88). Data on adherence included pre-hospital notifications and handovers and were collected through observations and audiotapes before and after the e-learning program. Data were analyzed using X(2)-tests and t-tests. In total, 78/88 (88.6%) professionals followed the e-learning program. During pre- and post-test, 146 and 169 handovers were observed respectively. After the e-learning program, no significant difference in the number of handovers with the DeMIST model (77.9% vs. 73.1%, p=.319) and the number of handovers with the correct sequence of the DeMIST model (69.9% vs. 70.5%, p=.159) existed. During the handover, the number of questions by ED staff and interruptions significantly increased from 49.0% to 68.9% and from 15.2% to 52.7% respectively (both p=.000). Most handovers were performed after patient transfer, this did not change after the intervention (p=.167). The number of handovers where information was documented during handover slightly increased from 26.9% to 29.3% (p=.632). The tailored e-learning program did not improve adherence to a handover guideline in the chain of emergency care. Results show a relatively high baseline adherence rate to usage and correct sequence of the DeMIST model. Improvements in the handover process can be made on the documentation of information during handover, the number of interruptions and questions, and the handover moment.

A Fast MAC-Layer Handover for an IEEE 802.16e-Based WMAN

NASA Astrophysics Data System (ADS)

Ray, Sayan K.; Pawlikowski, Krzysztof; Sirisena, Harsha

We propose a modification of the IEEE 802.16e hard handover (HHO) procedure, which significantly reduces the handover latency constraint of the original HHO procedure in IEEE 802.16e networks. It allows a better handling of the delay-sensitive traffic by avoiding unnecessary time-consuming scanning and synchronization activity as well as simplifies the network re-entry procedure. With the help of the backhaul network, it reduces the number of control messages in the original handover policy, making the handover latency acceptable also for real-time streaming traffic. Preliminary performance evaluation studies show that the modified handover procedure is able to reduce the total handover latency by about 50%.

Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

PubMed

Johnston, Maximilian J; King, Dominic; Arora, Sonal; Cooper, Kerri; Panda, Neha Aparajita; Gosling, Rebecca; Singh, Kaushiki; Sanders, Bradley; Cox, Benita; Darzi, Ara

2014-08-01

In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety. © 2014 John Wiley & Sons, Ltd.

Optimising the emergency to ward handover process: A mixed methods study.

PubMed

Bakon, Shannon; Millichamp, Tracey

2017-11-01

The effective handover of patient health data from the emergency department to other hospital units is integral for the continuity of patient care. Yet no handover process has been identified as superior to others within this context. This study within a regional Australian hospital employed mixed methods approach including focus groups and key stakeholder consultation to develop a handover form appropriate for patient transfer from the emergency department to a variety of clinical areas. Paper-based surveys and audits were then employed to evaluate the implementation and understand staff perceptions of the form. The implementation of a patient handover form within the emergency setting was well received. Participants indicated that the form is clear, well designed and easy to navigate. It provided prompts to standardise their clinical handover and increased their accountability and responsibility within this process. To deliver an optimal nursing handover from the emergency department to various wards handovers should be structured and provide standardised content. The positive reception and use of this form provides evidence that a structured handover process can ensure standardisation of emergency department to ward nursing handovers. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Paediatric team handover: a time to learn?

PubMed

Bradley, Stephen; Egan, John P; Henning, Marcus

2018-06-08

Paediatric team handovers provide medical professionals and students with the opportunity to exchange clinically relevant information about patients. This study explored the extent to which learning opportunities existed and were utilised within paediatric team handovers in New Zealand secondary hospitals. We undertook a qualitative, two-site case study within two paediatric departments in 2014 and 2015, and interviewed 29 participants, including medical students, junior doctors and consultants. We conducted a thematic analysis using a general inductive approach. Participants' narratives revealed that safe transfer of pertinent patient information between clinicians was the primary function of team handover. They described learning as an additional key component. Most learning opportunities were reported to be informal and opportunistic, related to the specific patients whose care was discussed within each handover. Handover team members indicated that implicit learning occurred as a feature of their handover experience. Learning opportunities exist within team handovers and the associated learning frequently occurs either opportunistically or implicitly. Adoption of a reflective approach to learning opportunities is likely to result in improved educational experiences for handover participants, particularly medical students and junior doctors. Handover represents a clinical event within which valuable workplace learning occurs.

The Handover Toolbox: a knowledge exchange and training platform for improving patient care.

PubMed

Drachsler, Hendrik; Kicken, Wendy; van der Klink, Marcel; Stoyanov, Slavi; Boshuizen, Henny P A; Barach, Paul

2012-12-01

Safe and effective patient handovers remain a global organisational and training challenge. Limited evidence supports available handover training programmes. Customisable training is a promising approach to improve the quality and sustainability of handover training and outcomes. We present a Handover Toolbox designed in the context of the European HANDOVER Project. The Toolbox aims to support physicians, nurses, individuals in health professions training, medical educators and handover experts by providing customised handover training tools for different clinical needs and contexts. The Handover Toolbox uses the Technology Enhanced Learning Design Process (TEL-DP), which encompasses user requirements analysis; writing personas; group concept mapping; analysis of suitable software; plus, minus, interesting rating; and usability testing. TEL-DP is aligned with participatory design approaches and ensures development occurs in close collaboration with, and engagement of, key stakeholders. Application of TEL-DP confirmed that the ideal formats of handover training differs for practicing professionals versus individuals in health profession education programmes. Training experts from different countries differed in their views on the optimal content and delivery of training. Analysis of suitable software identified ready-to-use systems that provide required functionalities and can be further customised to users' needs. Interest rating and usability testing resulted in improved usability, navigation and uptake of the Handover Toolbox. The design of the Handover Toolbox was based on a carefully led stakeholder participatory design using the TEL-DP approach. The Toolbox supports a customisable learning approach that allows trainers to design training that addresses the specific information needs of the various target groups. We offer recommendations regarding the application of the Handover Toolbox to medical educators.

Development of an orthopedic surgery trauma patient handover checklist.

PubMed

LeBlanc, Justin; Donnon, Tyrone; Hutchison, Carol; Duffy, Paul

2014-02-01

In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.

Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

PubMed

Clarke, Christina M; Persaud, Drepaul David

2011-03-01

Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

Introducing a New Junior Doctor Electronic Weekend Handover on an Orthopaedic Ward.

PubMed

Maroo, Siddharth; Raj, Dipak

2017-01-01

Junior Doctors working on the Orthopaedic wards at a district general hospital identified the lack of a formal weekend handover. The Royal Colleges,GMC and Foundation Programme curriculum all emphasise the importance of a safe and effective handover. Doctors found that the current system of using a written, paper-based handover was unreliable, un-legible, and inefficient. Baseline measurements were sought in the form of a questionnaire which allowed us to obtain the limitations to the current handover. After this and a focus group, a new electronic, 'Microsoft Word' based handover was created and a repeat surgery issued in 2 weeks. Further PDSA cycles over the course of 8 weeks helped to improve and implement the new handover. The overall rating, out of 10, of the new handover increased from 3.4 to 8. Doctors felt the new handover was safer for patients and could be used as a tool for reviewing or referring patients. This project describes the use of a simple, cost-effective intervention that helped to improve patient safety and staff satisfaction.

Interprofessional communication supporting clinical handover in emergency departments: An observation study.

PubMed

Redley, Bernice; Botti, Mari; Wood, Beverley; Bucknall, Tracey

2017-08-01

Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents; (2) Behaviours and interactions; (3) Content; and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

An Improved Cross-Layering Design for IPv6 Fast Handover with IEEE 802.16m Entry Before Break Handover

NASA Astrophysics Data System (ADS)

Kim, Ronny Yongho; Jung, Inuk; Kim, Young Yong

IEEE 802.16m is an advanced air interface standard which is under development for IMT-Advanced systems, known as 4G systems. IEEE 802.16m is designed to provide a high data rate and a Quality of Service (QoS) level in order to meet user service requirements, and is especially suitable for mobilized environments. There are several factors that have great impact on such requirements. As one of the major factors, we mainly focus on latency issues. In IEEE 802.16m, an enhanced layer 2 handover scheme, described as Entry Before Break (EBB) was proposed and adopted to reduce handover latency. EBB provides significant handover interruption time reduction with respect to the legacy IEEE 802.16 handover scheme. Fast handovers for mobile IPv6 (FMIPv6) was standardized by Internet Engineering Task Force (IETF) in order to provide reduced handover interruption time from IP layer perspective. Since FMIPv6 utilizes link layer triggers to reduce handover latency, it is very critical to jointly design FMIPv6 with its underlying link layer protocol. However, FMIPv6 based on new handover scheme, EBB has not been proposed. In this paper, we propose an improved cross-layering design for FMIPv6 based on the IEEE 802.16m EBB handover. In comparison with the conventional FMIPv6 based on the legacy IEEE 802.16 network, the overall handover interruption time can be significantly reduced by employing the proposed design. Benefits of this improvement on latency reduction for mobile user applications are thoroughly investigated with both numerical analysis and simulation on various IP applications.

Best Practices in Shift Handover Communication: Mars Exploration Rover Surface Operations

NASA Astrophysics Data System (ADS)

Parke, Bonny; Mishkin, Andrew

2005-12-01

During its prime mission, Mars Exploration Rover (MER) had many shift handovers in its surface operations. Because of the increased rates of accidents and errors historically associated with shift handovers, MER Mission management paid close attention to shift handovers and, when possible, developed them in accordance with best handover practices.We review the most important of these best practices, and include a generic "Checklist for Effective Handovers" to aid in the development of handovers.We present charts that depict structured information transfer across shifts. These charts show personnel schedules, meetings attended, handovers, and hand-offs on both the MER and on the earlier Mars Pathfinder Mission (MPF). It is apparent from these charts that although the MER Mission had a much larger number of surface operations personnel than MPF (approximately 300 vs. 178), and had three shifts instead of two, that it used many of the successful MPF communication strategies. Charts such as these can be helpful to those designing complicated and unique mission surface operations.

Cloud-based mobility management in heterogeneous wireless networks

NASA Astrophysics Data System (ADS)

Kravchuk, Serhii; Minochkin, Dmytro; Omiotek, Zbigniew; Bainazarov, Ulan; Weryńska-Bieniasz, RóŻa; Iskakova, Aigul

2017-08-01

Mobility management is the key feature that supports the roaming of users between different systems. Handover is the essential aspect in the development of solutions supporting mobility scenarios. The handover process becomes more complex in a heterogeneous environment compared to the homogeneous one. Seamlessness and reduction of delay in servicing the handover calls, which can reduce the handover dropping probability, also require complex algorithms to provide a desired QoS for mobile users. A challenging problem to increase the scalability and availability of handover decision mechanisms is discussed. The aim of the paper is to propose cloud based handover as a service concept to cope with the challenges that arise.

Enhanced Handover Decision Algorithm in Heterogeneous Wireless Network

PubMed Central

Abdullah, Radhwan Mohamed; Zukarnain, Zuriati Ahmad

2017-01-01

Transferring a huge amount of data between different network locations over the network links depends on the network’s traffic capacity and data rate. Traditionally, a mobile device may be moved to achieve the operations of vertical handover, considering only one criterion, that is the Received Signal Strength (RSS). The use of a single criterion may cause service interruption, an unbalanced network load and an inefficient vertical handover. In this paper, we propose an enhanced vertical handover decision algorithm based on multiple criteria in the heterogeneous wireless network. The algorithm consists of three technology interfaces: Long-Term Evolution (LTE), Worldwide interoperability for Microwave Access (WiMAX) and Wireless Local Area Network (WLAN). It also employs three types of vertical handover decision algorithms: equal priority, mobile priority and network priority. The simulation results illustrate that the three types of decision algorithms outperform the traditional network decision algorithm in terms of handover number probability and the handover failure probability. In addition, it is noticed that the network priority handover decision algorithm produces better results compared to the equal priority and the mobile priority handover decision algorithm. Finally, the simulation results are validated by the analytical model. PMID:28708067

Improving residents' handovers through just-in-time training for structured communication.

PubMed

Rourke, Liam; Amin, Aditi; Boyington, Curtiss; Ao, Peter; Frolova, Natalia

2016-01-01

In a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover. During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.

Time as a Key Topic in Health Professionals’ Perceptions of Clinical Handovers

PubMed Central

Watson, Bernadette M.; Jones, Liz; Cretchley, Julia

2014-01-01

Clinical handovers are an essential part of the daily care and treatment of hospital patients. We invoked a language and social psychology lens to investigate how different health professional groups discussed the communication problems and strengths they experienced in handovers. We conducted in-depth interviews with three different health professional groups within a large metropolitan hospital. We used Leximancer text analytics software as a tool to analyze the data. Results showed that time was of concern to all groups in both similar and diverse ways. All professionals discussed time management, time pressures, and the difficulties of coordinating different handovers. Each professional group had its own unique perceptions and priorities about handovers. Our findings indicated that health professionals understood what was required for handover improvement but did not have the extra capacity to alter their current environment. Hospital management, with clinicians, need to implement handover schedule processes that prioritize interprofessional representation. PMID:28462291

A Cross-Layer User Centric Vertical Handover Decision Approach Based on MIH Local Triggers

NASA Astrophysics Data System (ADS)

Rehan, Maaz; Yousaf, Muhammad; Qayyum, Amir; Malik, Shahzad

Vertical handover decision algorithm that is based on user preferences and coupled with Media Independent Handover (MIH) local triggers have not been explored much in the literature. We have developed a comprehensive cross-layer solution, called Vertical Handover Decision (VHOD) approach, which consists of three parts viz. mechanism for collecting and storing user preferences, Vertical Handover Decision (VHOD) algorithm and the MIH Function (MIHF). MIHF triggers the VHOD algorithm which operates on user preferences to issue handover commands to mobility management protocol. VHOD algorithm is an MIH User and therefore needs to subscribe events and configure thresholds for receiving triggers from MIHF. In this regard, we have performed experiments in WLAN to suggest thresholds for Link Going Down trigger. We have also critically evaluated the handover decision process, proposed Just-in-time interface activation technique, compared our proposed approach with prominent user centric approaches and analyzed our approach from different aspects.

Reducing the Handover Delay in FMIPv6 Using Proactive Care-of Address Scheme

NASA Astrophysics Data System (ADS)

Li, Yong; Jin, Depeng; Su, Li; Zeng, Lieguang

To deal with the increasing number of mobile devices accessing the Internet and the increasing demands of mobility management, IETF has proposed Mobile IPv6 and its fast handover protocol FMIPv6. In FMIPv6, the possibility of Care-of Address (CoA) collision and the time for Return Routability (RR) procedure result in long handover delay, which makes it unsuitable for real-time applications. In this paper, we propose an improved handover scheme for FMIPv6, which reduces the handover delay by using proactive CoA acquisition, configuration and test method. In our proposal, collision-free CoA is proactively prepared, and the time for RR procedure does not contribute to the handover delay. Furthermore, we analyze our proposal's benefits and overhead tradeoff. The numerical results demonstrate that it outperforms the current schemes, such as FMIPv6 and enhanced FMIPv6, on the aspect of handover delay and packet transmission delay.

Building an Electronic Handover Tool for Physicians Using a Collaborative Approach between Clinicians and the Development Team.

PubMed

Guilbeault, Peggy; Momtahan, Kathryn; Hudson, Jordan

2015-01-01

In an effort by The Ottawa Hospital (TOH) to become one of the top 10% performers in patient safety and quality of care, the hospital embarked on improving the communication process during handover between physicians by building an electronic handover tool. It is expected that this tool will decrease information loss during handover. The Information Systems (IS) department engaged a workgroup of physicians to become involved in defining requirements to build an electronic handover tool that suited their clinical handover needs. This group became ultimately responsible for defining the graphical user interface (GUI) and all functionality related to the tool. Prior to the pilot, the Information Systems team will run a usability testing session to ensure the application is user friendly and has met the goals and objectives of the workgroup. As a result, The Ottawa Hospital has developed a fully integrated electronic handover tool built on the Clinical Mobile Application (CMA) which allows clinicians to enter patient problems, notes and tasks available to all physicians to facilitate the handover process.

Influence of learner knowledge and case complexity on handover accuracy and cognitive load: results from a simulation study.

PubMed

Young, John Q; van Dijk, Savannah M; O'Sullivan, Patricia S; Custers, Eugene J; Irby, David M; Ten Cate, Olle

2016-09-01

The handover represents a high-risk event in which errors are common and lead to patient harm. A better understanding of the cognitive mechanisms of handover errors is essential to improving handover education and practice. This paper reports on an experiment conducted to study the effects of learner knowledge, case complexity (i.e. cases with or without a clear diagnosis) and their interaction on handover accuracy and cognitive load. Participants were 52 Dutch medical students in Years 2 and 6. The experiment employed a repeated-measures design with two explanatory variables: case complexity (simple or complex) as the within-subject variable, and learner knowledge (as indicated by illness script maturity) as the between-subject covariate. The dependent variables were handover accuracy and cognitive load. Each participant performed a total of four simulated handovers involving two simple cases and two complex cases. Higher illness script maturity predicted increased handover accuracy (p < 0.001) and lower cognitive load (p = 0.007). Case complexity did not independently affect either outcome. For handover accuracy, there was no interaction between case complexity and illness script maturity. For cognitive load, there was an interaction effect between illness script maturity and case complexity, indicating that more mature illness scripts reduced cognitive load less in complex cases than in simple cases. Students with more mature illness scripts performed more accurate handovers and experienced lower cognitive load. For cognitive load, these effects were more pronounced in simple than complex cases. If replicated, these findings suggest that handover curricula and protocols should provide support that varies according to the knowledge of the trainee. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings.

PubMed

Redley, Bernice; Waugh, Rachael

2018-04-01

Nurse bedside handover quality is influenced by complex interactions related to the content, processes used and the work environment. Audit tools are seldom tested in 'real' settings. Examine the reliability, validity and usability of a quality improvement tool for audit of nurse bedside handover. Naturalistic, descriptive, mixed-methods. Six inpatient wards at a single large not-for-profit private health service in Victoria, Australia. Five nurse experts and 104 nurses involved in 199 change-of-shift bedside handovers. A focus group with experts and pilot test were used to examine content and face validity, and usability of the handover audit tool. The tool was examined for inter-rater reliability and usability using observation audits of handovers across six wards. Data were collected in 2013-2014. Two independent observers for 72 audits demonstrated acceptable inter-observer agreement for 27 (77%) items. Reliability was weak for items examining the handover environment. Seventeen items were not observed reflecting gaps in practices. Across 199 observation audits, gaps in nurse bedside handover practice most often related to process and environment, rather than content items. Usability was impacted by high observer burden, familiarity and non-specific illustrative behaviours. The reliability and validity of most items to audit handover content was acceptable. Gaps in practices for process and environment items were identified. Context specific exemplars and reducing the items used at each handover audit can enhance usability. Further research is needed to develop context specific exemplars and undertake additional reliability testing using a wide range of handover settings. CONTRIBUTION OF THE PAPER. Copyright © 2017 Elsevier Inc. All rights reserved.

A preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer.

PubMed

Weiss, Matthew J; Bhanji, Farhan; Fontela, Patricia S; Razack, Saleem I

2013-08-01

To assess the impact of a written cognitive aid on expressed clinical reasoning and quantity and the accuracy of information transfer during resident doctor handover. This study was a randomised controlled trial in an academic paediatric intensive care unit (PICU) of 20 handover events (10 events per group) from residents in their first PICU rotation using a written handover cognitive aid (intervention) or standard practice (control). Before rounds, an investigator generated a reference standard of the handover event by completing a handover aid. Resident handovers were then audio-recorded and transcribed by a blinded research assistant. The content of this transcript was inserted into a blank handover aid. A blinded content expert scored the quantity and accuracy of the information in this aid according to predetermined criteria and these information scores (ISs) were compared with the reference standard. The same expert also blindly scored the transcripts in five domains of clinical reasoning and effectiveness: (i) effective summary of events; (ii) expressed understanding of the care plan; (iii) presentation clarity; (iv) organisation; (v) overall handover effectiveness. Differences between intervention and control groups were assessed using the Mann-Whitney test and multivariate linear regression. The intervention group had total ISs that more closely approximated the reference standard (81% versus 61%; p < 0.01). The intervention group had significantly higher clinical reasoning scores when compared by total score (21.1 versus 15.9 points; p = 0.01) and in each of the five domains. No difference was observed in the duration of handover between groups (7.4 versus 7.7 minutes; p = 0.97). Using a novel scoring system, our simple handover cognitive aid was shown to improve information transfer and resident expression of clinical reasoning without prolonging the handover duration. © 2013 John Wiley & Sons Ltd.

Handover procedures in integrated satellite and terrestrial mobile systems

NASA Technical Reports Server (NTRS)

Corazza, G. E.; Ruggieri, M.; Santucci, F.; Vatalaro, F.

1993-01-01

The integration of satellite and terrestrial mobile systems is investigated in terms of the strategies for handover across the integrated cellular coverage. The handover procedure is subdivided into an initialization phase, where the need for issuing a handover request must be identified, and an execution phase, where the request must be satisfied, if possible, according to a certain channel assignment strategy. A modeling approach that allows the design of the parameters that influence the performance of the overall handover procedure is presented, along with a few numerical results.

Improving clinical handover in a paediatric ward: implications for nursing management.

PubMed

Mannix, Trudi; Parry, Yvonne; Roderick, Allison

2017-04-01

To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group. After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks. A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise. © 2017 John Wiley & Sons Ltd.

Integration of FMIPv6 in HMIPv6 to Improve Hand-over Performance

NASA Astrophysics Data System (ADS)

Patil, Dipali P.; Patil, G. A.

2010-11-01

Mobile users move frequently between networks, as they stay connected to the Internet. Thus, as mobility increases across networks, handovers will significantly impact the quality of the connection and user application. Handover performance is very important when evaluating IP mobility protocols. Since handover request are driven by several needs such as cost reduction criteria, network resource optimization and service related requirements. Current works to support seamless mobility in IPv6 network are classified into HMIPv6 and FMIPv6. These two approaches have pros and cons respectively and are being standardized independently in IETF. If one can integrate properly these two approaches, it is expected that the one can get more effective protocols that can provide better handover performance. This paper integrates FHMIPv6 in HMIPv6 (F-HMIPv6) so as to provide effectively fast handover on the hierarchical Mobile IPv6. The simulation performed using Ns-2 extensions to show that a performance of proposed system is better in terms of packet loss and hand-over delay.

An Investigation of How Lecturers' Teaching Strategies Promote Productive Classroom Interaction

ERIC Educational Resources Information Center

Sit, Helena Hing Wa

2013-01-01

Both the Mainland and Hong Kong have witnessed the trend of educational internationalisation since the handover. The recruitment of non-local students is regarded as an important strategy to internalise universities in Hong Kong. Within Hong Kong's western-style educational setting, an increasing number of Mainland students attracted by the…

The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses.

PubMed

Randmaa, Maria; Engström, Maria; Swenne, Christine Leo; Mårtensson, Gunilla

2017-08-04

To investigate different professionals' (nurse anaesthetists', anaesthesiologists', and postanaesthesia care unit nurses') descriptions of and reflections on the postoperative handover. A focus group interview study with a descriptive design using qualitative content analysis of transcripts. One anaesthetic clinic at two hospitals in Sweden. Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8). Patterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals' perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patient's privacy and that frequent interruptions could be disturbing. The present findings revealed variations in different professionals' views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals' perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The key actor: a qualitative study of patient participation in the handover process in Europe

PubMed Central

Flink, Maria; Hesselink, Gijs; Pijnenborg, Loes; Wollersheim, Hub; Vernooij-Dassen, Myrra; Dudzik-Urbaniak, Ewa; Orrego, Carola; Toccafondi, Giulio; Schoonhoven, Lisette; Gademan, Petra J; Johnson, Julie K; Öhlén, Gunnar; Hansagi, Helen; Olsson, Mariann; Barach, Paul

2012-01-01

Background Patient safety experts have postulated that increasing patient participation in communications during patient handovers will improve the quality of patient transitions, and that this may reduce hospital readmissions. Choosing strategies that enhance patient safety through improved handovers requires better understanding of patient experiences and preferences for participation. Objective The aim of this paper is to explore the patients’ experiences and perspectives related to the handovers between their primary care providers and the inpatient hospital. Methods A qualitative secondary analysis was performed, based on individual and focus group patient interviews with 90 patients in five European countries. Results The analysis revealed three themes: patient positioning in the handover process; prerequisites for patient participation and patient preferences for the handover process. Patients’ participation ranged from being the key actor, to sharing the responsibility with healthcare professional(s), to being passive participants. For active participation patients required both personal and social resources as well as prerequisites such as information and respect. Some patients preferred to be the key actor in charge; others preferred their healthcare professionals to be the key actors in the handover. Conclusions Patients’ participation is related to the healthcare system, the activity of healthcare professionals’ and patients’ capacity for participation. Patients prefer a handover process where the responsibility is clear and unambiguous. Healthcare organisations need a clear and well-considered system of responsibility for handover processes, that takes into account the individual patient's need of clarity, and support in relation to his/hers own recourses. PMID:23112290

Patient handover in the emergency department: 'How' is as important as 'what'.

PubMed

de Lange, Santel; van Eeden, Ilze; Heyns, Tanya

2018-01-01

We explored the existing patient handover practices between emergency care practitioners and healthcare professionals in the emergency department. In the emergency department, patient handover between emergency care practitioner's and healthcare professionals is a complex process involving multiple functions, such as the transfer of information, responsibility and accountability from one person to another. We used a qualitative study design. Emergency care practitioners and healthcare professionals were identified using purposive and convenience sampling data. Data were collected through unstructured participant observation. We conducted 20 observation sessions, varying between 15 and 20min. The data were analysed using a creative hermeneutic approach. The 'how' or manner of patient handover observed between emergency care practitioners and health professionals was perceived as important. A diagnosis of disrespectful behaviour was made which could negatively influence patient handover and ultimately patient outcome. Disrespectful behaviour stemmed from the two signs that supported the diagnosis: task-orientated behaviour and the use of indigenous language. Involving the emergency care practitioners and healthcare professionals in observing and analysing the existing patient handover practices in the ED raised their awareness of the current workplace culture. Transforming behaviour from disrespectful to respectful should include greeting one another, listening attentively to the patient handover and include emergency care practitioners, patients and their significant other in the handover process that should be conducted in a commonly understood language. Emergency care practitioners and healthcare professionals should recognise that during patient handover 'how' is as important as 'what'. Copyright © 2017 Elsevier Ltd. All rights reserved.

Arginine methylation of REF/ALY promotes efficient handover of mRNA to TAP/NXF1

PubMed Central

Hung, Ming-Lung; Hautbergue, Guillaume M.; Snijders, Ambrosius P. L.; Dickman, Mark J.; Wilson, Stuart A.

2010-01-01

The REF/ALY mRNA export adaptor binds TAP/NXF1 via an arginine-rich region, which overlaps with its RNA-binding domain. When TAP binds a REF:RNA complex, it triggers transfer of the RNA from REF to TAP. Here, we have examined the effects of arginine methylation on the activities of the REF protein in mRNA export. We have mapped the arginine methylation sites of REF using mass spectrometry and find that several arginines within the TAP and RNA binding domains are methylated in vivo. However, arginine methylation has no effect on the REF:TAP interaction. Instead, arginine methylation reduces the RNA-binding activity of REF in vitro and in vivo. The reduced RNA-binding activity of REF in its methylated state is essential for efficient displacement of RNA from REF by TAP in vivo. Therefore, arginine methylation fine-tunes the RNA-binding activity of REF such that the RNA–protein interaction can be readily disrupted by export factors further down the pathway. PMID:20129943

Patient and nurse preferences for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment.

PubMed

Whitty, Jennifer A; Spinks, Jean; Bucknall, Tracey; Tobiano, Georgia; Chaboyer, Wendy

2017-08-01

To describe and compare patients' and nurses' preferences for the implementation of bedside handover. Discrete choice experiment describing handover choices using six characteristics: whether the patient is invited to participate; whether a family member/carer/friend is invited; the number of nurses present; the level of patient involvement; the information content; and privacy. Two Australian hospitals. Adult patients (n=401) and nurses (n=200) recruited from medical wards. Mean importance scores for handover characteristics estimated using mixed multinomial logit regression of the choice data. Both patient and nurse participants preferred handover at the bedside rather than elsewhere (P<.05). Being invited to participate, supporting strong two-way communication, having a family member/carer/friend present and having two nurses rather than the nursing team present were most important for patients. Patients being invited to participate and supporting strong two-way communication were most important for nurses. However, contrary to patient preferences, having a family member/carer/friend present was not considered important by nurses. Further, while patients expressed a weak preference to have sensitive information handed over quietly at the bedside, nurses expressed a relatively strong preference for handover of sensitive information verbally away from the bedside. All participants strongly support handover at the bedside and want patients to participate although patient and nurse preferences for various aspects of bedside handover differ. An understanding of these preferences is expected to support recommendations for improving the patient hospital experience and the consistent implementation of bedside handover as a safety initiative. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

A tailored intervention to improving the quality of intrahospital nursing handover.

PubMed

Bergs, Jochen; Lambrechts, Frank; Mulleneers, Ines; Lenaerts, Kim; Hauquier, Caroline; Proesmans, Geert; Creemers, Sarah; Vandijck, Dominique

2018-01-01

Nursing handover is a process central to the delivery of high-quality and safe care. We aimed to improve the quality of nursing handover from the emergency department to ward and intensive care unit (ICU). A quasi-experimental non-equivalent control group pre-test - post-test design was applied. Handover quality was measured using the Handover Evaluation Scale (HES). A tailored intervention, inspired by appreciative inquiry, was designed to improve the implementation of an existing handover form and procedure. In total 130 nurses participated, 66 before and 64 after the intervention. Initial structure of the HES showed no good fit to our data; the questions were reshaped into 3 dimensions: Quality of information, Interaction and support, and Relevance of information. Following the intervention, mean changes in HES factor scores ranged from -3.99 to +15.9. No significant difference in factor scoring by ward and ICU nurses was found. Emergency department nurses, however, perceived Interaction and support to be improved following the intervention. The intervention did not result in an improved perception of handover quality by ward and ICU nurses. There was improvement in the perception of Interaction and support among emergency department nurses. The intervention positively effected teamwork and mutual understanding concerning nursing handover practice amongst emergency nurses. In order to improve intrahospital nursing handover, hospital-wide interventions are suggested. These interventions should be aimed at creating a generative story, improving mutual understanding, and establishing a supportive attitude regarding standardised procedures to reduce human error. Copyright © 2017 Elsevier Ltd. All rights reserved.

Context, culture and (non-verbal) communication affect handover quality.

PubMed

Frankel, Richard M; Flanagan, Mindy; Ebright, Patricia; Bergman, Alicia; O'Brien, Colleen M; Franks, Zamal; Allen, Andrew; Harris, Angela; Saleem, Jason J

2012-12-01

Transfers of care, also known as handovers, remain a substantial patient safety risk. Although research on handovers has been done since the 1980s, the science is incomplete. Surprisingly few interventions have been rigorously evaluated and, of those that have, few have resulted in long-term positive change. Researchers, both in medicine and other high reliability industries, agree that face-to-face handovers are the most reliable. It is not clear, however, what the term face-to-face means in actual practice. We studied the use of non-verbal behaviours, including gesture, posture, bodily orientation, facial expression, eye contact and physical distance, in the delivery of information during face-to-face handovers. To address this question and study the role of non-verbal behaviour on the quality and accuracy of handovers, we videotaped 52 nursing, medicine and surgery handovers covering 238 patients. Videotapes were analysed using immersion/crystallisation methods of qualitative data analysis. A team of six researchers met weekly for 18 months to view videos together using a consensus-building approach. Consensus was achieved on verbal, non-verbal, and physical themes and patterns observed in the data. We observed four patterns of non-verbal behaviour (NVB) during handovers: (1) joint focus of attention; (2) 'the poker hand'; (3) parallel play and (4) kerbside consultation. In terms of safety, joint focus of attention was deemed to have the best potential for high quality and reliability; however, it occurred infrequently, creating opportunities for education and improvement. Attention to patterns of NVB in face-to-face handovers coupled with education and practice can improve quality and reliability.

Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case studies.

PubMed

Balka, Ellen; Tolar, Marianne; Coates, Shannon; Whitehouse, Sandra

2013-12-01

Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. The purpose of this paper is to broaden our understanding of clinical handover as a patient safety issue, and to identify socio-technical issues which may come to bear on the success of computer based handover tools. Three in depth ethnographic case studies were undertaken. Field notes were transcribed and analyzed with the aid of qualitative data analysis software. Within case analysis was performed on each case, and subsequently, cross case analyses were performed. We identified five types of socio-technical issues which must be addressed if electronic handover tools are to succeed. The inter-dependencies of these issues are addressed in relation to arenas in which health care work takes place. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover, and issues related to data standards and system interoperability must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Handover training: does one size fit all? The merits of mass customisation.

PubMed

Kicken, Wendy; Van der Klink, Marcel; Barach, Paul; Boshuizen, H P A

2012-12-01

Experts have recommended training and standardisation as promising approaches to improve handovers and minimise the negative consequences of discontinuity of care. Yet the content and delivery of handover training have been only superficially examined and described in literature. The aim of this study was to formulate recommendations for effective handover training and to examine whether standardisation is a viable approach to training large numbers of healthcare professionals. A training needs analysis was conducted by means of a questionnaire, which was filled out by 96 healthcare professionals in primary and secondary care in the Netherlands, Spain, Sweden and Poland. Preferences and recommendations regarding training delivery aspects and training topics that should be included in the handover training were measured. The majority of the participants recommended a short conventional training session with practice assignments, to be completed in small, multidisciplinary groups. Formal examination, e-learning and self-study were not favoured. Recommended training topics were: communication skills, standardised procedures, knowing what to hand over, alertness to vulnerable patient groups and awareness of responsibility. The idea of completely standardised handover training is not in line with the identified differences in preferences and recommendations between different handover stakeholders. Mass customisation of training, in which generic training is adapted to local or individual needs, presents a promising solution to address general and specific needs, while containing the financial and time costs of designing and delivering handover training.

Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit.

PubMed

Waters, Amanda; Sands, Natisha; Keppich-Arnold, Sandra; Henderson, Kathryn

2015-06-01

Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm. © 2014 Australian College of Mental Health Nurses Inc.

Improving patient handover between teams using a business improvement model: PDSA cycle.

PubMed

Luther, Vishal; Hammersley, Daniel; Chekairi, Ahmed

2014-01-01

Medical admission units are continuously under pressure to move patients off the unit to outlying medical wards and allow for new admissions. In a typical district general hospital, doctors working in these medical wards reported that, on average, three patients each week arrived from the medical admission unit before any handover was received, and a further two patients arrived without any handover at all. A quality improvement project was therefore conducted using a 'Plan, Do, Study, Act' cycle model for improvement to address this issue. P - Plan: as there was no framework to support doctors with handover, a series of standard handover procedures were designed. D - Do: the procedures were disseminated to all staff, and championed by key stakeholders, including the clinical director and matron of the medical admission unit. S - STUDY: Measurements were repeated 3 months later and showed no change in the primary end points. A - ACT: The post take ward round sheet was redesigned, creating a checkbox for a medical admission unit doctor to document that handover had occurred. Nursing staff were prohibited from moving the patient off the ward until this had been completed. This later evolved into a separate handover sheet. Six months later, a repeat study revealed that only one patient each week was arriving before or without a verbal handover. Using a 'Plan, Do, Study, Act' business improvement tool helped to improve patient care.

Supporting Teachers in Vietnam to Monitor Preschool Children's Wellbeing and Involvement in Preschool Classrooms

ERIC Educational Resources Information Center

Lenaerts, Filip; Braeye, Sarah; Nguyen, Thi Lan Huong; Dang, Tuyet Anh; Vromant, Nico

2017-01-01

Vietnam is promoting active teaching and learning as a key strategy to enhance children's learning in preschools. This change depends largely on building the capacities of teachers to implement child-centered education in practice and handover the initiative for learning to children. Vietnamese teachers need to be better equipped with pedagogical…

Limitations in Prehospital Communication Between Trauma Helicopter, Ambulance Services, and Dispatch Centers.

PubMed

Harmsen, Annelieke Maria Karien; Giannakopoulos, Georgios; Franschman, Gaby; Christiaans, Herman; Bloemers, Frank

2017-04-01

Prehospital communication with Emergency Medical Services (EMS) is carried out in hectic situations. Proper communication among all medical personal is required to enhance collaboration, to provide the best care and enable shared situational awareness. The objective of this article was to give insight into current Dutch prehospital emergency care communication among all EMS and evaluate the usage of a new physician staffed helicopter EMS (P-HEMS) cancellation model. Trauma-related P-HEMS dispatches between November 1, 2014 and May 31, 2015 for the Lifeliner 1 were included; a random sample of 100 dispatches was generated. Tape recordings on all verbal prehospital communication between the dispatch center, EMS, and P-HEMS were transcribed and analyzed. Qualitative content analysis was performed, using open coding to code key messages. Ninety-two tape recordings were analyzed. The most frequent reason for P-HEMS dispatch was suspicion of brain injury (24%). The cancellation model was followed in 66%, overruled in 9%, and not applicable in 25%. The main reason for not adhering to the model was hemodynamic stability. In 5% of P-HEMS dispatches, a complete ABCD (airway, breathing, circulation, disability) methodology was used for handover, in 9% a complete Situation-Background-Assessment-Recommendation technique, in 2% a complete Mechanism-Injuries-Signs-Treatment method was used. The other handovers were incomplete. Prehospital handover between EMS on-scene and P-HEMS often entails insufficient information. The cancellation model for P-HEMS is frequently used and promotes adequate information transfer. To increase joined decision-making, more patient and situational information needs to be handed over. Standardization of prehospital trauma handovers will facilitate this and improve trauma patient's outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

Medication communication during handover interactions in specialty practice settings.

PubMed

Braaf, Sandra; Rixon, Sascha; Williams, Allison; Liew, Danny; Manias, Elizabeth

2015-10-01

To investigate what and how medication information is communicated during handover interactions in specialty hospital settings. Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care. An exploratory qualitative design and observational study. Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed. Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover. Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings. For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered. © 2015 John Wiley & Sons Ltd.

Communication failures during clinical handovers lead to a poor patient outcome: Lessons from a case report.

PubMed

Manias, Elizabeth; Geddes, Fiona; Watson, Bernadette; Jones, Dorothy; Della, Phillip

2015-01-01

In the emergency department, communication failures occur in clinical handover due to the urgent, changing and unpredictable nature of care provision. We present a case report of a female patient who was assaulted, and identify how various factors interacted to produce communication failures at multiple clinical handovers, leading to a poor patient outcome. Several handovers created many communication failures at diverse time points. The bedside medical handover produced misunderstandings during verbal exchange of information between emergency department consultants and junior doctors, and there was miscommunication involving plastic registrars. There was a failure in adequately informing the general practitioner and the patient relating to follow-up care after discharge. Deficiencies of communication occurred with conveying changes in an investigative report. Communication could be improved by dividing the conduct of handover in a quiet room and at the bedside, ensuring multiple sources of information are used and encouraging role-modelling behaviours for junior clinicians.

Stories of change: the text analysis of handovers in an Italian psychiatric residential care home.

PubMed

Accordini, M; Saita, E; Irtelli, F; Buratti, M; Savuto, G

2017-05-01

WHAT IS KNOWN ON THE SUBJECT?: There is a growing emphasis on communication as a result of the move towards the more inclusive approach associated with the community-based rehabilitation model. Therefore, more importance is attached to handovers. Besides ensuring transfer of information, handovers enhance group cohesion, socialize staff members to the practices of the service and capture its organizational culture. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: While handovers are mainly used for information transfer and to manage the services' daily routine, this paper offers an insight on how handovers can be conceived as valuable instruments to document cultural and organizational change. Only a limited amount of studies has focused on handovers in mental healthcare settings, and most of them only consider the perspectives of psychiatric nurses, while embracing a broader perspective, this paper provides valuable insights into the perspectives of various service providers. The overcoming of the dichotomy deficit-based vs. recovery-oriented model is possible if professionals use handovers to reflect upon their practice and the ways in which their cultural models are affected by the environmental context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Handovers are valuable instruments to document organizational change. It would be important for psychiatric and rehabilitation facilities to keep track of the handover records over time as they may provide insightful information about cultural change and the transformations in the core values and beliefs held by professionals. Handovers assure a timely and correct information transfer while socializing workers to the service's culture; however, no study describes them as instruments to document organizational change and only a few have focused on psychiatric settings. Aim To investigate the change in the culture of an Italian psychiatric residential care home as perceived by its mental health workers (MHWs) over the course of two decades. Method Emotional text analysis (ETA) was used to analyse the MHWs' handovers completed from 1990 to 2011. Results The analysis generated four clusters and three main factors illustrating the change in the MHWs' representations of the residential care home and its occupants. The factors showed: (1) the shift from an individualistic, problem-focused view to an inclusive, community-based approach; (2) the presence of a descriptive as well as a specialized language; and (3) the presence of a double focus: on patients and professionals. Conclusions Handovers transcripts document the following changes: (1) a shift from a symptom-based to a recovery-oriented approach; (2) a modification of the MHWs values towards an holistic view of the patient; (3) a growing importance assigned to accountability, services integration and teamwork. The paper shows that handovers can be used diachronically to document organizational change. © 2017 John Wiley & Sons Ltd.

Reported Speech in Conversational Storytelling during Nursing Shift Handover Meetings

ERIC Educational Resources Information Center

Bangerter, Adrian; Mayor, Eric; Pekarek Doehler, Simona

2011-01-01

Shift handovers in nursing units involve formal transmission of information and informal conversation about non-routine events. Informal conversation often involves telling stories. Direct reported speech (DRS) was studied in handover storytelling in two nursing care units. The study goal is to contribute to a better understanding of conversation…

The feasibility, acceptability and preliminary testing of a novel, low-tech intervention to improve pre-hospital data recording for pre-alert and handover to the Emergency Department.

PubMed

Fitzpatrick, David; Maxwell, Douglas; Craigie, Alan

2018-06-25

Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality. This study aimed to measure the feasibility and acceptability of a novel, low tech intervention, designed to support clinical information recording and delivery during pre-alert and handover within the pre-hospital and ED setting. A simple pre and post-test design was used with a historical control. Eligible participants included all ambulance clinicians based at one large city Ambulance Station (n = 69) and all nursing and physician staff (n = 99) based in a city Emergency Department. Twenty five (36%) ambulance clinicians responded to the follow-up survey. Most felt both the pre-alert and handover components of the card were either 'useful-very useful' (n = 23 (92%); and n = 18 (72%) respectively. Nineteen (76%) used the card to record clinical information and almost all (n = 23 (92%) felt it 'useful' to 'very useful' in supporting pre-alert. Similarly, 65% (n = 16) stated they 'often' or 'always' used the card to support handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables. ​ Results from the post-test survey measuring ED staff (n = 37) perceptions of handover demonstrated small (p < 0.05) improvements in handover in 3/5 domains measured. This novel low-tech intervention was highly acceptable to ambulance clinician participants, improving their data recording and information exchange processes. However, further well conducted studies are required to test the impact of this intervention on information exchange during pre-alert and handover.

Keep handovers in the office.

PubMed

Richards, Louise

2017-06-14

Patient information is meant to be confidential. How is that possible when you give a bedside handover with other patients in the room (Readers' Panel, June 7). Handovers should be done in the office, followed by a walk around to introduce yourself as the nurse taking over the care, and to check on any infusions.

ESS-FH: Enhanced Security Scheme for Fast Handover in Hierarchical Mobile IPv6

NASA Astrophysics Data System (ADS)

You, Ilsun; Lee, Jong-Hyouk; Sakurai, Kouichi; Hori, Yoshiaki

Fast Handover for Hierarchical Mobile IPv6 (F-HMIPv6) that combines advantages of Fast Handover for Mobile IPv6 (FMIPv6) and Hierarchical Mobile IPv6 (HMIPv6) achieves the superior performance in terms of handover latency and signaling overhead compared with previously developed mobility protocols. However, without being secured, F-HMIPv6 is vulnerable to various security threats. In 2007, Kang and Park proposed a security scheme, which is seamlessly integrated into F-HMIPv6. In this paper, we reveal that Kang-Park's scheme cannot defend against the Denial of Service (DoS) and redirect attacks while largely relying on the group key. Then, we propose an Enhanced Security Scheme for F-HMIPv6 (ESS-FH) that achieves the strong key exchange and the key independence as well as addresses the weaknesses of Kang-Park's scheme. More importantly, it enables fast handover between different MAP domains. The proposed scheme is formally verified based on BAN-logic, and its handover latency is analyzed and compared with that of Kang-Park's scheme.

Developing a minimum dataset for nursing team leader handover in the intensive care unit: A focus group study.

PubMed

Spooner, Amy J; Aitken, Leanne M; Corley, Amanda; Chaboyer, Wendy

2018-01-01

Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit. The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover. This focus group study was conducted in a 21-bed medical/surgical intensive care unit in Australia. Senior registered nurses involved in team leader handovers were recruited. Focus groups were conducted using a nominal group technique to generate and prioritise minimum dataset items. Nurses were presented with content from previous team leader handovers and asked to select which content items to include in a minimum dataset. Participant responses were summarised as frequencies and percentages. Seventeen senior nurses participated in three focus groups. Participants agreed that ISBAR (Identify-Situation-Background-Assessment-Recommendations) was a useful tool to guide clinical handover. Items recommended to be included in the minimum dataset (≥65% agreement) included Identify (name, age, days in intensive care), Situation (diagnosis, surgical procedure), Background (significant event(s), management of significant event(s)) and Recommendations (patient plan for next shift, tasks to follow up for next shift). Overall, 30 of the 67 (45%) items in the Assessment category were considered important to include in the minimum dataset and focused on relevant observations and treatment within each body system. Other non-ISBAR items considered important to include related to the ICU (admissions to ICU, staffing/skill mix, theatre cases) and patients (infectious status, site of infection, end of life plan). Items were further categorised into those to include in all handovers and those to discuss only when relevant to the patient. The findings suggest a minimum dataset for intensive care nursing team leader shift-to-shift handover should contain items within ISBAR along with unit and patient specific information to maintain continuity of care and patient safety across shift changes. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

Exploring the structure and organization of information within nursing clinical handovers.

PubMed

Johnson, Maree; Jefferies, Diana; Nicholls, Daniel

2012-10-01

Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress. © 2012 Wiley Publishing Asia Pty Ltd.

Improving Learner Handovers in Medical Education.

PubMed

Warm, Eric J; Englander, Robert; Pereira, Anne; Barach, Paul

2017-07-01

Multiple studies have demonstrated that the information included in the Medical Student Performance Evaluation fails to reliably predict medical students' future performance. This faulty transfer of information can lead to harm when poorly prepared students fail out of residency or, worse, are shuttled through the medical education system without an honest accounting of their performance. Such poor learner handovers likely arise from two root causes: (1) the absence of agreed-on outcomes of training and/or accepted assessments of those outcomes, and (2) the lack of standardized ways to communicate the results of those assessments. To improve the current learner handover situation, an authentic, shared mental model of competency is needed; high-quality tools to assess that competency must be developed and tested; and transparent, reliable, and safe ways to communicate this information must be created.To achieve these goals, the authors propose using a learner handover process modeled after a patient handover process. The CLASS model includes a description of the learner's Competency attainment, a summary of the Learner's performance, an Action list and statement of Situational awareness, and Synthesis by the receiving program. This model also includes coaching oriented towards improvement along the continuum of education and care. Just as studies have evaluated patient handover models using metrics that matter most to patients, studies must evaluate this learner handover model using metrics that matter most to providers, patients, and learners.

Ethnographic analysis on the use of the electronic medical record for clinical handoff.

PubMed

Nelson, Philippa; Bell, Anthony J; Nathanson, Larry; Sanchez, Leon D; Fisher, Jonathan; Anderson, Philip D

2017-12-01

The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase. This study uses an ethnographic qualitative research design incorporating semistructured interviews, participant observation on the ED floor and fieldwork notes. The setting for this research was in the ED at a tertiary University affiliated hospital. Triangulation was used to combine information obtained from multiple sources and information from fieldwork and interviews refined into useable chunks culminating in a thematic analysis. Thematic analysis yielded five central themes that reflected how the clinical staff utilised this IT system and why it had become embedded in the culture of clinical referral and handover. Efficient time management for improved patient flow was demonstrated, value added communication (at the interpersonal level), the building trust at the ED-inpatient interface, the maintenance of mutual respect across medical cultures and an overall enhancement of the quality of ED communication (in terms of the information available). A robust electronic handover process, resulted in an integrated approach to patient care by removing barriers to admission for medical inpatients, admitted via ED. The value proposition for patients was a more complete information transfer, both within the ED and between departments.

Implementation of fast handover for proxy mobile IPv6: Resolving out-of-order packets

PubMed Central

Anh, Khuong Quoc; Choo, Hyunseung

2017-01-01

Mobile IP allows for location-independent routing of IP datagrams on the Internet. Mobile IP specifies how a mobile node (MN) registers with its home agent and how the home agent routes datagrams to the MN through the tunnel. Current Mobile IP protocols have difficulties meeting the stringent handover delay requirements of future wireless networks. Fast handover for Proxy Mobile IPv6 (FPMIPv6) is used to resolve handover latency and packet loss problems that occur in the Proxy Mobile IPv6 (PMIPv6) protocol. However, while implementing the FPMIPv6 scheme in a testbed, we encounter the out-of-order packet (OoOP) problem. The cause of this problem is the existence of two paths for data transmitted from a correspondent node (CN) to an MN. Since the problem affects the quality of service (QoS) of the network and the performance of the MN, we propose a new scheme using the last packet marker and packet buffering to solve this problem in FPMIPv6. The new Mobile Access Gateway (MAG) can control and deliver the data transmitted via the old path or the new path to an MN in order, using the last packet marker to notify the end of the data delivery in the old path and the packet buffering for holding the data delivered in the new path. We implement both the proposed scheme and FPMIPv6 in a testbed as a real network environment to demonstrate the correctness, cost effectiveness, and performance of the proposed scheme. A performance evaluation reveals that the proposed scheme can handle the OoOP problem efficiently. PMID:28968450

Implementation of fast handover for proxy mobile IPv6: Resolving out-of-order packets.

PubMed

Kang, Byungseok; Anh, Khuong Quoc; Choo, Hyunseung

2017-01-01

Mobile IP allows for location-independent routing of IP datagrams on the Internet. Mobile IP specifies how a mobile node (MN) registers with its home agent and how the home agent routes datagrams to the MN through the tunnel. Current Mobile IP protocols have difficulties meeting the stringent handover delay requirements of future wireless networks. Fast handover for Proxy Mobile IPv6 (FPMIPv6) is used to resolve handover latency and packet loss problems that occur in the Proxy Mobile IPv6 (PMIPv6) protocol. However, while implementing the FPMIPv6 scheme in a testbed, we encounter the out-of-order packet (OoOP) problem. The cause of this problem is the existence of two paths for data transmitted from a correspondent node (CN) to an MN. Since the problem affects the quality of service (QoS) of the network and the performance of the MN, we propose a new scheme using the last packet marker and packet buffering to solve this problem in FPMIPv6. The new Mobile Access Gateway (MAG) can control and deliver the data transmitted via the old path or the new path to an MN in order, using the last packet marker to notify the end of the data delivery in the old path and the packet buffering for holding the data delivered in the new path. We implement both the proposed scheme and FPMIPv6 in a testbed as a real network environment to demonstrate the correctness, cost effectiveness, and performance of the proposed scheme. A performance evaluation reveals that the proposed scheme can handle the OoOP problem efficiently.

Use of Mobile Applications for Hospital Discharge Letters: Improving Handover at Point of Practice

ERIC Educational Resources Information Center

Maher, Bridget; Drachsler, Hendrik; Kalz, Marco; Hoare, Cathal; Sorensen, Humphrey; Lezcano, Leonardo; Henn, Pat; Specht, Marcus

2013-01-01

Handover of patient care is a time of particular risk and it is important that accurate and relevant information is clearly communicated. The hospital discharge letter is an important part of handover. However, the quality of hospital discharge letters is variable and letters frequently omit important information. The Cork Letter-Writing…

The quality of intensive care unit nurse handover related to end of life: a descriptive comparative international study.

PubMed

Ganz, Freda DeKeyser; Endacott, Ruth; Chaboyer, Wendy; Benbinishty, Julie; Ben Nun, Maureen; Ryan, Helen; Schoter, Amanda; Boulanger, Carole; Chamberlain, Wendy; Spooner, Amy

2015-01-01

Quality ICU end-of-life-care has been found to be related to good communication. Handover is one form of communication that can be problematic due to lost or omitted information. A first step in improving care is to measure and describe it. The objective of this study was to describe the quality of ICU nurse handover related to end-of-life care and to compare the practices of different ICUs in three different countries. This was a descriptive comparative study. The study was conducted in seven ICUs in three countries: Australia (1 unit), Israel (3 units) and the UK (3 units). A convenience sample of 157 handovers was studied. Handover quality was rated based on the ICU End-of-Life Handover tool, developed by the authors. The highest levels of handover quality were in the areas of goals of care and pain management while lowest levels were for legal issues (proxy and advanced directives) related to end of life. Significant differences were found between countries and units in the total handover score (country: F(2,154)=25.97, p=<.001; unit: F(6,150)=58.24, p=<.001), for the end of life subscale (country: F(2, 154)=28.23, p<.001; unit: F(6,150)=25.25, p=<.001), the family communication subscale (country: F(2,154)=15.04, p=<.001; unit: F(6,150)=27.38, p=<.001), the family needs subscale (F(2,154)=22.33, p=<.001; unit: F(6,150)=42.45, p=<.001) but only for units on the process subscale (F(6,150)=8.98, p=<.001. The total handover score was higher if the oncoming RN did not know the patient (F(1,155)=6.51, p=<.05), if the patient was expected to die during the shift (F(1,155)=89.67, p=<.01) and if the family were present (F(1,155)=25.81, p=<.01). Practices of end-of-life-handover communication vary greatly between units. However, room for improvement exists in all areas in all of the units studied. The total score was higher when quality of care might be deemed at greater risk (if the nurses did not know the patient or the patient was expected to die), indicating that nurses were exercising some form of discretionary decision making around handover communication; thus validating the measurement tool. Copyright © 2014. Published by Elsevier Ltd.

Development of electronic software for the management of trauma patients on the orthopaedic unit.

PubMed

Patel, Vishal P; Raptis, Demitri; Christofi, T; Mathew, Rajeev; Horwitz, M D; Eleftheriou, K; McGovern, Paul D; Youngman, J; Patel, J V; Haddad, F S

2009-04-01

Continuity of patient care is an essential prerequisite for the successful running of a trauma surgery service. This is becoming increasingly difficult because of the new working arrangements of junior doctors. Handover is now central to ensure continuity of care following shift change over. The purpose of this study was to compare the quality of information handed over using the traditional ad hoc method of a handover sheet versus a web-based electronic software programme. It was hoped that through improved quality of handover the new system would have a positive impact on clinical care, risk and time management. Data was prospectively collected and analyzed using the SPSS 14 statistical package. The handover data of 350 patients using a paper-based system was compared to the data of 357 cases using the web-based system. Key data included basic demographic data, responsible surgeon, location of patient, injury site including site, whether fractures were open or closed, concomitant injuries and the treatment plan. A survey was conducted amongst health care providers to assess the impact of the new software. With the introduction of the electronic handover system, patients with missing demographic data reduced from 35.1% to 0.8% (p<0.0001) and missing patient location from 18.6% to 3.6% (p<0.0001). Missing consultant information and missing diagnosis dropped from 12.9% to 2.0% (p<0.0001) and from 11.7% to 0.8% (p<0.0001), respectively. The missing information regarding side and anatomical site of the injury was reduced from 31.4% to 0.8% (p<0.0001) and from 13.7% to 1.1% (p<0.0001), respectively. In 96.6% of paper ad hoc handovers it was not stated whether the injury was 'closed' or 'open', whereas in the electronic group this information was evident in all 357 patients (p<0.0001). A treatment plan was included only in 52.3% of paper handovers compared to 94.7% (p<0.0001) of electronic handovers. A survey revealed 96% of members of the trauma team felt an improvement of handover since the introduction of the software, and 94% of members were satisfied with the software. The findings of our study show that the use of web-based electronic software is effective in facilitating and improving the quality of information passed during handover. Structured software also aids in improving work flow amongst the trauma team. We argue that an improvement in the quality of handover is an improvement in clinical practice.

Who to handover: a case-control study of a novel scoring system to prioritise handover of internal medicine inpatients.

PubMed

Bittman, Jesse; Tam, Penny; Little, Chris; Khan, Nadia

2017-06-01

Handover of patients between care providers is a critical event in patient care. There is, however, little evidence to guide the handover process, including determining which patients to handover. Compare the ability of gestalt-based handover with two structured scores, the modified early warning score (MEWS) and our novel iHAND clinical decision support system, to predict which patients will be assessed by a physician overnight. This case-control study included 90 inpatients, comprising 32 patients assessed overnight (cases) and 58 patients not assessed overnight (controls) at a teaching hospital in British Columbia, Canada (May 2012). Gestalt, MEWS and iHAND scores were analysed against patients seen overnight using logistic regression and receiver-operating characteristic (ROC) curves. Neither current gestalt-based handover practice (odds ratio (OR) 1.50, 95% CI 0.89 to 3.83) nor MEWS (OR 0.96, 95% CI 0.75 to 1.24, area under the ROC curve (AUC) 0.61, 95% CI 0.49 to 0.73) were significantly associated with need to be seen overnight. The iHAND score was associated with need to be seen (OR 1.93, 95% CI 1.24 to 3.02, AUC 0.70, 95% CI 0.60 to 0.81). The iHAND score had moderate ability to predict which patients required assessment overnight, while MEWS score and current gestalt approach correlated poorly, suggesting the iHAND score may help prioritisation of patients likely to be seen overnight for handover. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Patient handover in orthopaedics, improving safety using Information Technology.

PubMed

Pearkes, Tim

2015-01-01

Good inpatient handover ensures patient safety and continuity of care. An adjunct to this is the patient list which is routinely managed by junior doctors. These lists are routinely created and managed within Microsoft Excel or Word. Following the merger of two orthopaedic departments into a single service in a new hospital, it was felt that a number of safety issues within the handover process needed to be addressed. This quality improvement project addressed these issues through the creation and implementation of a new patient database which spanned the department, allowing trouble free, safe, and comprehensive handover. Feedback demonstrated an improved user experience, greater reliability, continuity within the lists and a subsequent improvement in patient safety.

Enhanced Predictive Handover for Fast Proxy Mobile IPv6

NASA Astrophysics Data System (ADS)

Jeon, Seil; Kang, Namhi; Kim, Younghan

Proxy Mobile IPv6 (PMIPv6) has been proposed in order to overcome the limitations of host-based mobility management in IPv6 networks. However, packet losses during doing handover are still a problem. To solve this issue, several schemes have been developed, and can be classified into two approaches: predictive and reactive handover. Both approaches commonly use bi-directional tunnel between mobile access gateways (MAGs). In predictive schemes especially, mobility support for a mobile node (MN) is triggered by simplified link signal strength. Thereafter, the MN sends handover notification to its serving MAG, and is then able to initiate packet forwarding. Therefore, if the MN moves toward an unexpected MAG that does not have any pre-established tunnel with the serving MAG, it may lead to packet losses. In this paper, we define this problem as Early Packet Forwarding (EPF). As a solution, we propose an enhanced PMIPv6 scheme using two-phase tunnel control based on the IEEE 802.21 Media Independent Handover (MIH).

Passing the Baton: An Experimental Study of Shift Handover

NASA Technical Reports Server (NTRS)

Parke, Bonny; Hobbs, Alan; Kanki, Barbara

2010-01-01

Shift handovers occur in many safety-critical environments, including aviation maintenance, medicine, air traffic control, and mission control for space shuttle and space station operations. Shift handovers are associated with increased risk of communication failures and human error. In dynamic industries, errors and accidents occur disproportionately after shift handover. Typical shift handovers involve transferring information from an outgoing shift to an incoming shift via written logs, or in some cases, face-to-face briefings. The current study explores the possibility of improving written communication with the support modalities of audio and video recordings, as well as face-to-face briefings. Fifty participants participated in an experimental task which mimicked some of the critical challenges involved in transferring information between shifts in industrial settings. All three support modalities, face-to-face, video, and audio recordings, reduced task errors significantly over written communication alone. The support modality most preferred by participants was face-to-face communication; the least preferred was written communication alone.

Managing competing organizational priorities in clinical handover across organizational boundaries.

PubMed

Sujan, Mark A; Chessum, Peter; Rudd, Michelle; Fitton, Laurence; Inada-Kim, Matthew; Cooke, Matthew W; Spurgeon, Peter

2015-01-01

Handover across care boundaries poses additional challenges due to the different professional, organizational and cultural backgrounds of the participants involved. This paper provides a qualitative account of how practitioners in emergency care attempt to align their different individual and organizational priorities and backgrounds when handing over patients across care boundaries (ambulance service to emergency department (ED), and ED to acute medicine). A total of 270 clinical handovers were observed in three emergency care pathways involving five participating NHS organizations (two ambulance services and three hospitals). Half-day process mapping sessions were conducted for each pathway. Semi-structured interviews were carried out with 39 participants and analysed thematically. The management of patient flow and the fulfilment of time-related performance targets can create conflicting priorities for practitioners during handover. Practitioners involved in handover manage such competing organizational priorities through additional coordination effort and dynamic trade-offs. Practitioners perceive greater collaboration across departments and organizations, and mutual awareness of each other's goals and constraints as possible ways towards more sustainable improvement. Sustainable improvement in handover across boundaries in emergency care might require commitment by leaders from all parts of the local health economy to work as partners to establish a culture of integrated, patient-centred care. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Measuring cognitive load: mixed results from a handover simulation for medical students.

PubMed

Young, John Q; Irby, David M; Barilla-LaBarca, Maria-Louise; Ten Cate, Olle; O'Sullivan, Patricia S

2016-02-01

The application of cognitive load theory to workplace-based activities such as patient handovers is hindered by the absence of a measure of the different load types. This exploratory study tests a method for measuring cognitive load during handovers. The authors developed the Cognitive Load Inventory for Handoffs (CLI4H) with items for intrinsic, extraneous, and germane load. Medical students completed the measure after participating in a simulated handover. Exploratory factor and correlation analyses were performed to collect evidence for validity. Results yielded a two-factor solution for intrinsic and germane load that explained 50 % of the variance. The extraneous load items performed poorly and were removed from the model. The score for intrinsic load correlated with the Paas Cognitive Load scale (r = 0.31, p = 0.004) and was lower for students with more prior handover training (p = 0.036). Intrinsic load did not, however, correlate with performance. Germane load did not correlate with the Paas Cognitive Load scale but did correlate as expected with performance (r = 0.30, p = 0.005) and was lower for those students with more prior handover training (p = 0.03). The CLI4H yielded mixed results with some evidence for validity of the score from the intrinsic load items. The extraneous load items performed poorly and the use of only a single item for germane load limits conclusions. The instrument requires further development and testing. Study results and limitations provide guidance to future efforts to measure cognitive load during workplace-based activities, such as handovers.

Audit on the Quality of Handovers of a Psychiatric Liaison Team in the UK: a Short Report.

PubMed

Koli, Trupti; Filippidou, Maria

2017-09-01

The importance of handovers has been recognised and proven in clinical practice. In liaison psychiatry, this is particularly important due to the high turnover of patients seen, the shift work pattern and the number of member staff engaging in this process. An Audit on the Quality of Handovers was carried out within a Psychiatric Liaison team of a General hospital in UK with an intention to review and improve this. Handovers were evaluated against the gold standard of the SBAR tool (Situation/Background/Assessment/Recommendations) over a period of 4 weeks. Handovers were assessed by 2 members of staff (a Consultant & a Specialty doctor). Data was analysed using Microsoft Excel. Results showed that the team's handover practice is mostly "Good" but there was also an amount of "Poor" under "Situation & Background", mostly presented by mid-grade doctors & trainees. Nurses scored higher than medics on overall rating, nearly 50%.This could be attributed to the fact that handovers form an essential & integral part of Nurse's training & culture. Also mid-grade (staff grade) doctors have had a significant amount of "excellent" scoring that other groups didn't have, mostly on the Assessment & Recommendations domains, which can be attributed to the fact that importance is stressed more on the assessment & treatment module by the doctors. The multi-disciplinary composition of the liaison psychiatry team has a positive impact on the patient care. This audit has revealed overall good communication amongst the members of the team, nevertheless one that needs some improvement, particularly amongst the doctors. Doctors tend to focus on the remedial (assessment & treatment) module rather than the holistic approach. SBAR remains an effective & handy tool to improve the handover quality. A re-audit will be carried out in 6 months time to assess the improvements observed following the implementation of this new tool.

Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers.

PubMed

Randmaa, Maria; Swenne, Christine L; Mårtensson, Gunilla; Högberg, Hans; Engström, Maria

2016-03-01

Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking. The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover. A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention. The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012. Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital. Implementation of the communication tool SBAR in one hospital. The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form. Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time. Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover. Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.

Introduction of a Microsoft Excel-based unified electronic weekend handover document in Acute and General Medicine in a DGH: aims, outcomes and challenges.

PubMed

Kostelec, Pablo; Emanuele Garbelli, Pietro; Emanuele Garbelli, Pietro

2017-01-01

On-call weekends in medicine can be a busy and stressful time for junior doctors, as they are responsible for a larger pool of patients, most of whom they would have never met. Clinical handover to the weekend team is extremely important and any communication errors may have a profound impact on patient care, potentially even resulting in avoidable harm or death. Several senior clinical bodies have issued guidelines on best practice in written and verbal handover. These include: standardisation, use of pro forma documents prompting doctors to document vital information (such as ceiling of care/resuscitation status) and prioritisation according to clinical urgency. These guidelines were not consistently followed in our hospital site at the onset of 2014 and junior doctors were becoming increasingly dissatisfied with the handover processes. An initial audit of handover documents used across the medical division on two separate weekends in January 2014, revealed high variability in compliance with documentation of key information. For example, ceiling of care was documented for only 14-42% of patients and resuscitation status in 26-72% of patients respectively. Additionally, each ward used their own self-designed pro forma and patients were not prioritised by clinical urgency. Within six months from the introduction of a standardised, hospital-wide weekend handover pro forma across the medical division and following initial improvements to its layout, ceiling of therapy and resuscitation status were documented in approximately 80% of patients (with some minor variability). Moreover, 100% of patients in acute medicine and 75% of those in general medicine were prioritised by clinical urgency and all wards used the same handover pro forma.

Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius

PubMed Central

Kassean, Hemant K; Jagoo, Zaheda B

2005-01-01

Background The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system. Methods A force field analysis in terms of the driving forces had shown that there was dissatisfaction with the traditional method of handover which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The restraining forces identified were a fear of accountability, lack of confidence and that this change would lead to more work. A 3 – step planned change model consisting of unfreezing, moving and refreezing was used to guide us through the change process. Resistance to change was managed by creating a climate of open communication where stakeholders were allowed to voice opinions, share concerns, insights, and ideas thereby actively participating in decision making. Results An evaluation had shown that this process was successfully implemented to the satisfaction of patients, and staff in general. Conclusion This successful change should encourage other nurses to become more proactive in identifying areas for change management in order to improve our health care system. PMID:15676078

A tool for assessing the quality of nursing handovers: a validation study.

PubMed

Ferrara, Paolo; Terzoni, Stefano; Davì, Salvatore; Bisesti, Alberto; Destrebecq, Anne

2017-08-10

Handover, in particular between two shifts, is a crucial aspect of nursing for patient safety, aimed at ensuring continuity of care. During this process, several factors can affect quality of care and cause errors. This study aimed to assess quality of handovers, by validating the Handoff CEX-Italian scale. The scale was translated from English into Italian and the content validity index was calculated and internal consistency assessed. The scale was used in several units of the San Paolo Teaching Hospital in Milan, Italy. A total of 48 reports were assessed (192 evaluations). The median score was 6, interquartile range (IQR) [5;7] and was not influenced by specific (p=0.21) or overall working experience (p=0.13). The domains showing the lowest median values (median=6, IQR [4;8]) were context, communication, and organisation. Night to morning handovers obtained the lowest scores. CVI-S was 0.96, Cronbach's alpha was 0.79. The Handoff CEX-Italian scale is valid and reliable and it can be used to assess the quality of nurse handovers.

A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units

PubMed Central

Malekzadeh, Javad; Mazluom, Seyed Reza; Etezadi, Toktam; Tasseri, Alireza

2013-01-01

Introduction: For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. Methods: In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses’ Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. Results: Study findings revealed that nurses’ mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7) to 17.0 (1.8) (P < 0.001). Conclusion: using a standard handover protocol for communicating patient’s needs and information improves nurses’ safe practice in the area of basic nursing care. PMID:25276725

The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda

PubMed Central

Karamagi, Esther; Kigonya, Angella; Lawino, Anna; Marquez, Lani; Lunsford, Sarah Smith; Twinomugisha, Albert

2018-01-01

Background Uganda is working to increase voluntary medical male circumcision (VMMC) to prevent HIV infection. To support VMMC quality improvement, this study compared three methods of disseminating information to facilities on how to improve VMMC quality: M—providing a written manual; MH—providing the manual plus a handover meeting in which clinicians shared advice on implementing key changes and participated in group discussion; and MHC—manual, handover meeting, and three site visits to the facility in which a coach provided individualized guidance and mentoring on improvement. We determined the different effects these had on compliance with indicators of quality of care. Methods This controlled pre-post intervention study randomized health facility groups to receive M, MH, or MHC. Observations of VMMCs performance determined compliance with quality indicators. Intervention costs per patient receiving VMMC were used in a decision-tree cost-effectiveness model to calculate the incremental cost per additional patient treated to compliance with indicators of informed consent, history taking, anesthesia administration, and post-operative instructions. Results The most intensive method (MHC) cost $28.83 per patient and produced the biggest gains in history taking (35% improvement), anesthesia administration (20% improvement), and post-operative instructions (37% improvement). The least intensive method (M; $1.13 per patient) was most efficient because it produced small gains for a very low cost. The handover meeting (MH) was the most expensive among the three interventions but did not have a corresponding positive effect on quality. Conclusion Health workers in facilities that received the VMMC improvement manual and participated in the handover meeting and coaching visits showed more improvement in VMMC quality indicators than those in the other two intervention groups. Providing the manual alone cost the least but was also the least effective in achieving improvements. The MHC intervention is recommended for broader implementation to improve VMMC quality in Uganda. PMID:29672578

Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients.

PubMed

Smeulers, Marian; Lucas, Cees; Vermeulen, Hester

2014-06-24

An accurate handover of clinical information is of great importance to continuity and safety of care. If clinically relevant information is not shared accurately and in a timely manner it may lead to adverse events, delays in treatment and diagnosis, inappropriate treatment and omission of care. During the last decade the call for interventions to improve handovers has increased. These interventions aim to reduce the risk of miscommunication, misunderstanding and the omission of critical information. To determine the effectiveness of interventions designed to improve hospital nursing handover, specifically:to identify which nursing handover style(s) are associated with improved outcomes for patients in the hospital setting and which nursing handover style(s) are associated with improved nursing process outcomes. We searched the following electronic databases for primary studies: Cochrane EPOC Group specialised register (to 19 September 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (to 1 March 2013), MEDLINE (1950 to 1 March 2013) OvidSP, EMBASE (1947 to 1 March 2013) OvidSP, CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1980 to 1 March 2013) EbscoHost and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index) (to 9 July 2012). The Database of Abstracts of Reviews (DARE) was searched for related reviews. We screened the reference lists of included studies and relevant reviews. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) http://www.who.int/ictrp/en/ and Current Controlled Trials www.controlled-trials.com/mrct and we conducted a search of grey literature web sites. Randomised controlled trials (RCTs or cluster-RCTs) evaluating any nursing handover style between nurses in a hospital setting with the aim of preventing adverse events or optimising the transfer of accurate essential information required for continuity of care, or both. Two review authors independently assessed trial quality and extracted data. The search identified 2178 citations, 28 of which were considered potentially relevant. After independent review of the full text of these studies, no eligible studies were identified for inclusion in this review due to the absence of studies with a randomised controlled study design. There was no evidence available to support conclusions about the effectiveness of nursing handover styles for ensuring continuity of information in hospitalised patients because we found no studies that fulfilled the methodological criteria for this review. As a consequence, uncertainty about the most effective practice remains. Research efforts should focus on strengthening the evidence abut the effectiveness of nursing handover styles using well designed, rigorous studies. According to current knowledge, the following guiding principles can be applied when redesigning the nursing handover process: face-to-face communication, structured documentation, patient involvement and use of IT technology to support the process.

A Lightweight TwiddleNet Portal

DTIC Science & Technology

2008-03-01

MAC PHY Media Independent Handover Function (Network)ES CS IS 802 Interface Client Station 802 Networks 3GPP 3 GPP 2 Network MIH Network...Entity ( . e g ). MIH Server Controller Media Independent Handover Function (Client) Information Service over L2 Transport Remote MIH Events over L2...Co-located with MIH MGMTMGMT E v e n t s E S C S IS E v e n t s E v e n t s E v e n t s Media Independent Handover User Media

The use of information technology to enhance patient safety and nursing efficiency.

PubMed

Lee, Tso-Ying; Sun, Gi-Tseng; Kou, Li-Tseng; Yeh, Mei-Ling

2017-10-23

Issues in patient safety and nursing efficiency have long been of concern. Advancing the role of nursing informatics is seen as the best way to address this. The aim of this study was to determine if the use, outcomes and satisfaction with a nursing information system (NIS) improved patient safety and the quality of nursing care in a hospital in Taiwan. This study adopts a quasi-experimental design. Nurses and patients were surveyed by questionnaire and data retrieval before and after the implementation of NIS in terms of blood drawing, nursing process, drug administration, bar code scanning, shift handover, and information and communication integration. Physiologic values were easier to read and interpret; it took less time to complete electronic records (3.7 vs. 9.1 min); the number of errors in drug administration was reduced (0.08% vs. 0.39%); bar codes reduced the number of errors in blood drawing (0 vs. 10) and transportation of specimens (0 vs. 0.42%); satisfaction with electronic shift handover increased significantly; there was a reduction in nursing turnover (14.9% vs. 16%); patient satisfaction increased significantly (3.46 vs. 3.34). Introduction of NIS improved patient safety and nursing efficiency and increased nurse and patient satisfaction. Medical organizations must continually improve the nursing information system if they are to provide patients with high quality service in a competitive environment.

Improving client and nurse satisfaction through the utilization of bedside report.

PubMed

Vines, Mary M; Dupler, Alice E; Van Son, Catherine R; Guido, Ginny W

2014-01-01

Bedside reporting improves client safety and trust and facilitates nursing teamwork and accountability; however, many nurses do not consider it best practice when caring for their clients. A literature review was conducted to determine whether bedside report is an essential shift handover process that promotes both client and nursing satisfaction. Implications for nurses in professional development are discussed, and strategies for developing and implementing bedside report using Lewin's theory of planned change are provided.

Wireless cellular networks with Pareto-distributed call holding times

NASA Astrophysics Data System (ADS)

Rodriguez-Dagnino, Ramon M.; Takagi, Hideaki

2001-07-01

Nowadays, there is a growing interest in providing internet to mobile users. For instance, NTT DoCoMo in Japan deploys an important mobile phone network with that offers the Internet service, named 'i-mode', to more than 17 million subscribers. Internet traffic measurements show that the session duration of Call Holding Time (CHT) has probability distributions with heavy-tails, which tells us that they depart significantly from the traffic statistics of traditional voice services. In this environment, it is particularly important to know the number of handovers during a call for a network designer to make an appropriate dimensioning of virtual circuits for a wireless cell. The handover traffic has a direct impact on the Quality of Service (QoS); e.g. the service disruption due to the handover failure may significantly degrade the specified QoS of time-constrained services. In this paper, we first study the random behavior of the number of handovers during a call, where we assume that the CHT are Pareto distributed (heavy-tail distribution), and the Cell Residence Times (CRT) are exponentially distributed. Our approach is based on renewal theory arguments. We present closed-form formulae for the probability mass function (pmf) of the number of handovers during a Pareto distributed CHT, and obtain the probability of call completion as well as handover rates. Most of the formulae are expressed in terms of the Whittaker's function. We compare the Pareto case with cases of $k(subscript Erlang and hyperexponential distributions for the CHT.

A cooperative positioning with Kalman filters and handover mechanism for indoor microcellular visible light communication network

NASA Astrophysics Data System (ADS)

Xiong, Jieqing; Huang, Zhitong; Zhuang, Kaiyu; Ji, Yuefeng

2016-08-01

We propose a novel handover scheme for indoor microcellular visible light communication (VLC) network. With such a scheme, the room, which is fully coverage by light, is divided into several microcells according to the layout of light-emitting diodes (LEDs). However, the directionality of light arises new challenges in keeping the connectivity between the mobile devices and light source under the mobile circumstances. The simplest solution is that all LEDs broadcast data of every user simultaneously, but it wastes too much bandwidth resource, especially when the amount of users increases. To solve this key problem, we utilize the optical positioning assisting handover procedure in this paper. In the positioning stage, the network manager obtains the location information of user device via downlink and uplink signal strength information, which is white light and infrared, respectively. After that, a Kalman filter is utilized for improving the tracking performance of a mobile device. Then, the network manager decides how to initiate the handover process by the previous information. Results show that the proposed scheme can achieve low-cost, seamless data communication, and a high probability of successful handover.

Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians.

PubMed

Mount-Campbell, Austin F; Rayo, Michael F; OʼBrien, James J; Allen, Theodore T; Patterson, Emily S

Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.

Advanced mobility handover for mobile IPv6 based wireless networks.

PubMed

Safa Sadiq, Ali; Fisal, Norsheila Binti; Ghafoor, Kayhan Zrar; Lloret, Jaime

2014-01-01

We propose an Advanced Mobility Handover scheme (AMH) in this paper for seamless mobility in MIPv6-based wireless networks. In the proposed scheme, the mobile node utilizes a unique home IPv6 address developed to maintain communication with other corresponding nodes without a care-of-address during the roaming process. The IPv6 address for each MN during the first round of AMH process is uniquely identified by HA using the developed MN-ID field as a global permanent, which is identifying uniquely the IPv6 address of MN. Moreover, a temporary MN-ID is generated by access point each time an MN is associated with a particular AP and temporarily saved in a developed table inside the AP. When employing the AMH scheme, the handover process in the network layer is performed prior to its default time. That is, the mobility handover process in the network layer is tackled by a trigger developed AMH message to the next access point. Thus, a mobile node keeps communicating with the current access point while the network layer handover is executed by the next access point. The mathematical analyses and simulation results show that the proposed scheme performs better as compared with the existing approaches.

Traffic sharing algorithms for hybrid mobile networks

NASA Technical Reports Server (NTRS)

Arcand, S.; Murthy, K. M. S.; Hafez, R.

1995-01-01

In a hybrid (terrestrial + satellite) mobile personal communications networks environment, a large size satellite footprint (supercell) overlays on a large number of smaller size, contiguous terrestrial cells. We assume that the users have either a terrestrial only single mode terminal (SMT) or a terrestrial/satellite dual mode terminal (DMT) and the ratio of DMT to the total terminals is defined gamma. It is assumed that the call assignments to and handovers between terrestrial cells and satellite supercells take place in a dynamic fashion when necessary. The objectives of this paper are twofold, (1) to propose and define a class of traffic sharing algorithms to manage terrestrial and satellite network resources efficiently by handling call handovers dynamically, and (2) to analyze and evaluate the algorithms by maximizing the traffic load handling capability (defined in erl/cell) over a wide range of terminal ratios (gamma) given an acceptable range of blocking probabilities. Two of the algorithms (G & S) in the proposed class perform extremely well for a wide range of gamma.

Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.

PubMed

Chenault, Kristin; Moga, Michael-Alice; Shin, Minah; Petersen, Emily; Backer, Carl; De Oliveira, Gildasio S; Suresh, Santhanam

2016-05-01

Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied. The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit. This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase). A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively. We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery. © 2016 John Wiley & Sons Ltd.

Educational Interventions to Improve Handover in Health Care: An Updated Systematic Review.

PubMed

Gordon, Morris; Hill, Elaine; Stojan, Jennifer N; Daniel, Michelle

2018-04-03

Effective handovers (handoffs) are vital to patient safety. Medical educators investigated educational interventions to improve handovers in a 2011 systematic review. The number of publications on handover education has increased since then, so authors undertook this updated review. The authors considered studies involving educational interventions to improve handover amongst undergraduate or postgraduate health professionals in acute care settings. In September 2016, two authors independently conducted a standardized search of online databases and completed a data extraction and quality assessment of the articles included. They conducted a content analysis of and extracted key themes from the interventions described. Eighteen reports met the inclusion criteria. All but two were based in the United States. Interventions most commonly involved single-patient exercises based on simulation and role play. Many studies mentioned multiprofessional education or practice, but interventions occurred largely in single-professional contexts. Analysis of interventions revealed three major themes: facilitating information management, reducing the potential for errors, and improving confidence. The majority of studies assessed Kirkpatrick's outcomes of knowledge and skill improvement (Levels 1 and 2). The strength of conclusions was generally weak. Despite increased interest in and publications on handover, the quality of published research remains poor. Inadequate reporting of interventions, especially as they relate to educational theory, pedagogy, curricula, and resource requirements, continues to impede replication. Weaknesses in methodologies, length of follow-up, and scope of outcomes evaluation (Kirkpatrick levels) persist. Future work to address these issues, and to consider the role of multiprofessional and multiple-patient handovers, is vital.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Lost information during the handover of critically injured trauma patients: a mixed-methods study.

PubMed

Zakrison, Tanya Liv; Rosenbloom, Brittany; McFarlan, Amanda; Jovicic, Aleksandra; Soklaridis, Sophie; Allen, Casey; Schulman, Carl; Namias, Nicholas; Rizoli, Sandro

2016-12-01

Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer. A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis. Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety. Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Improving Continuity of Care via the Discharge Summary

PubMed Central

Sakaguchi, Farrant H.; Lenert, Leslie A.

2015-01-01

Discharge summaries (DCS) frequently fail to improve the continuity of care. A chart review of 188 DCS was performed to identify specific components that could be improved through health information technology. Medication reconciliations were analyzed for completeness and for medical reasoning. Documentation of pending results and follow-up details were analyzed. Patient preferences, patient goals, and the handover tone were noted. Patients were discharged on an average of 9.8 medications, only 3% of medication reconciliations were complete and medical reasoning was frequently absent. There were 358 pending results in 188 hospital discharges though only 14% were mentioned in the DCS. Documentation of clear, timely follow-up was present for less than 50% of patients. Patient preferences, patient goals, and lessons learned were rarely included. A handover tone was in only 17% of the DCS. Evaluating the DCS as a clinical handover is novel but information for safe handovers is frequently missing. PMID:26958250

"Chase CRP", "Review patient": Improving the Quality of Weekend Medical Handover at a London Teaching Hospital.

PubMed

Saifuddin, Aamir; Magee, Lucia; Barrett, Rachael

2015-01-01

Clinical handover has been identified as a "major preventable cause of harm" by the Royal College of Physicians (RCP). Whilst working at a London teaching hospital from August 2013, we noted substandard weekend handover of medical patients. The existing pro forma was filled incompletely by day doctors so it was difficult for weekend colleagues to identify unwell patients, with inherent safety implications. Furthermore, on-call medical staff noted that poor accessibility of vital information in patients' files was affecting acute clinical management. We audited the pro formas over a six week period (n=83) and the Friday ward round (WR) entries for medical inpatients over two weekends (n=84) against the RCP's handover guidance. The results showed poor documentation of several important details on the pro formas, for example, ceiling of care (4%) and past medical history (PMH) (23%). Problem lists were specified on 62% of the WR entries. We designed new handover pro formas and 'Friday WR sheets' to provide prompts for this information and used Medical Meetings and emails to explain the project's aims. Re-audit demonstrated significant improvement in all parameters; for instance, PMH increased to 52% on the pro formas. Only 10% of Friday WR entries used our sheet. However, when used, outcomes were much better, for example, problem list documentation increased to 100%. In conclusion, our interventions improved the provision of crucial information needed to prioritise and manage patients over the weekend. Future work should further highlight the importance of safe handover to all doctors to induce a shift in culture and optimise patient care.

An Adaptive Handover Prediction Scheme for Seamless Mobility Based Wireless Networks

PubMed Central

Safa Sadiq, Ali; Fisal, Norsheila Binti; Ghafoor, Kayhan Zrar; Lloret, Jaime

2014-01-01

We propose an adaptive handover prediction (AHP) scheme for seamless mobility based wireless networks. That is, the AHP scheme incorporates fuzzy logic with AP prediction process in order to lend cognitive capability to handover decision making. Selection metrics, including received signal strength, mobile node relative direction towards the access points in the vicinity, and access point load, are collected and considered inputs of the fuzzy decision making system in order to select the best preferable AP around WLANs. The obtained handover decision which is based on the calculated quality cost using fuzzy inference system is also based on adaptable coefficients instead of fixed coefficients. In other words, the mean and the standard deviation of the normalized network prediction metrics of fuzzy inference system, which are collected from available WLANs are obtained adaptively. Accordingly, they are applied as statistical information to adjust or adapt the coefficients of membership functions. In addition, we propose an adjustable weight vector concept for input metrics in order to cope with the continuous, unpredictable variation in their membership degrees. Furthermore, handover decisions are performed in each MN independently after knowing RSS, direction toward APs, and AP load. Finally, performance evaluation of the proposed scheme shows its superiority compared with representatives of the prediction approaches. PMID:25574490

An adaptive handover prediction scheme for seamless mobility based wireless networks.

PubMed

Sadiq, Ali Safa; Fisal, Norsheila Binti; Ghafoor, Kayhan Zrar; Lloret, Jaime

2014-01-01

We propose an adaptive handover prediction (AHP) scheme for seamless mobility based wireless networks. That is, the AHP scheme incorporates fuzzy logic with AP prediction process in order to lend cognitive capability to handover decision making. Selection metrics, including received signal strength, mobile node relative direction towards the access points in the vicinity, and access point load, are collected and considered inputs of the fuzzy decision making system in order to select the best preferable AP around WLANs. The obtained handover decision which is based on the calculated quality cost using fuzzy inference system is also based on adaptable coefficients instead of fixed coefficients. In other words, the mean and the standard deviation of the normalized network prediction metrics of fuzzy inference system, which are collected from available WLANs are obtained adaptively. Accordingly, they are applied as statistical information to adjust or adapt the coefficients of membership functions. In addition, we propose an adjustable weight vector concept for input metrics in order to cope with the continuous, unpredictable variation in their membership degrees. Furthermore, handover decisions are performed in each MN independently after knowing RSS, direction toward APs, and AP load. Finally, performance evaluation of the proposed scheme shows its superiority compared with representatives of the prediction approaches.

Advanced Mobility Handover for Mobile IPv6 Based Wireless Networks

PubMed Central

Safa Sadiq, Ali; Fisal, Norsheila Binti; Ghafoor, Kayhan Zrar; Lloret, Jaime

2014-01-01

We propose an Advanced Mobility Handover scheme (AMH) in this paper for seamless mobility in MIPv6-based wireless networks. In the proposed scheme, the mobile node utilizes a unique home IPv6 address developed to maintain communication with other corresponding nodes without a care-of-address during the roaming process. The IPv6 address for each MN during the first round of AMH process is uniquely identified by HA using the developed MN-ID field as a global permanent, which is identifying uniquely the IPv6 address of MN. Moreover, a temporary MN-ID is generated by access point each time an MN is associated with a particular AP and temporarily saved in a developed table inside the AP. When employing the AMH scheme, the handover process in the network layer is performed prior to its default time. That is, the mobility handover process in the network layer is tackled by a trigger developed AMH message to the next access point. Thus, a mobile node keeps communicating with the current access point while the network layer handover is executed by the next access point. The mathematical analyses and simulation results show that the proposed scheme performs better as compared with the existing approaches. PMID:25614890

Solar Dynamics Observatory High Gain Antenna Handover Planning

NASA Technical Reports Server (NTRS)

Hashmall, Joseph A.; Mann, Laurie

2007-01-01

The Solar Dynamics Observatory (SDO) is planned to launch in early 2009 as a mission to study the solar variability and its impact on Earth. To best satisfy its science goal, SDO will fly in a geosynchronous orbit with an inclination of approximately 29 deg. The spacecraft attitude is designed so that the science instruments point directly at the Sun with high accuracy. One of SDO s principal requirements is to obtain long periods of uninterrupted observations. The observations have an extremely high data volume so SDO must be in continuous contact with the ground during the observation periods. To maintain this contact, SDO is equipped with a pair of high gain antennas (HGAs) transmitting to a pair of ground antennas at the SDO ground station (SDOGS) located in White Sands, New Mexico. Either HGA can transmit to either SDOGS antenna. Neither HGA can be powered down. During a portion of each year, each of the HGA beams will intersect with the SDO body for a portion of the orbit. The original SDO antenna contact plan used each HGA for the half of each year during which its beam would not intersect the spacecraft. No data would be lost except, possibly, when switching from one antenna to another. After this plan was adopted, further analysis showed that daily handovers would be necessary for significant periods of the year. This unexpected need for extensive handovers necessitated that a handover design be developed to minimize the impact on the mission. This antenna handover design was developed and successfully tested with simulated data using the slew rate limits from preliminary jitter analysis. Subsequent analysis provided significant revision of allowed rates requiring modification of the handover plans.

Solar Dynamics Observatory High Gain Antenna Handover Planning

NASA Technical Reports Server (NTRS)

Hashmall, Joseph A.; Mann, Laurie

2007-01-01

The Solar Dynamics Observatory (SDO) is planned to launch in early 2009 as a mission to study the solar variability and its impact on Earth. To best satisfy its science goal, SDO will fly in a geosynchronous orbit with an inclination of approximately 29 deg. The spacecraft attitude is designed so that the science instruments point directly at the Sun with high accuracy. One of SDO's principal requirements is to obtain long periods of uninterrupted observations. The observations have an extremely high data volume so SDO must be in continuous contact with the ground during the observation periods. To maintain this contact, SDO is equipped with a pair of high gain antennas (HGAs) transmitting to a pair of ground antennas at the SDO ground station (SDOGS) located in White Sands, New Mexico. Either HGA can transmit to either SDOGS antenna. Neither HGA can be powered down. During a portion of each year, each of the HGA beams will intersect with the SDO body for a portion of the orbit. The original SDO antenna contact plan used each HGA for the half of each year during which its beam would not intersect the spacecraft. No data would be lost except, possibly, when switching from one antenna to another. After this plan was adopted, further analysis showed that daily handovers would be necessary for significant periods of the year. This unexpected need for extensive handovers necessitated that a handover design be developed to minimize the impact on the mission. This antenna handover design was developed and successfully tested with simulated data using the slew rate limits from preliminary jitter analysis. Subsequent analysis provided significant revision of allowed rates requiring modification of the handover plans.

Transferring information to an out-of-hours primary care service for patients with palliative care needs: an action research study to improve the use of handover forms.

PubMed

Asprey, Anthea; Richards, Suzanne H; Wright, Christine; Seamark, Clare; Seamark, David; Moxon, Jane

2013-01-01

To work with service users and providers to optimise the design and implementation of handover forms to support the transfer of information between daytime and out-of-hours primary care services for patients with palliative care needs. There is a need for improved informational continuity between daytime and out-of-hours primary care services for patients with palliative care needs. Research suggests that while handover forms are vital to ensure continuity of care, they remain underused for such patients. Audit work in an out-of-hours primary care service in South West England identified that their current system of handover forms was underused. An action research study consisting of two phases was undertaken. In phase one, the views of general practitioners and nurses working in the out-of-hours and daytime primary care services (29 health professionals) in Devon (population c.1.4 million) and patients with palliative care needs and their carers (8 participants) were investigated using qualitative interviews and focus group methods. Participants' views on the content and use of handover forms, and of the systems supporting their generation were sought. In phase two, additional feedback from the health professional stakeholder groups was collected and collaborative work undertaken with the out-of-hours service to implement recommendations emerging from the qualitative research. Findings Respondents identified variable use of handover forms and inconsistent practice in terms of: who was responsible for generating and updating forms; when and where they were discussed in primary care; the criteria used to define which patient needed a form; and the information forms should contain. There was uncertainty about how handover forms were used by the out-of-hours service and concerns about incomplete access to forms for certain groups of staff. An action plan to improve the existing system was developed. This included distribution of educational materials (desktop guide, newsletter) to key stakeholders, and the modification of information systems to facilitate the updating of messages and the accessibility of electronic records for previously under-served staff.

[Handover between home and respite care facilities : Delphi survey within the context of continuity of care for people with dementia].

PubMed

Kuske, S; Roes, M; Bartholomeyczik, S

2016-07-01

Criteria for the handover between healthcare settings were identified based on a review and on results of empirical data. This study was carried out to select the most relevant criteria for defining the quality of continuity of care of people with dementia (PwD) in the context of the handover between care at home and respite care facilities. A modified classical two-step Delphi design was used in combination with a group Delphi design. A total of 28 core criteria with a consensus strength of > 60 % are presented. Safety-relevant information, especially the personal habits of PwD and the role of informal caregivers in the handover between care settings are important. Furthermore, the following general principles to ensure the quality of continuity of the care of PwD were deduced: completeness, verification, multipath communication, timeliness and topicality, accessibility and defined responsibilities, roles and standardization. A successful transition of PwD to respite care facilities relies on the provision of relevant information, considering personal habits, before the day of transition. Furthermore, a timely preparation for discharge is important. The individual needs of the informal caregivers with regard to their support should be considered. Professionals who are responsible in handover processes should have solid communication competence in order to collect relevant information from informal caregivers, who have a strong individual care experience with the PwD.

Structure Basis for Directional R-loop Formation and Substrate Handover Mechanisms in Type I CRISPR-Cas System.

PubMed

Xiao, Yibei; Luo, Min; Hayes, Robert P; Kim, Jonathan; Ng, Sherwin; Ding, Fang; Liao, Maofu; Ke, Ailong

2017-06-29

Type I CRISPR systems feature a sequential dsDNA target searching and degradation process, by crRNA-displaying Cascade and nuclease-helicase fusion enzyme Cas3, respectively. Here we present two cryo-EM snapshots of the Thermobifida fusca type I-E Cascade: (1) unwinding 11 bp of dsDNA at the seed-sequence region to scout for sequence complementarity, and (2) further unwinding of the entire protospacer to form a full R-loop. These structures provide the much-needed temporal and spatial resolution to resolve key mechanistic steps leading to Cas3 recruitment. In the early steps, PAM recognition causes severe DNA bending, leading to spontaneous DNA unwinding to form a seed-bubble. The full R-loop formation triggers conformational changes in Cascade, licensing Cas3 to bind. The same process also generates a bulge in the non-target DNA strand, enabling its handover to Cas3 for cleavage. The combination of both negative and positive checkpoints ensures stringent yet efficient target degradation in type I CRISPR-Cas systems. Copyright © 2017 Elsevier Inc. All rights reserved.

User-centered design in clinical handover: exploring post-implementation outcomes for clinicians.

PubMed

Wong, Ming Chao; Cummings, Elizabeth; Turner, Paul

2013-01-01

This paper examines the outcomes for clinicians from their involvement in the development of an electronic clinical hand-over tool developed using principles of user-centered design. Conventional e-health post-implementation evaluations tend to emphasize technology-related (mostly positive) outcomes. More recently, unintended (mostly negative) consequences arising from the implementation of e-health technologies have also been reported. There remains limited focus on the post-implementation outcomes for users, particularly those directly involved in e-health design processes. This paper presents detailed analysis and insights into the outcomes experienced post-implementation by a cohort of junior clinicians involved in developing an electronic clinical handover tool in Tasmania, Australia. The qualitative methods used included observations, semi-structured interviews and analysis of clinical handover notes. Significantly, a number of unanticipated flow-on effects were identified that mitigated some of the challenges arising during the design and implementation of the tool. The paper concludes by highlighting the importance of identifying post-implementation user outcomes beyond conventional system adoption and use and also points to the need for more comprehensive evaluative frameworks to encapsulate these broader socio-technical user outcomes.

Staff perception of patient discharge from ICU to ward-based care.

PubMed

James, Stephen; Quirke, Sara; McBride-Henry, Karen

2013-11-01

The quality of information exchange between intensive care unit (ICU) and ward nurses, when patients are transferred out of intensive care, is important to the continuity of safe care. This research aimed to explore nurses' experiences of the discharge process from ICU to the ward environment. The study was conducted in a New Zealand Metropolitan hospital, using an exploratory descriptive design we adapted a questionnaire based on Whittaker and Ball's research on ICU patient handover. The questionnaires were then analysed using a descriptive thematic approach. The response rate of 48% included 45 ICU and 47 ward nurses. Key findings were that the written and verbal communication needs differ dependent upon setting and the timing of a discharge. Timing of handover also requires negotiation. Being able to negotiate the timing and nature of handover is important for nurses. In addition, standardized approaches to communication are believed to enhance patient safety. Standardized handover, with content and processes that are mutually negotiated, is crucial to providing the safest environment for patients. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

Similarity and accuracy of mental models formed during nursing handovers: A concept mapping approach.

PubMed

Drach-Zahavy, Anat; Broyer, Chaya; Dagan, Efrat

2017-09-01

Shared mental models are crucial for constructing mutual understanding of the patient's condition during a clinical handover. Yet, scant research, if any, has empirically explored mental models of the parties involved in a clinical handover. This study aimed to examine the similarities among mental models of incoming and outgoing nurses, and to test their accuracy by comparing them with mental models of expert nurses. A cross-sectional study, exploring nurses' mental models via the concept mapping technique. 40 clinical handovers. Data were collected via concept mapping of the incoming, outgoing, and expert nurses' mental models (total of 120 concept maps). Similarity and accuracy for concepts and associations indexes were calculated to compare the different maps. About one fifth of the concepts emerged in both outgoing and incoming nurses' concept maps (concept similarity=23%±10.6). Concept accuracy indexes were 35%±18.8 for incoming and 62%±19.6 for outgoing nurses' maps. Although incoming nurses absorbed fewer number of concepts and associations (23% and 12%, respectively), they partially closed the gap (35% and 22%, respectively) relative to expert nurses' maps. The correlations between concept similarities, and incoming as well as outgoing nurses' concept accuracy, were significant (r=0.43, p<0.01; r=0.68 p<0.01, respectively). Finally, in 90% of the maps, outgoing nurses added information concerning the processes enacted during the shift, beyond the expert nurses' gold standard. Two seemingly contradicting processes in the handover were identified. "Information loss", captured by the low similarity indexes among the mental models of incoming and outgoing nurses; and "information restoration", based on accuracy measures indexes among the mental models of the incoming nurses. Based on mental model theory, we propose possible explanations for these processes and derive implications for how to improve a clinical handover. Copyright © 2017 Elsevier Ltd. All rights reserved.

Core trainee boot camp-A method for improving technical and non-technical skills of novice surgical trainees. A before and after study.

PubMed

Bamford, R; Langdon, L; Rodd, C A; Eastaugh-Waring, S; Coulston, J E

2018-04-10

The transition to surgical training can be a stressful time for trainees and is most evident during national handover periods where new graduates start and senior trainees rotate to new programmes. During this time, patient mortality can increase and Hospital efficiency reduces. This influence is compounded by the impact of working time directives. Intensive, simulation rich training programmes or "Boot Camps" have been postulated as a solution. This article highlights the development of a surgical boot camp for novice surgical trainees and the impact this can have on training. A novel surgical boot camp was developed for all trainees within a surgical training region including nine acute NHS trusts. Participating cohort of trainees completed pre and post course questionnaires to assess technical and non-technical skills. 25 trainees attended and completed the pre and post boot camp questionnaire. Significant improvements were seen with technical skills (p = 0.0429), overall non-technical skills (p < 0.001) including leadership (p = 0.022), communication (p = 0.010), situational awareness (p = 0.022), patient handover (p = 0.003), ward round skills (p = 0.005) and outpatient skill (p = 0.002). Trainees reported significantly increased ability to assess and manage a critically unwell patient (p = 0.001) and a trauma patient (p = 0.001). 96% of trainees have utilised the skills they learnt on Boot Camp and all trainees would recommend it as an induction programme. Surgical Boot Camps offer a timely chance to develop technical and non-technical skills whilst enhancing a trainee's confidence and knowledge and reduce the patient safety impact of the handover period. Copyright © 2018. Published by Elsevier Ltd.

Fast and secure handover of intra-ASN IEEE802.16 network by proposed certificate based pre-authentication

NASA Astrophysics Data System (ADS)

Sridevi, B.; Supriya, T. S.; Rajaram, S.

2013-01-01

The current generation of wireless networks has been designed predominantly to support voice and more recently data traffic. WiMAX is currently one of the hottest technologies in wireless. The main motive of the mobile technologies is to provide seamless cost effective mobility. But this is affected by Authentication cost and handover delay since on each handoff the Mobile Station (MS) has to undergo all steps of authentication. Pre-Authentication is used to reduce the handover delay and increase the speed of the Intra-ASN Handover. Proposed Pre-Authentication method is intended to reduce the authentication delay by getting pre authenticated by central authority called Pre Authentication Authority (PAA). MS requests PAA for Pre Authentication Certificate (PAC) before performing handoff. PAA verifies the identity of MS and provides PAC to MS and also to the neighboring target Base Stations (tBSs). MS having time bound PAC can skip the authentication process when recognized by target BS during handoff. It also prevents the DOS (Denial Of Service) attack and Replay attack. It has no wastage of unnecessary key exchange of the resources. The proposed work is simulated by NS2 model and by MATLAB.

Experimental Investigation of the Performance of Vertical Handover Algorithms between WiFi and UMTS Networks

NASA Astrophysics Data System (ADS)

Busanelli, Stefano; Martalò, Marco; Ferrari, Gianluigi; Spigoni, Giovanni; Iotti, Nicola

In this paper, we analyze the performance of vertical handover (VHO) algorithms for seamless mobility between WiFi and UMTS networks. We focus on a no-coupling scenario, characterized by the lack of any form of cooperation between the involved players (users and network operators). In this context, we first propose a low-complexity Received Signal Strength Indicator (RSSI)-based algorithm, and then an improved hybrid RSSI/goodput version. We present experimental results based on the implementation of a real testbed with commercial WiFi (Guglielmo) and UMTS (Telecom Italia) deployed networks. Despite the relatively long handover times experienced in our testbed, the proposed RSSI-based VHO algorithm guarantees an effective goodput increase at the MTs. Moreover, this algorithm mitigates the ping-pong phenomenon.

Improving communication at handover and transfer reduces retained swabs in maternity services.

PubMed

Lean, Katie; Page, Bethan F; Vincent, Charles

2018-01-01

To reduce the incidence of retained vaginal swabs and near misses. A review of previous retained swab incidents and near misses in a large maternity unit identified handovers and transfers as a key point of vulnerability. Interventions were introduced to improve communication at handover from the delivery suite to theatre and from theatre to the high dependency unit. Process data was collected to monitor compliance. The outcome measures were the incidence of retained swab never events and the incidence of near misses. Chi-squared analysis was used to test the significance of the results. For transfers from delivery suite to theatre, verbal handover significantly increased from 28.8% to 75.6% (p<0.0001), and written handover significantly increased from 4.4% to 62.9% (p<0.0001). There were 291 transfers to theatre post-intervention: in 88 (30.2%) of these transfers a vaginal swab was already in situ. In 70/88 (79.5%) of cases the presence of the swab was communicated to theatre staff in three ways (verbally, written and transfer of opened swab packets) according to the new policy. In the post-intervention period there were 56 women transferred from theatre to the high-dependency unit with a vaginal pack in situ: 52 (92.9%) of these women had a sticker in place serving as a constant reminder of the presence of the vaginal pack to staff. Following a baseline of four near misses in two months, there has been only one near miss in the 15 months since the interventions were implemented, (33.3% vs. 1.1%, p<0.0001). There have been no retained swab incidents since the project commenced. Simple interventions to improve communication at handover and transfer can reduce the incidence of retained vaginal swabs and near misses. Further work is needed to raise the profile of swab counting in maternity settings: swab counting needs to be the responsibility of all disciplines, not just the responsibility of theatre staff. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Design and implementation of a virtual world training simulation of ICU first hour handover processes.

PubMed

Brown, Ross; Rasmussen, Rune; Baldwin, Ian; Wyeth, Peta

2012-08-01

Nursing training for an Intensive Care Unit (ICU) is a resource intensive process. High demands are made on staff, students and physical resources. Interactive, 3D computer simulations, known as virtual worlds, are increasingly being used to supplement training regimes in the health sciences; especially in areas such as complex hospital ward processes. Such worlds have been found to be very useful in maximising the utilisation of training resources. Our aim is to design and develop a novel virtual world application for teaching and training Intensive Care nurses in the approach and method for shift handover, to provide an independent, but rigorous approach to teaching these important skills. In this paper we present a virtual world simulator for students to practice key steps in handing over the 24/7 care requirements of intensive care patients during the commencing first hour of a shift. We describe the modelling process to provide a convincing interactive simulation of the handover steps involved. The virtual world provides a practice tool for students to test their analytical skills with scenarios previously provided by simple physical simulations, and live on the job training. Additional educational benefits include facilitation of remote learning, high flexibility in study hours and the automatic recording of a reviewable log from the session. To the best of our knowledge, we believe this is a novel and original application of virtual worlds to an ICU handover process. The major outcome of the work was a virtual world environment for training nurses in the shift handover process, designed and developed for use by postgraduate nurses in training. Copyright © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Changing Intergroup Relations with Mainland Chinese: An Analysis of Changes in Hong Kong Movies as a Popular Cultural Discourse

ERIC Educational Resources Information Center

Fong, Emily Tsz Yan

2010-01-01

Hong Kong popular culture played an important role in the construction and consolidation of Hong Kong identity long before the handover to China. In the past few years leading up to the 10th anniversary of the handover, both Hong Kong and China have undergone numerous changes which seem to be changing their relations. Whilst Hong Kong people had…

An Integrated Multi-layer Approach for Seamless Soft Handoff in Mobile Ad Hoc Networks

DTIC Science & Technology

2011-01-01

network to showcase how to leverage the IEEE 802.21 Media Independent Handover ( MIH ) framework [3] in our handoff solution. Moreover, to further...to the seamless handoff problem. The architecture leverages the IEEE 802.21 MIH standard to facilitate handover related decisions on multiple...provided by the MIH function (MIHF), the topology control manager dynamically activates/deactivates the wireless interfaces to ensure the network is

Polling-Based High-Bit-Rate Packet Transfer in a Microcellular Network to Allow Fast Terminals

NASA Astrophysics Data System (ADS)

Hoa, Phan Thanh; Lambertsen, Gaute; Yamada, Takahiko

A microcellular network will be a good candidate for the future broadband mobile network. It is expected to support high-bit-rate connection for many fast mobile users if the handover is processed fast enough to lessen its impact on QoS requirements. One of the promising techniques is believed to use for the wireless interface in such a microcellular network is the WLAN (Wireless LAN) technique due to its very high wireless channel rate. However, the less capability of mobility support of this technique must be improved to be able to expand its utilization for the microcellular environment. The reason of its less support mobility is large handover latency delay caused by contention-based handover to the new BS (base station) and delay of re-forwarding data from the old to new BS. This paper presents a proposal of multi-polling and dynamic LMC (Logical Macro Cell) to reduce mentioned above delays. Polling frame for an MT (Mobile Terminal) is sent from every BS belonging to the same LMC — a virtual single macro cell that is a multicast group of several adjacent micro-cells in which an MT is communicating. Instead of contending for the medium of a new BS during handover, the MT responds to the polling sent from that new BS to enable the transition. Because only one BS of the LMC receives the polling ACK (acknowledgement) directly from the MT, this ACK frame has to be multicast to all BSs of the same LMC through the terrestrial network to continue sending the next polling cycle at each BS. Moreover, when an MT hands over to a new cell, its current LMC is switched over to a newly corresponding LMC to prevent the future contending for a new LMC. By this way, an MT can do handover between micro-cells of an LMC smoothly because the redundant resource is reserved for it at neighboring cells, no need to contend with others. Our simulation results using the OMNeT++ simulator illustrate the performance achievements of the multi-polling and dynamic LMC scheme in eliminating handover latency, packet loss and keeping mobile users' throughput stable in the high traffic load condition though it causes somewhat overhead on the neighboring cells.

Evaluation and Implementation of Media-Independent Handover in Hastily Formed Networks

DTIC Science & Technology

2013-03-01

the Media Independent Handover ( MIH ) in HFNs can be an adequate solution for these problems. MIH could be the solution to not only the mobility...and roaming problems but also for other HFN problems due to the intelligent layer-two functions it offers. We tried to combine MIH and Session...showed the limitations of MIH and its open source implementation (ODTONE). We were also able to describe the steps needed for the integration of SIP

Context-based handover of persons in crowd and riot scenarios

NASA Astrophysics Data System (ADS)

Metzler, Jürgen

2015-02-01

In order to control riots in crowds, it is helpful to get ringleaders under control and pull them out of the crowd if one has become an offender. A great support to achieve these tasks is the capability of observing the crowd and ringleaders automatically by using cameras. It also allows a better conservation of evidence in riot control. A ringleader who has become an offender should be tracked across and recognized by several cameras, regardless of whether overlapping camera's fields of view exist or not. We propose a context-based approach for handover of persons between different camera fields of view. This approach can be applied for overlapping as well as for non-overlapping fields of view, so that a fast and accurate identification of individual persons in camera networks is feasible. Within the scope of this paper, the approach is applied to a handover of persons between single images without having any temporal information. It is particularly developed for semiautomatic video editing and a handover of persons between cameras in order to improve conservation of evidence. The approach has been developed on a dataset collected during a Crowd and Riot Control (CRC) training of the German armed forces. It consists of three different levels of escalation. First, the crowd started with a peaceful demonstration. Later, there were violent protests, and third, the riot escalated and offenders bumped into the chain of guards. One result of the work is a reliable context-based method for person re-identification between single images of different camera fields of view in crowd and riot scenarios. Furthermore, a qualitative assessment shows that the use of contextual information can support this task additionally. It can decrease the needed time for handover and the number of confusions which supports the conservation of evidence in crowd and riot scenarios.

What can artefact analysis tell us about patient transitions between the hospital and primary care? Lessons from the HANDOVER project.

PubMed

Johnson, Julie K; Arora, Vineet M; Barach, Paul R

2013-09-01

Hospital discharge often faces breakdowns in information, communication, and coordination. The European Union FP7 Health Research Programme commissioned the European HANDOVER Project in 2008, a three year, 3.5 million Euro programme to examine transitions of patient care from the hospital to the community care settings. Six European countries--Italy, the Netherlands, Poland, United Kingdom, Spain, and Sweden--participated in this collaborative study. This paper highlights a multi-centre, multi-national research programme. We describe how HANDOVER participants conducted an 'artefact analysis' as one element of the mixed methods study to inform opportunities to make patient handovers between hospital and community care more effective. The artefact analysis consisted of a four-step process to assess different tools used in communication and treatment and their effects on the communication processes between the hospital and general practice settings. Four themes emerged from our analysis: (a) The inpatient care of a patient is 'hospital centric' whereby the hospital 'pulls' information regarding a patient's family physician (b) There are rich cognitive artefacts that support the patient clinician encounter; c) The use of information technology does not necessarily improve the communication process; and (d) There is a role for the patient, albeit not particularly well-defined or explicit, as a conduit for essential information communication. Cognitive artefact analysis is an innovative method to provide insights into transitions of patient care. It may be most useful to think about interventions at both the individual patient and the system levels that more fully address and overcome the system issues at work.

Handover in Intensive Care.

PubMed

Sirgo Rodríguez, G; Chico Fernández, M; Gordo Vidal, F; García Arias, M; Holanda Peña, M S; Azcarate Ayerdi, B; Bisbal Andrés, E; Ferrándiz Sellés, A; Lorente García, P J; García García, M; Merino de Cos, P; Allegue Gallego, J M; García de Lorenzo Y Mateos, A; Trenado Álvarez, J; Rebollo Gómez, P; Martín Delgado, M C

2018-04-01

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

The Preservation of Cued Recall in the Acute Mentally Fatigued State: A Randomised Crossover Study.

PubMed

Flindall, Ian Richard; Leff, Daniel Richard; Pucks, Neysan; Sugden, Colin; Darzi, Ara

2016-01-01

The objective of this study is to investigate the impact of acute mental fatigue on the recall of clinical information in the non-sleep-deprived state. Acute mental fatigue in the non-sleep-deprived subject is rarely studied in the medical workforce. Patient handover has been highlighted as an area of high risk especially in fatigued subjects. This study evaluates the deterioration in recall of clinical information over 2 h with cognitively demanding work in non-sleep-deprived subjects. A randomised crossover study involving twenty medical students assessed free (presentation) and cued (MCQ) recall of clinical case histories at 0 and 2 h under low and high cognitive load using the N-Back task. Acute mental fatigue was assessed through the Visual Analogue Scale, Stanford Scale and NASA-TLX Mental Workload Rating Scale. Free recall is significantly impaired by increased cognitive load (p < 0.05) with subjects demonstrating perceived mental fatigue during the high cognitive load assessment. There was no significant difference in the amount of information retrieved by cued recall under high and low cognitive load conditions (p = 1). This study demonstrates the loss of clinical information over a short time period involving a mentally fatiguing, high cognitive load task. Free recall for the handover of clinical information is unreliable. Memory cues maintain recall of clinical information. This study provides evidence towards the requirement for standardisation of a structured patient handover. The use of memory cues (involving recognition memory and cued recall methodology) would be beneficial in a handover checklist to aid recall of clinical information and supports evidence for their adoption into clinical practice.

Improvement of Physical Therapist Assessment of Risk of Falls in the Hospital and Discharge Handover Through an Intervention to Modify Clinical Behavior.

PubMed

Thomas, Susie; Mackintosh, Shylie

2016-06-01

Discharge from the hospital is a high risk transition period for older adults at risk of falls. Guidelines relevant to physical therapists for managing this risk are well documented, but commonly not implemented. This project implemented an intervention to improve physical therapists' adherence to key guideline recommendations for managing risk of falls on discharge from one hospital. A pretest-posttest study design was undertaken and was underpinned by the Theoretical Domains Framework (TDF) to aid in the design of interventions to increase physical therapists' adherence to guideline recommendations and to identify barriers to these interventions. A multifaceted intervention was implemented, including the establishment of a governance committee, education sessions, development of a "pathway" to guide practice, modification of an existing standardized assessment proforma, development of standardized processes and indicators for handover, increasing availability of educational handouts, audit and feedback processes, and allocation of dedicated staffing to oversee falls prevention within the physical therapy department. There were significant improvements in physical therapist behavior leading to key guideline recommendations being met, including: the proportion of patients who were identified to be at risk of falls (6.3% preintervention versus 94.8% postintervention) prior to discharge, an increase in documentation of clinical handover at discharge (68.6% preintervention versus 90.9% postintervention), and improvement in the quality of this documented clinical handover (34.9% of case notes met 5 criteria preintervention versus 92.9% postintervention). The approach was resource intensive and consequently may be difficult to replicate at other sites. A multifaceted intervention underpinned by the TDF, designed to modify physical therapists' behavior to improve adherence to guideline recommendations for managing risk of falls on discharge from one hospital, was successful. © 2016 American Physical Therapy Association.

Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers.

PubMed

Yao, Guiqing Lily; Novielli, Nicola; Manaseki-Holland, Semira; Chen, Yen-Fu; van der Klink, Marcel; Barach, Paul; Chilton, Peter J; Lilford, Richard J

2012-12-01

We developed a method to estimate the expected cost-effectiveness of a service intervention at the design stage and 'road-tested' the method on an intervention to improve patient handover of care between hospital and community. The development of a nine-step evaluation framework: 1. Identification of multiple endpoints and arranging them into manageable groups; 2. Estimation of baseline overall and preventable risk; 3. Bayesian elicitation of expected effectiveness of the planned intervention; 4. Assigning utilities to groups of endpoints; 5. Costing the intervention; 6. Estimating health service costs associated with preventable adverse events; 7. Calculating health benefits; 8. Cost-effectiveness calculation; 9. Sensitivity and headroom analysis. Literature review suggested that adverse events follow 19% of patient discharges, and that one-third are preventable by improved handover (ie, 6.3% of all discharges). The intervention to improve handover would reduce the incidence of adverse events by 21% (ie, from 6.3% to 4.7%) according to the elicitation exercise. Potentially preventable adverse events were classified by severity and duration. Utilities were assigned to each category of adverse event. The costs associated with each category of event were obtained from the literature. The unit cost of the intervention was €16.6, which would yield a Quality Adjusted Life Year (QALY) gain per discharge of 0.010. The resulting cost saving was €14.3 per discharge. The intervention is cost-effective at approximately €214 per QALY under the base case, and remains cost-effective while the effectiveness is greater than 1.6%. We offer a usable framework to assist in ex ante health economic evaluations of health service interventions.

Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers

PubMed Central

Yao, Guiqing Lily; Novielli, Nicola; Manaseki-Holland, Semira; Chen, Yen-Fu; van der Klink, Marcel; Barach, Paul; Chilton, Peter J; Lilford, Richard J

2012-01-01

Background We developed a method to estimate the expected cost-effectiveness of a service intervention at the design stage and ‘road-tested’ the method on an intervention to improve patient handover of care between hospital and community. Method The development of a nine-step evaluation framework: 1. Identification of multiple endpoints and arranging them into manageable groups; 2. Estimation of baseline overall and preventable risk; 3. Bayesian elicitation of expected effectiveness of the planned intervention; 4. Assigning utilities to groups of endpoints; 5. Costing the intervention; 6. Estimating health service costs associated with preventable adverse events; 7. Calculating health benefits; 8. Cost-effectiveness calculation; 9. Sensitivity and headroom analysis. Results     Literature review suggested that adverse events follow 19% of patient discharges, and that one-third are preventable by improved handover (ie, 6.3% of all discharges). The intervention to improve handover would reduce the incidence of adverse events by 21% (ie, from 6.3% to 4.7%) according to the elicitation exercise. Potentially preventable adverse events were classified by severity and duration. Utilities were assigned to each category of adverse event. The costs associated with each category of event were obtained from the literature. The unit cost of the intervention was €16.6, which would yield a Quality Adjusted Life Year (QALY) gain per discharge of 0.010. The resulting cost saving was €14.3 per discharge. The intervention is cost-effective at approximately €214 per QALY under the base case, and remains cost-effective while the effectiveness is greater than 1.6%. Conclusions We offer a usable framework to assist in ex ante health economic evaluations of health service interventions. PMID:22976505

A Network Selection Algorithm Considering Power Consumption in Hybrid Wireless Networks

NASA Astrophysics Data System (ADS)

Joe, Inwhee; Kim, Won-Tae; Hong, Seokjoon

In this paper, we propose a novel network selection algorithm considering power consumption in hybrid wireless networks for vertical handover. CDMA, WiBro, WLAN networks are candidate networks for this selection algorithm. This algorithm is composed of the power consumption prediction algorithm and the final network selection algorithm. The power consumption prediction algorithm estimates the expected lifetime of the mobile station based on the current battery level, traffic class and power consumption for each network interface card of the mobile station. If the expected lifetime of the mobile station in a certain network is not long enough compared the handover delay, this particular network will be removed from the candidate network list, thereby preventing unnecessary handovers in the preprocessing procedure. On the other hand, the final network selection algorithm consists of AHP (Analytic Hierarchical Process) and GRA (Grey Relational Analysis). The global factors of the network selection structure are QoS, cost and lifetime. If user preference is lifetime, our selection algorithm selects the network that offers longest service duration due to low power consumption. Also, we conduct some simulations using the OPNET simulation tool. The simulation results show that the proposed algorithm provides longer lifetime in the hybrid wireless network environment.

A secure 2G-RFID-Sys mechanism for applying to the medical emergency system.

PubMed

Chen, Yu-Yi; Wang, Yao-Jen; Jan, Jinn-Ke

2013-06-01

In the Medical Emergency System, any moment of delay in an emergency such as ambulance dispatch, ambulance diversion and clinical handover communication can significantly reduce a patient's chance of survival. Without the disadvantage of centralized management, a new type of RFID application named 2G-RFID-Sys will be more efficient. It is suitable for the tagged ambulance dispatch management in a huge range. In this article, the prototype of 2G-RFID-Sys and the responsibility of each participant are refined. We take an example of applying the 2G-RFID-Sys to the Medical Emergency System, the traffic condition of the ambulance will be able to ensure.

A New Reactive FMIPv6 Mechanism for Minimizing Packet Loss

NASA Astrophysics Data System (ADS)

Kim, Pyungsoo

This paper considers a new reactive fast handover MIPv6 (FMIPv6) mechanism to minimize packet loss of the existing mechanism. The primary idea of the proposed reactive FMIPv6 mechanism is that the serving access router buffers packets toward the mobile node (MN) as soon as the link layer between MN and serving base station is disconnected. To implement the proposed mechanism, the router discovery message exchanged between MN and serving access router is extended. In addition, the IEEE 802.21 Media Independent Handover Function event service message is defined newly. Through analytic performance evaluation and experiments, the proposed reactive FMIPv6 mechanism can be shown to minimize packet loss much than the existing mechanism.

Implementation of a Transfer Intervention Procedure (TIP) to improve handovers from hospital to home: interrupted time series analysis.

PubMed

van Seben, Rosanne; Geerlings, Suzanne E; Verhaegh, Kim J M; Hilders, Carina G J M; Buurman, Bianca M

2016-09-07

Accurate and timely patient handovers from hospital to other health care settings are essential in order to provide high quality of care and to ensure patient safety. We aim to investigate the effect of a comprehensive discharge bundle, the Transfer Intervention Procedure (TIP), on the time between discharge and the time when the medical, medication and nursing handovers are sent to the next health care provider. Our goal is to reduce this time to 24 h after hospital discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days rates. The current study is set to implement the TIP, a structured discharge process for all patients admitted to the hospital, with the purpose to provide a safe, reliable and accurate discharge process. Eight hospitals in the Netherlands will implement the TIP on one internal medicine and one surgical ward. An interrupted time series (ITS) analysis, with pre-defined pre and post intervention periods, will be conducted. Patients over the age of 18 admitted for more than 48 h to the participating wards are eligible for inclusion. At least 1000 patients will be included in both the pre-implementation and post-implementation group. The primary outcome is the number of medical, medication and nursing handovers being sent within 24 h after discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days. With regard to potential confounders, data will be collected on patient's characteristics and information regarding the hospitalization. We will use segmented regression methods for analyzing the data, which allows assessing how much TIP changed the outcomes of interest immediately and over time. This study protocol describes the implementation of TIP, which provides the foundation for a safe, reliable and accurate discharge process. If effective, nationwide implementation of the discharge bundle may result from this study protocol. Dutch Trial Registry: NTR5951.

Nurses' expert opinions of workplace interventions for a healthy working environment: a Delphi survey.

PubMed

Doran, Diane; Clarke, Sean; Hayes, Laureen; Nincic, Vera

2014-09-01

Much has been written about interventions to improve the nursing work environment, yet little is known about their effectiveness. A Delphi survey of nurse experts was conducted to explore perceptions about workplace interventions in terms of feasibility and likelihood of positive impact on nurse outcomes such as job satisfaction and nurse retention. The interventions that received the highest ratings for likelihood of positive impact included: bedside handover to improve communication at shift report and promote patient-centred care; training program for nurses in dealing with violent or aggressive behaviour; development of charge nurse leadership team; training program focused on creating peer-supportive atmospheres and group cohesion; and schedule that recognizes work balance and family demands. The overall findings are consistent with the literature that highlights the importance of communication and teamwork, nurse health and safety, staffing and scheduling practices, professional development and leadership and mentorship. Nursing researchers and decision-makers should work in collaboration to implement and evaluate interventions for promoting practice environments characterized by effective communication and teamwork, professional growth and adequate support for the health and well-being of nurses.

An approach to efficient mobility management in intelligent networks

NASA Technical Reports Server (NTRS)

Murthy, K. M. S.

1995-01-01

Providing personal communication systems supporting full mobility require intelligent networks for tracking mobile users and facilitating outgoing and incoming calls over different physical and network environments. In realizing the intelligent network functionalities, databases play a major role. Currently proposed network architectures envision using the SS7-based signaling network for linking these DB's and also for interconnecting DB's with switches. If the network has to support ubiquitous, seamless mobile services, then it has to support additionally mobile application parts, viz., mobile origination calls, mobile destination calls, mobile location updates and inter-switch handovers. These functions will generate significant amount of data and require them to be transferred between databases (HLR, VLR) and switches (MSC's) very efficiently. In the future, the users (fixed or mobile) may use and communicate with sophisticated CPE's (e.g. multimedia, multipoint and multisession calls) which may require complex signaling functions. This will generate volumness service handling data and require efficient transfer of these message between databases and switches. Consequently, the network providers would be able to add new services and capabilities to their networks incrementally, quickly and cost-effectively.

Improving surgical weekend handover.

PubMed

Culwick, Caroline; Devine, Chris; Coombs, Catherine

2014-01-01

Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting.

Improving surgical weekend handover

PubMed Central

Culwick, Caroline; Devine, Chris; Coombs, Catherine

2014-01-01

Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting. PMID:26734294

A TOTP-based enhanced route optimization procedure for mobile IPv6 to reduce handover delay and signalling overhead.

PubMed

Shah, Peer Azmat; Hasbullah, Halabi B; Lawal, Ibrahim A; Aminu Mu'azu, Abubakar; Tang Jung, Low

2014-01-01

Due to the proliferation of handheld mobile devices, multimedia applications like Voice over IP (VoIP), video conferencing, network music, and online gaming are gaining popularity in recent years. These applications are well known to be delay sensitive and resource demanding. The mobility of mobile devices, running these applications, across different networks causes delay and service disruption. Mobile IPv6 was proposed to provide mobility support to IPv6-based mobile nodes for continuous communication when they roam across different networks. However, the Route Optimization procedure in Mobile IPv6 involves the verification of mobile node's reachability at the home address and at the care-of address (home test and care-of test) that results in higher handover delays and signalling overhead. This paper presents an enhanced procedure, time-based one-time password Route Optimization (TOTP-RO), for Mobile IPv6 Route Optimization that uses the concepts of shared secret Token, time based one-time password (TOTP) along with verification of the mobile node via direct communication and maintaining the status of correspondent node's compatibility. The TOTP-RO was implemented in network simulator (NS-2) and an analytical analysis was also made. Analysis showed that TOTP-RO has lower handover delays, packet loss, and signalling overhead with an increased level of security as compared to the standard Mobile IPv6's Return-Routability-based Route Optimization (RR-RO).

A TOTP-Based Enhanced Route Optimization Procedure for Mobile IPv6 to Reduce Handover Delay and Signalling Overhead

PubMed Central

Shah, Peer Azmat; Hasbullah, Halabi B.; Lawal, Ibrahim A.; Aminu Mu'azu, Abubakar; Tang Jung, Low

2014-01-01

Due to the proliferation of handheld mobile devices, multimedia applications like Voice over IP (VoIP), video conferencing, network music, and online gaming are gaining popularity in recent years. These applications are well known to be delay sensitive and resource demanding. The mobility of mobile devices, running these applications, across different networks causes delay and service disruption. Mobile IPv6 was proposed to provide mobility support to IPv6-based mobile nodes for continuous communication when they roam across different networks. However, the Route Optimization procedure in Mobile IPv6 involves the verification of mobile node's reachability at the home address and at the care-of address (home test and care-of test) that results in higher handover delays and signalling overhead. This paper presents an enhanced procedure, time-based one-time password Route Optimization (TOTP-RO), for Mobile IPv6 Route Optimization that uses the concepts of shared secret Token, time based one-time password (TOTP) along with verification of the mobile node via direct communication and maintaining the status of correspondent node's compatibility. The TOTP-RO was implemented in network simulator (NS-2) and an analytical analysis was also made. Analysis showed that TOTP-RO has lower handover delays, packet loss, and signalling overhead with an increased level of security as compared to the standard Mobile IPv6's Return-Routability-based Route Optimization (RR-RO). PMID:24688398

Proactive AP Selection Method Considering the Radio Interference Environment

NASA Astrophysics Data System (ADS)

Taenaka, Yuzo; Kashihara, Shigeru; Tsukamoto, Kazuya; Yamaguchi, Suguru; Oie, Yuji

In the near future, wireless local area networks (WLANs) will overlap to provide continuous coverage over a wide area. In such ubiquitous WLANs, a mobile node (MN) moving freely between multiple access points (APs) requires not only permanent access to the Internet but also continuous communication quality during handover. In order to satisfy these requirements, an MN needs to (1) select an AP with better performance and (2) execute a handover seamlessly. To satisfy requirement (2), we proposed a seamless handover method in a previous study. Moreover, in order to achieve (1), the Received Signal Strength Indicator (RSSI) is usually employed to measure wireless link quality in a WLAN system. However, in a real environment, especially if APs are densely situated, it is difficult to always select an AP with better performance based on only the RSSI. This is because the RSSI alone cannot detect the degradation of communication quality due to radio interference. Moreover, it is important that AP selection is completed only on an MN, because we can assume that, in ubiquitous WLANs, various organizations or operators will manage APs. Hence, we cannot modify the APs for AP selection. To overcome these difficulties, in the present paper, we propose and implement a proactive AP selection method considering wireless link condition based on the number of frame retransmissions in addition to the RSSI. In the evaluation, we show that the proposed AP selection method can appropriately select an AP with good wireless link quality, i.e., high RSSI and low radio interference.

A Tree Based Self-routing Scheme for Mobility Support in Wireless Sensor Networks

NASA Astrophysics Data System (ADS)

Kim, Young-Duk; Yang, Yeon-Mo; Kang, Won-Seok; Kim, Jin-Wook; An, Jinung

Recently, WSNs (Wireless Sensor Networks) with mobile robot is a growing technology that offer efficient communication services for anytime and anywhere applications. However, the tiny sensor node has very limited network resources due to its low battery power, low data rate, node mobility, and channel interference constraint between neighbors. Thus, in this paper, we proposed a tree based self-routing protocol for autonomous mobile robots based on beacon mode and implemented in real test-bed environments. The proposed scheme offers beacon based real-time scheduling for reliable association process between parent and child nodes. In addition, it supports smooth handover procedure by reducing flooding overhead of control packets. Throughout the performance evaluation by using a real test-bed system and simulation, we illustrate that our proposed scheme demonstrates promising performance for wireless sensor networks with mobile robots.

The use of analgesia in mountain rescue casualties with moderate or severe pain.

PubMed

Ellerton, John Alexander; Greene, Mike; Paal, Peter

2013-06-01

To assess the effectiveness of analgesia used in mountain rescue (MR) in casualties with moderate or severe pain. To determine if a verbal numeric pain score is practical in this environment. To describe the analgesic strategies used by MR. Prospective, descriptive study. Fifty-one MR teams in England and Wales. The study period was 1 September 2008 to 31 August 2010. 92 MR casualties with a pain scoreof 4/10 or greater. 38% of casualties achieved a pain reduction of 50% or greater in their initial score at 15 min and 60.2% had achieved this at handover. The initial pain score was 8 (median), reducing to 5 at 15 min and 3 at handover. The mean pain reduction was 2.5 ± 2.4 at 15 min and 3.9 ± 2.5 at handover. 80 casualties (87%) were treated with an opioid and seven had two different opioids administered. Seven main strategies were identified in which the principal agent was entonox, intramuscular opioid, oral analgesia, fentanyl lozenge, intranasal or intravenous opioid. The choice of strategy varied with the skills of the casualty carer. Pain should be assessed using a pain score. When possible, intravenous opioid is the gold standard to achieve early and continuing pain control in patients with moderate or severe pain. Entonox and oral analgesics, as sole agents, have limited use in moderate or severe pain. Intranasal opioid and fentanyl lozenge are effective, and appropriate in MR. Research priorities include bioavailability in different environmental conditions and patient's satisfaction with their pain management.

Design-build agreements : a case study review of the included handover requirements.

DOT National Transportation Integrated Search

2009-04-01

Road infrastructure is a key component of any regions transportation system. It allows : unprecedented levels of mobility, accessibility, and economic growth. On the other hand, the cost : associated with inadequate road infrastructure can amount ...

The effect of handover location on trauma theatre start time: An estimated cost saving of £131 000 per year.

PubMed

Nahas, Sam; Ali, Adam; Majid, Kiran; Joseph, Roshan; Huber, Chris; Babu, Victor

2018-02-08

The National Health Service was estimated to be in £2.45 billion deficit in 2015 to 2016. Trauma theatre utilization and efficiency has never been so important as it is estimated to cost £15/minute. Structured questionnaires were given to 23 members of staff at our Trust who are actively involved in the organization or delivery of orthopaedic trauma lists at least once per week. This was used to identify key factors that may improve theatre efficiency. Following focus group evaluation, the location of the preoperative theatre meeting was changed, with all staff involved being required to attend this. Our primary outcome measure was mean theatre start time (time of arrival in the anaesthetic room) during the 1 month immediately preceding the change and the month following the change. Theatre start time was improved on average 24 minutes (1 month premeeting and postmeeting change). This equates to a saving of £360 per day, or £131 040 per year. Changing the trauma meeting location to a venue adjacent to the trauma theatre can improve theatre start times, theatre efficiency, and therefore result in significant cost savings. Copyright © 2018 John Wiley & Sons, Ltd.

Assessment of Three “WHO” Patient Safety Solutions: Where Do We Stand and What Can We Do?

PubMed Central

Banihashemi, Sheida; Hatam, Nahid; Zand, Farid; Kharazmi, Erfan; Nasimi, Soheila; Askarian, Mehrdad

2015-01-01

Background: Most medical errors are preventable. The aim of this study was to compare the current execution of the 3 patient safety solutions with WHO suggested actions and standards. Methods: Data collection forms and direct observation were used to determine the status of implementation of existing protocols, resources, and tools. Results: In the field of patient hand-over, there was no standardized approach. In the field of the performance of correct procedure at the correct body site, there were no safety checklists, guideline, and educational content for informing the patients and their families about the procedure. In the field of hand hygiene (HH), although availability of necessary resources was acceptable, availability of promotional HH posters and reminders was substandard. Conclusions: There are some limitations of resources, protocols, and standard checklists in all three areas. We designed some tools that will help both wards to improve patient safety by the implementation of adapted WHO suggested actions. PMID:26900434

An Australian Approach to School Design

ERIC Educational Resources Information Center

Robinson, Leigh; Robinson, Taylor

2009-01-01

Contemporary education design strongly emphasises stimulating, adaptable learning environments, with spaces able to support various styles of teaching and learning. Delivering successful school buildings requires a close collaborative relationship between the architect and all key stakeholders from initial briefing through to project handover. The…

Introduction of Situation, Background, Assessment, Recommendation into Nursing Practice: A Prospective Study.

PubMed

Achrekar, Meera S; Murthy, Vedang; Kanan, Sadhana; Shetty, Rani; Nair, Mini; Khattry, Navin

2016-01-01

The aim of the study was to introduce and evaluate the compliance to documentation of situation, background, assessment, recommendation (SBAR) form. Twenty nurses involved in active bedside care were selected by simple random sampling. Use of SBAR was illustrated thru self-instructional module (SIM). Content validity and reliability were established. The situation, background, assessment, recommendation (SBAR) form was disseminated for use in a clinical setting during shift handover. A retrospective audit was undertaken at 1 st week (A1) and 16 th week (A2), post introduction of SIM. Nurse's opinion about the SBAR form was also captured. Majority of nurses were females (65%) in the age group 21-30 years (80%). There was a significant association ( P = 0.019) between overall audit scores and graduate nurses. Significant improvement ( P = 0.043) seen in overall scores between A1 (mean: 23.20) and A2 (mean: 24.26) and also in "Situation" domain ( P = 0.045) as compared to other domains. There was only a marginal improvement in documentation related to patient's allergies and relevant past history (7%) while identifying comorbidities decreased by 40%. Only 70% of nurses had documented plan of care. Most (76%) of nurses expressed that SBAR form was useful, but 24% nurses felt SBAR documentation was time-consuming. The assessment was easy (53%) to document while recommendation was the difficult (53%) part. SBAR technique has helped nurses to have a focused and easy communication during transition of care during handover. Importance and relevance of capturing information need to be reinforced. An audit to look for reduced number of incidents related to communication failures is essential for long-term evaluation of patient outcomes. Use of standardized SBAR in nursing practice for bedside shift handover will improve communication between nurses and thus ensure patient safety.

Physiological and subjective evaluation of a human-robot object hand-over task.

PubMed

Dehais, Frédéric; Sisbot, Emrah Akin; Alami, Rachid; Causse, Mickaël

2011-11-01

In the context of task sharing between a robot companion and its human partners, the notions of safe and compliant hardware are not enough. It is necessary to guarantee ergonomic robot motions. Therefore, we have developed Human Aware Manipulation Planner (Sisbot et al., 2010), a motion planner specifically designed for human-robot object transfer by explicitly taking into account the legibility, the safety and the physical comfort of robot motions. The main objective of this research was to define precise subjective metrics to assess our planner when a human interacts with a robot in an object hand-over task. A second objective was to obtain quantitative data to evaluate the effect of this interaction. Given the short duration, the "relative ease" of the object hand-over task and its qualitative component, classical behavioral measures based on accuracy or reaction time were unsuitable to compare our gestures. In this perspective, we selected three measurements based on the galvanic skin conductance response, the deltoid muscle activity and the ocular activity. To test our assumptions and validate our planner, an experimental set-up involving Jido, a mobile manipulator robot, and a seated human was proposed. For the purpose of the experiment, we have defined three motions that combine different levels of legibility, safety and physical comfort values. After each robot gesture the participants were asked to rate them on a three dimensional subjective scale. It has appeared that the subjective data were in favor of our reference motion. Eventually the three motions elicited different physiological and ocular responses that could be used to partially discriminate them. Copyright © 2011 Elsevier Ltd and the Ergonomics Society. All rights reserved.

Signing ISS RS Handover Protocol

NASA Image and Video Library

2014-09-09

ISS040-E-123948 (9 Sept. 2014) --- In the Zvezda Service Module, Russian cosmonaut Maxim Suraev (right), Expedition 41 commander, signs a ceremonial document as the new commander of the International Space Station following the traditional Change of Command Ceremony. Russian cosmonaut Alexander Skvortsov, Expedition 40 flight engineer, looks on.

The Device Centric Communication System for 5G Networks

NASA Astrophysics Data System (ADS)

Biswash, S. K.; Jayakody, D. N. K.

2017-01-01

The Fifth Generation Communication (5G) networks have several functional features such as: Massive Multiple Input and Multiple Output (MIMO), Device centric data and voice support, Smarter-device communications, etc. The objective for 5G networks is to gain the 1000x more throughput, 10x spectral efficiency, 100 x more energy efficiency than existing technologies. The 5G system will provide the balance between the Quality of Experience (QoE) and the Quality of Service (QoS), without compromising the user benefit. The data rate has been the key metric for wireless QoS; QoE deals with the delay and throughput. In order to realize a balance between the QoS and QoE, we propose a cellular Device centric communication methodology for the overlapping network coverage area in the 5G communication system. The multiple beacon signals mobile tower refers to an overlapping network area, and a user must be forwarded to the next location area. To resolve this issue, we suggest the user centric methodology (without Base Station interface) to handover the device in the next area, until the users finalize the communication. The proposed method will reduce the signalling cost and overheads for the communication.

A New Signaling Architecture THREP with Autonomous Radio-Link Control for Wireless Communications Systems

NASA Astrophysics Data System (ADS)

Hirono, Masahiko; Nojima, Toshio

This paper presents a new signaling architecture for radio-access control in wireless communications systems. Called THREP (for THREe-phase link set-up Process), it enables systems with low-cost configurations to provide tetherless access and wide-ranging mobility by using autonomous radio-link controls for fast cell searching and distributed call management. A signaling architecture generally consists of a radio-access part and a service-entity-access part. In THREP, the latter part is divided into two steps: preparing a communication channel, and sustaining it. Access control in THREP is thus composed of three separated parts, or protocol phases. The specifications of each phase are determined independently according to system requirements. In the proposed architecture, the first phase uses autonomous radio-link control because we want to construct low-power indoor wireless communications systems. Evaluation of channel usage efficiency and hand-over loss probability in the personal handy-phone system (PHS) shows that THREP makes the radio-access sub-system operations in a practical application model highly efficient, and the results of a field experiment show that THREP provides sufficient protection against severe fast CNR degradation in practical indoor propagation environments.

A Network Topology Control and Identity Authentication Protocol with Support for Movable Sensor Nodes

PubMed Central

Zhang, Ying; Chen, Wei; Liang, Jixing; Zheng, Bingxin; Jiang, Shengming

2015-01-01

It is expected that in the near future wireless sensor network (WSNs) will be more widely used in the mobile environment, in applications such as Autonomous Underwater Vehicles (AUVs) for marine monitoring and mobile robots for environmental investigation. The sensor nodes’ mobility can easily cause changes to the structure of a network topology, and lead to the decline in the amount of transmitted data, excessive energy consumption, and lack of security. To solve these problems, a kind of efficient Topology Control algorithm for node Mobility (TCM) is proposed. In the topology construction stage, an efficient clustering algorithm is adopted, which supports sensor node movement. It can ensure the balance of clustering, and reduce the energy consumption. In the topology maintenance stage, the digital signature authentication based on Error Correction Code (ECC) and the communication mechanism of soft handover are adopted. After verifying the legal identity of the mobile nodes, secure communications can be established, and this can increase the amount of data transmitted. Compared to some existing schemes, the proposed scheme has significant advantages regarding network topology stability, amounts of data transferred, lifetime and safety performance of the network. PMID:26633405

A Network Topology Control and Identity Authentication Protocol with Support for Movable Sensor Nodes.

PubMed

Zhang, Ying; Chen, Wei; Liang, Jixing; Zheng, Bingxin; Jiang, Shengming

2015-12-01

It is expected that in the near future wireless sensor network (WSNs) will be more widely used in the mobile environment, in applications such as Autonomous Underwater Vehicles (AUVs) for marine monitoring and mobile robots for environmental investigation. The sensor nodes' mobility can easily cause changes to the structure of a network topology, and lead to the decline in the amount of transmitted data, excessive energy consumption, and lack of security. To solve these problems, a kind of efficient Topology Control algorithm for node Mobility (TCM) is proposed. In the topology construction stage, an efficient clustering algorithm is adopted, which supports sensor node movement. It can ensure the balance of clustering, and reduce the energy consumption. In the topology maintenance stage, the digital signature authentication based on Error Correction Code (ECC) and the communication mechanism of soft handover are adopted. After verifying the legal identity of the mobile nodes, secure communications can be established, and this can increase the amount of data transmitted. Compared to some existing schemes, the proposed scheme has significant advantages regarding network topology stability, amounts of data transferred, lifetime and safety performance of the network.

Towards "Biliteracy and Trilingualism" in Hong Kong (SAR): Problems, Dilemmas and Stakeholders' Views

ERIC Educational Resources Information Center

Li, David C. S.

2009-01-01

Despite the Hong Kong SAR (Special Administrative Region) government's determination to implement the "mother tongue education" policy amid strong social resistance one year after the handover, English remains a prestigious language in society. The need for Putonghua (Mandarin/Standard Chinese) is also increasing following ever-expanding…

Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study.

PubMed

Siassakos, D; Bristowe, K; Draycott, T J; Angouri, J; Hambly, H; Winter, C; Crofts, J F; Hunt, L P; Fox, R

2011-04-01

To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies. Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial. Six secondary and tertiary maternity units. A total of 114 randomly selected healthcare professionals, in 19 teams of six members. Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature. Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated. More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall's rank correlation coefficient τ(b) = -0.53, 95% CI from -0.74 to -0.32, P=0.004); and (2) have managed the critical task using closed-loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (τ(b) = 0.46, 95% CI 0.17-0.74, P=0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2-5) versus six exits (IQR 5-6) (P=0.03, Mann-Whitney U-test). Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Hong Kong: Ten Years After the Handover

DTIC Science & Technology

2007-06-29

Liberties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Freedom of Speech and Assembly...surrounding the proposed anti-sedition legislation in 2003. The freedoms of speech and assembly appear to have been largely respected by the Chinese and...undermined the civil liberties of Hong Kong residents. However, there have been perceived threats of the freedom of speech and assembly, and erosion of press

Neoliberalism in Two Hong Kong School Categories

ERIC Educational Resources Information Center

Woo, David

2013-01-01

This article examines the link between the governance of Hong Kong's international school and Direct Subsidy Scheme school categories and changes in the broader Hong Kong society through a neoliberal framework. As Hong Kong's economy has grown since the 1997 handover to the People's Republic of China, an increasing number of people have come to…

Decentralization of Education in Indonesia--A Study on Education Development Gaps in the Provincial Areas

ERIC Educational Resources Information Center

Winardi

2017-01-01

Decentralization is acknowledged as the handover of government from central government to local government, including giving broader authority to local governments to manage education. This study aims to discovering education development gap between regions in Indonesia as a result of decentralization. This research method uses descriptive…

A Study of Macao Tertiary Students' Language Attitudes after the Handover

ERIC Educational Resources Information Center

Yan, Xi

2017-01-01

This study investigates Macao tertiary students' language attitudes under the dynamic interplay of local, national, and global forces. The Portuguese established their settlement at Macao during the mid-sixteenth century and their colonial rule over Macao during the mid-nineteenth century. Macao's sovereignty was transferred to China at midnight…

A Mobility-Aware QoS Signaling Protocol for Ambient Networks

NASA Astrophysics Data System (ADS)

Jeong, Seong-Ho; Lee, Sung-Hyuck; Bang, Jongho

Mobility-aware quality of service (QoS) signaling is crucial to provide seamless multimedia services in the ambient environment where mobile nodes may move frequently between different wireless access networks. The mobility of an IP-based node in ambient networks affects routing paths, and as a result, can have a significant impact on the operation and state management of QoS signaling protocols. In this paper, we first analyze the impact of mobility on QoS signaling protocols and how the protocols operate in mobility scenarios. We then propose an efficient mobility-aware QoS signaling protocol which can operate adaptively in ambient networks. The key features of the protocol include the fast discovery of a crossover node where the old and new paths converge or diverge due to handover and the localized state management for seamless services. Our analytical and simulation/experimental results show that the proposed/implemented protocol works better than existing protocols in the IP-based mobile environment.

Improving physician's hand over among oncology staff using standardized communication tool

PubMed Central

Alolayan, Ashwaq; Alkaiyat, Mohammad; Ali, Yosra; Alshami, Mona; Al-Surimi, Khaled; Jazieh, Abdul-Rahman

2017-01-01

Cancer patients are frequently admitted to hospital for many reasons. During their hospitalization they are handled by different physicians and other care providers. Maintaining good communication among physicians is essential to assure patient safety and the delivery of quality patient care. Several incidents of miscommunication issues have been reported due to lack of a standardized communication tool for patients' hand over among physicians at our oncology department. Hence, this improvement project aims at assessing the impact of using a standardized communication tool on improving patients' hand over and quality of patient care. A quality improvement team has been formed to address the issue of cancer patients' hand over. We adopted specific hand over tool to be used by physicians. This tool was developed based on well-known and validated communication tool called ISBAR - Identify, Situation, Background, Assessment and Recommendation, which contains pertinent information about the patient's condition. The form should be shared at a specific point in time during the handover process. We monitored the compliance of physician's with this tool over 16 weeks embedded by four ‘purposive’ and ‘sequential’ Plan-Do-Study-Act (PDSA) cycles; where each PDSA cycle was developed based on the challenges faced and lessons learned in each step and the result of the previous PDSA cycle. Physicians compliance rate of using the tool had improved significantly from 45% (baseline) to 100% after the fourth PDSA cycle. Other process measure was measuring acknowledgment of hand over receipt email at two checkpoints at 8:00 – 9:00 a.m. and 4:00 – 5:00 p.m. The project showed that using a standardized handover form as a daily communication method between physicians is a useful idea and feasible to improve cancer patients handover with positive impact on many aspects of healthcare process and outcomes. PMID:28174657

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis

PubMed Central

Phillips, Nicole M; Kent, Bridie; Colgan, Stephen; Mohebbi, Mohammadreza

2015-01-01

Introduction While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs. Methods and analysis A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs. Conclusions This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs. PMID:26033942

Encountering Culture through Gender Norms in International Education: The Case of Volunteers in Ecuador

ERIC Educational Resources Information Center

McGivern, Martha

2012-01-01

Demonstrating how international education programs can be used to study theoretical issues relevant to comparative education, this article reports on a scholarly analysis of 83 handover letters written by US participants in a volunteer program in Ecuador to their incoming counterparts between 2006 and 2010. It applies Swidler's notion of…

Challenges of Chinese Language Education in Multi-Lingual Societies: Hong Kong and Singapore

ERIC Educational Resources Information Center

Tong, Ho-kin; Goh, Yeng-seng

2008-01-01

This paper aims to study the current challenges of Chinese language education in the multilingual societies of Hong Kong and Singapore through policy documents. After the handover of Hong Kong to China in 1997, the role of "Putonghua" is far more important than before due to political and economic reasons. However, the medium of…

The Politics of 'Lifelong Learning' in Post-1997 Hong Kong

ERIC Educational Resources Information Center

Kennedy, Peter

2004-01-01

This article is concerned with the politics of lifelong learning policy in post-1997 Hong Kong (HK). The paper is in four parts. Continuing Education, recast as 'lifelong learning', is to be the cornerstone of the post-Handover education reform agenda. The lineaments of a familiar discourse are evident in the Education Commission policy documents.…

Western Perceptions of Hong Kong Ten Years on: A Corpus-Driven Critical Discourse Study

ERIC Educational Resources Information Center

Cheng, Winnie; Lam, Phoenix W. Y.

2013-01-01

This article studies the Western perceptions of and relations with Hong Kong a decade after the reversion of the sovereignty from Britain to China in 1997. Previous studies have demonstrated that the West had a significantly negative view on the future of Hong Kong with respect to the handover. According to recent observations, however, the…

Media Independent Handover for Wireless Full Motion Video Dissemination

DTIC Science & Technology

2012-09-01

ODTONE Configuration Files 51 References 63 Initial Distribution List 65 viii List of Figures Figure 2.1 MIH framework as defined by the IEEE 802.21...10 Figure 2.3 Link commands and MIH commands. From [1]. . . . . . . . . . . . . 12 Figure 2.4 Remote MIH Commands. From [1...13 Figure 2.5 Link commands. From [1]. . . . . . . . . . . . . . . . . . . . . . . . 14 Figure 2.6 MIH commands. From [1

Hong Kong Junior Secondary Students' Changing Conceptions of Mainland China

ERIC Educational Resources Information Center

Lam, Chi Chung; Lai, Edith; Wong, Janice Lai Yin

2012-01-01

This study attempted to investigate Hong Kong junior secondary students' conceptions of China before and after the 1997 handover of Hong Kong to China, with a view to finding out any changes in their conceptions, and if any, the factors that might have contributed to these changes. The study found that, over the years from 1997 to 2009, students…

Partnering to develop a continuing professional development program in a low-resource setting: Cambodia.

PubMed

Mack, Heather G; Meng, Ngy; Parsons, Tanya; Schlenther, Gerhard; Murray, Neil; Hart, Richard

2017-08-01

To design and implement a continuing professional development (CPD) program for Cambodian ophthalmologists. Partnering (twinning) between the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and the Cambodian Ophthalmological Society (COS). Practicing ophthalmologists in Cambodia. A conjoint committee comprising 4 ophthalmologists from RANZCO and 3 ophthalmologists from COS was established, supported by a RANZCO administrative team experienced in CPD administration. CPD requirements and recording were adapted from the RANZCO CPD framework. Cambodian ophthalmologists were surveyed during program implementation and after handover to COS. At the end of the 3-year program at handover to COS, a CPD program and online recording system was established. All 47 (100%) practicing ophthalmologists in Cambodia were registered for CPD, and 21/47 (45%) were actively participating in the COS CPD program online recording. Surveys of attitudes toward CPD demonstrated no significant change. Partnering was moderately effective in establishing a CPD program for Cambodian ophthalmologists. Uptake of CPD may have been limited by lack of a requirement for CPD for continuing medical licensure in Cambodia. Follow-up will be necessary to demonstrate CPD program longevity. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

The effect of various parameters of large scale radio propagation models on improving performance mobile communications

NASA Astrophysics Data System (ADS)

Pinem, M.; Fauzi, R.

2018-02-01

One technique for ensuring continuity of wireless communication services and keeping a smooth transition on mobile communication networks is the soft handover technique. In the Soft Handover (SHO) technique the inclusion and reduction of Base Station from the set of active sets is determined by initiation triggers. One of the initiation triggers is based on the strong reception signal. In this paper we observed the influence of parameters of large-scale radio propagation models to improve the performance of mobile communications. The observation parameters for characterizing the performance of the specified mobile system are Drop Call, Radio Link Degradation Rate and Average Size of Active Set (AS). The simulated results show that the increase in altitude of Base Station (BS) Antenna and Mobile Station (MS) Antenna contributes to the improvement of signal power reception level so as to improve Radio Link quality and increase the average size of Active Set and reduce the average Drop Call rate. It was also found that Hata’s propagation model contributed significantly to improvements in system performance parameters compared to Okumura’s propagation model and Lee’s propagation model.

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover.

PubMed

Reid, Daniel Brooks; Parsons, Shaun R; Gill, Stephen D; Hughes, Andrew J

2015-04-01

To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. Department heads were invited to complete a questionnaire about departmental discharge summary practices. Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation's practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice.

Special Education in Hong Kong: Background, Contemporary Trends and Issues in Programs for Learners with Disabilities

ERIC Educational Resources Information Center

Lian, Ming-Gon John; Tse, Andrew Chung-yee; Li, Alison Man Ching

2007-01-01

Since the handover of the sovereignty from the United Kingdom to the People's Republic of China in 1997, there have been a series of change, development, and related issues in special education programs for learners with disabilities in Hong Kong. In this paper, we try to describe the background and recent trends, issues, and implications that…

Teachers' Misconceptions and Questionable Practices when Using Putonghua as the Medium-of-Instruction: A Case Study of Hong Kong

ERIC Educational Resources Information Center

Tam, Angela Choi Fung

2012-01-01

Immediately after the handover of Hong Kong to China, the teaching of Chinese in Putonghua was promulgated by the Hong Kong SAR government as a long-term goal. However, no clear definition and guidance regarding Putonghua instruction has been provided to teachers to facilitate the smooth implementation of this change. A review of the literature…

Building Information Modeling (BIM) Primer. Report 1: Facility Life-Cycle Process and Technology Innovation

DTIC Science & Technology

2012-08-01

Building Information Modeling ( BIM ) Primer Report 1: Facility Life-cycle Process and Technology Innovation In fo...is unlimited. ERDC/ITL TR-12-2 August 2012 Building Information Modeling ( BIM ) Primer Report 1: Facility Life-cycle Process and Technology...and to enhance the quality of projects through the design, construction, and handover phases. Building Information Modeling ( BIM ) is a

Impact of Adding a Pictorial Display to Enhance Recall of Cancer Patient Histories: A Randomized Trial.

PubMed

Wolch, Gary; Ghosh, Sunita; Boyington, Curtiss; Watanabe, Sharon M; Fainsinger, Robin; Burton-Macleod, Sarah; Thai, Vincent; Thai, JoAnn; Fassbender, Konrad

2017-01-01

Current health care delivery models have increased the need for safe and concise patient handover. Handover interventions in the literature have focused on the use of structured tools but have not evaluated their ability to facilitate retention of patient information. In this study, mock pictorial displays were generated in an attempt to create a snapshot of each patient's medical and social circumstances. These pictorial displays contained the patient's photograph and other disease- and treatment-related images. The objective of this randomized trial was to assess the ability of these snapshots to enhance delayed information recall by care providers. Participating physicians were given four advanced cancer patient histories to review, two at a time over two weeks. Pictorial image displays, referred to as the Electronic Whiteboard (EWB) were added, in a randomized manner to half of the textual histories. The impact of the EWB on information recall was tested in immediate and delayed time frames. Overall, patient information recall declined significantly over time, with or without the EWB. Still, this trial demonstrates significantly higher test scores after 24 hours with the addition of pictures to textual patient information, compared with textual information alone (P = 0.0002). A more modest improvement was seen with the addition of the EWB for questionnaires administered immediately after history review (P = 0.008). Most participants agreed that the EWB was a useful enhancement and that seeing a patient's photograph improved their ability to retain information. Most studies examining the institution of handover protocols in the health care setting have failed to harness the power of pictures and other representative images. This study demonstrates the ability of pictorial displays to improve both immediate and delayed recall of patient histories without increasing review time. These types of displays may be amenable to generation by software programs and have the potential to enhance information transfer in various settings. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis.

PubMed

Street, Maryann; Phillips, Nicole M; Kent, Bridie; Colgan, Stephen; Mohebbi, Mohammadreza

2015-06-01

While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs. A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs. This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Shift report: a ritual play on a residential adolescent psychiatric unit.

PubMed

Yonge, O

2008-01-01

The author conducted an ethnographic study of an adolescent residential psychiatric unit which revealed a category of behaviour--the shift report. A questionnaire was administered to staff to reveal further meanings. Reporting was found to schematize knowledge according to common referents, promote and validate insider roles through language, offer a means of personal reintegration and catharsis, and provide a forum for the symbolic enactment of democratic values which permeated every aspect of culture on the unit. Staff members were categorically in favour of their verbal and private shift report. There was little partitioning of informal and formal aspects of report in the interest of saving time. Instead, socializing and 'catching up' were important aspects of shift report and constituted a large part of team building. The informal nature of report, particularly in the use of language allowed staff to come to terms with frustrations rather than constituting patient stereotyping. As a ritual, the shift report fostered behavioural synchrony, individual empowerment and a democratic 'all-channel network' of communication. It is hoped that this account will encourage more practising nurses and managers to view their shift report as something more than a simple 'handover'; that is, a ritual play of core values, roles and relationships.

Prehospital Use of Plasma for Traumatic Hemorrhage

DTIC Science & Technology

2014-06-01

known reagent B- cells o Mix o Spin in centrifuge for 15 seconds o Read for agglutination macroscopically o If agglutination is present, the unit...of days in the hospital, number of days on a ventilator, number of operations, number of infections, and cumulative utilization of blood products...procedure development and the items to be accomplished follow: GOALS:  Safe and adequate delivery, storage, and handover of plasma from Blood

Future Comparative Competitiveness under the Same Roof: A Survey of Self-Evaluation from Local and Mainland Students in Hong Kong

ERIC Educational Resources Information Center

Shen, Simon

2012-01-01

Since the handover of its sovereignty to the People's Republic of China, Hong Kong has had to increasingly rely on Beijing to sustain its economic growth and to maintain its competitiveness in the global arena. The almost unconditional support offered by Beijing is given largely on the assumption that the Hong Kong special administrative region,…

A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients.

PubMed

Hall, Michael; Robertson, Jamie; Merkel, Matthias; Aziz, Michael; Hutchens, Michael

2017-08-01

Serious complications are common during the intensive care of postoperative cardiac surgery patients. Some of these complications may be influenced by communication during the process of handover of care from the operating room to the intensive care unit (ICU) team. A structured transfer of care process may reduce the rate of communication errors and perioperative complications. We hypothesized that a collaborative, comprehensive, structured handover of care from the intraoperative team to the ICU team would reduce a specific set of postoperative complications. We tested this hypothesis by developing and introducing a comprehensive multidisciplinary transfer of care process. We measured patient outcomes before and after the intervention using a linkage between 2 care databases: an Anesthesia Information Management System and a critical care complication registry database. There were 1127 total postoperative cardiac surgery admissions during the study period, 550 before and 577 after the intervention. There was no statistical difference between overall complications before and after the intervention (P = .154). However, there was a statistically significant reduction in preventable complications after the intervention (P = .023). The main finding of this investigation is that the introduction of a collaborative, comprehensive transfer of care process from the operating room to the ICU was associated with patients suffering fewer preventable complications.

Surgical specimen handover from the operating theatre to laboratory-Can we improve patient safety by learning from aviation and other high-risk organisations?

PubMed

Brennan, Peter A; Brands, Marieke T; Caldwell, Lucy; Fonseca, Felipe Paiva; Turley, Nic; Foley, Susie; Rahimi, Siavash

2018-02-01

Essential communication between healthcare staff is considered one of the key requirements for both safety and quality care when patients are handed over from one clinical area to other. This is particularly important in environments such as the operating theatre and intensive care where mistakes can be devastating. Health care has learned from other high-risk organisations (HRO) such as aviation where the use of checklists and human factors awareness has virtually eliminated human error and mistakes. To our knowledge, little has been published around ways to improve pathology specimen handover following surgery, with pathology request forms often conveying the bare minimum of information to assist the laboratory staff. Furthermore, the request form might not warn staff about potential hazards. In this article, we provide a brief summary of the factors involved in human error and introduce a novel checklist that can be readily completed at the same time as the routine pathology request form. This additional measure enhances safety, can help to reduce processing and mislabelling errors and provides essential information in a structured way assisting both laboratory staff and pathologists when handling head and neck surgical specimens. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Investigation of Inter-Node B Macro Diversity for Single-Carrier Based Radio Access in Evolved UTRA Uplink

NASA Astrophysics Data System (ADS)

Kawai, Hiroyuki; Morimoto, Akihito; Higuchi, Kenichi; Sawahashi, Mamoru

This paper investigates the gain of inter-Node B macro diversity for a scheduled-based shared channel using single-carrier FDMA radio access in the Evolved UTRA (UMTS Terrestrial Radio Access) uplink based on system-level simulations. More specifically, we clarify the gain of inter-Node B soft handover (SHO) with selection combining at the radio frame length level (=10msec) compared to that for hard handover (HHO) for a scheduled-based shared data channel, considering the gains of key packet-specific techniques including channel-dependent scheduling, adaptive modulation and coding (AMC), hybrid automatic repeat request (ARQ) with packet combining, and slow transmission power control (TPC). Simulation results show that the inter-Node B SHO increases the user throughput at the cell edge by approximately 10% for a short cell radius such as 100-300m due to the diversity gain from a sudden change in other-cell interference, which is a feature specific to full scheduled-based packet access. However, it is also shown that the gain of inter-Node B SHO compared to that for HHO is small in a macrocell environment when the cell radius is longer than approximately 500m due to the gains from hybrid ARQ with packet combining, slow TPC, and proportional fairness based channel-dependent scheduling.

Exploring Bim for Operational Integrated Asset Management - a Preliminary Study Utilising Real-World Infrastructure Data

NASA Astrophysics Data System (ADS)

Boyes, G. A.; Ellul, C.; Irwin, D.

2017-10-01

The use of 3D information models within collaborative working environments and the practice of Building Information Modelling (BIM) are becoming more commonplace within infrastructure projects. Currently used predominantly during the design and construction phase, the use of BIM is capable in theory of providing the information at handover that will satisfy the Asset Information Requirements (AIRs) of the future Infrastructure Manager (IM). One particular challenge is establishing a link between existing construction-centric information and the asset-centric information needed for future operations. Crossrail, a project to build a new high-frequency railway underneath London, is handling many such challenges as they prepare to handover their digital information to the future operator, in particular the need to provide a two-way link between a federated 3D CAD model and an object-relational Asset Information Management System (AIMS). This paper focusses on the potential for improved Asset Management (AM) by integrating BIM and GIS systems and practices, and makes a preliminary report on how 3D spatial queries can be used to establish a two-way relational link between two information systems (3D geometry and asset lists), as well as the challenges being overcome to transform the data to be suitable for AM.

Software-Defined Radio Global System for Mobile Communications Transmitter Development for Heterogeneous Network Vulnerability Testing

DTIC Science & Technology

2013-12-01

AbdelWahab, “ 2G / 3G Inter-RAT Handover Performance Analysis,” Second European Conference on Antennas and Propagation, pp. 1, 8, 11–16, Nov. 2007. [19] J...RADIO GLOBAL SYSTEM FOR MOBILE COMMUNICATIONS TRANSMITTER DEVELOPMENT FOR HETEROGENEOUS NETWORK VULNERABILITY TESTING by Carson C. McAbee... MOBILE COMMUNICATIONS TRANSMITTER DEVELOPMENT FOR HETEROGENEOUS NETWORK VULNERABILITY TESTING 5. FUNDING NUMBERS 6. AUTHOR(S) Carson C. McAbee

Transitioning couple’s voluntary HIV counseling and testing (CVCT) from stand-alone weekend services into routine antenatal and VCT services in government clinics in Zambia’s two largest cities

PubMed Central

Inambao, Mubiana; Kilembe, William; Canary, Lauren A.; Czaicki, Nancy L.; Kakungu-Simpungwe, Matilda; Chavuma, Roy; Wall, Kristin M.; Tichacek, Amanda; Pulerwitz, Julie; Thior, Ibou; Chomba, Elwyn; Allen, Susan A.

2017-01-01

Introduction Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple’s voluntary HIV counseling and testing (CVCT) for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC) and individual voluntary testing and counseling (VCT) services in Zambia’s two largest cities from 2009–2015 is described. Methods Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO) subsidies were offered for overtime pay. Results Implementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for ‘partner testing’ with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities. Discussion A focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended. PMID:29036208

Transitioning couple's voluntary HIV counseling and testing (CVCT) from stand-alone weekend services into routine antenatal and VCT services in government clinics in Zambia's two largest cities.

PubMed

Inambao, Mubiana; Kilembe, William; Canary, Lauren A; Czaicki, Nancy L; Kakungu-Simpungwe, Matilda; Chavuma, Roy; Wall, Kristin M; Tichacek, Amanda; Pulerwitz, Julie; Thior, Ibou; Chomba, Elwyn; Allen, Susan A

2017-01-01

Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple's voluntary HIV counseling and testing (CVCT) for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC) and individual voluntary testing and counseling (VCT) services in Zambia's two largest cities from 2009-2015 is described. Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO) subsidies were offered for overtime pay. Implementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for 'partner testing' with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities. A focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended.

Towards Optimization of Macrocognitive Processes: Automating Analysis of the Emergence of Leadership in Ad Hoc Teams

DTIC Science & Technology

2014-04-21

Journal of Sociotechnology and Knowledge Development (IJSKD), 4(3), 17-37. Anders S, Schweikhart S, Woods DD, Ebright P, Patterson ES. (2012) The Effects...Ergonomics Society, 282-286. • Patterson ES, Rayo MF, Weiss C, Woods Z, Mount-Campbell AF. Online Training for Resilience Communication Strategies during...Shift Change Handovers, in Proceedings of the Human Factors and Ergonomics Society Annual Meeting. (Sep 2013). 57 (1). 1427- 1431. Woods Z, Beecroft

Utilization of Concurrent Buffers to Facilitate Seamless Data Transition in Tactical Cellular Communications

DTIC Science & Technology

2015-09-01

INTENTIONALLY LEFT BLANK xiii LIST OF ACRONYMS AND ABBREVIATIONS 2G 2nd Generation 3G 3rd Generation 3GPP 3rd Generation Partnership Project 4G 4th...System (UMTS) is the standard that governs 3rd Generation ( 3G ) migration of Global Services for Mobile (GSM) networks. It defines packet-based...network may assist or mitigate. 14. SUBJECT TERMS IEEE, 802.21, Media Independent Handover, mobile , communications, cyber, tactical, buffer, cellular

Surgical workload of a foreign medical team after Typhoon Haiyan.

PubMed

Read, David J; Holian, Annette; Moller, Cea-Cea; Poutawera, Vaughan

2016-05-01

On 8 November 2013, Typhoon Haiyan struck the Philippines causing widespread loss of lives and infrastructures. At the request of the Government of the Philippines, the Australian Government deployed a surgical field hospital to the city of Tacloban for 4 weeks. This paper describes the establishment of the hospital, the surgical workload and handover to the local health system upon the end of deployment. A Microsoft excel database was utilized throughout the deployment, recording demographics, relationship to the typhoon and surgical procedure performed. Over the 21 days of surgical activity, the Australian field hospital performed 222 operations upon 131 persons. A mean of 10.8 procedures were performed per day (range 3-20). The majority (70.2%) of procedures were soft tissue surgery. Diabetes was present in 22.9% and 67.9% were typhoon-related. The Australian Medical Assistance Team field hospital adhered to the World Health Organization guidelines for foreign medical teams, in ensuring informed consent, appropriate anaesthesia and surgery, and worked collaboratively with local surgeons, ensuring adequate documentation and clinical handover. This paper describes the experience of a trained, equipped and collaborative surgical foreign medical team in Tacloban in the aftermath of Typhoon Haiyan. Sepsis from foot injuries in diabetic patients constituted an unexpected majority of the workload. New presentations of typhoon-related injuries were presented throughout the deployment. © 2015 Royal Australasian College of Surgeons.

Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals.

PubMed

Rabøl, Louise Isager; Andersen, Mette Lehmann; Østergaard, Doris; Bjørn, Brian; Lilja, Beth; Mogensen, Torben

2011-03-01

Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (10 (23%)) and communication errors during teamwork (8 (18%)). The kappa values were 0.44-0.78. Unproceduralized communication and information exchange via telephone, related to transfer between units and consults from other specialties, were particularly vulnerable processes. With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors.

Engaging nurses in patient care: clinical reflection by a student nurse.

PubMed

Bail, Kasia Siobhan

2007-01-01

I stood by, the endless student nurse observer, as a woman (let's call her Joan) was transferred by trolley from the helicopter into emergency following an acute period of respiratory distress. Two nurses from the department were present for hand-over, and three ambulance persons brought her in. Joan's condition appeared stable, as far as I could tell; her bed was at a ninety-degree angle and her oxygen-assisted breathing was very laboured, but she seemed aware of her immediate surroundings. Joan traveled on the helicopter trolley into the emergency ward, was transferred to an emergency bed, the necessary tubes and wires were re-organised, her hand-over was verbalised and the personal weekends of the treating team were discussed amongst themselves. To my increasing frustration, not one staff member looked Joan in the eye, said hello, or did anything to acknowledge her presence as anything other than another technical detail. This paper was inspired by this incident viewed as a nursing student in the emergency department. The clinical reflection that developed around this particular incident was how easily care by nurses could be limited to the physical needs of the patient. This paper is premised on the clinical reflection that engagement by nurses with patients is necessary for optimal patient care. The literature was reviewed, and the concept of 'engagement' was used to refer to the actual connection of one person to another via honest care and dedicated communication. I suggest, with literary support, that this lack of engagement extends from the inability of the nurse to provide sufficient care to fulfill the needs of the patient. The current mismatch between duty and ability for nurses is cited as being due to an increasing number of stressors. Major stressors include a lack of support from senior staff; insufficient staff; having too much work and too little time, and the inability to meet patients' needs (McNeely 1996). Accumulated stress has detrimental effects on nursing care, namely the nurse's lack of energy and emotional resources due to the stress. These stressors result in coping mechanisms that can additionally affect the manner in which nurses engage their patients. Nursing is an emotional art form, and factors affecting the creation of such an art form are potentially debilitating to nurses and patients alike. This paper will clinically reflect on the implications of such a lack of engagement to both the patient and the nurse, and on the opportunity for individuals and organisations to realise their responsibility in the promotion of nurse-patient engagement.

A Security Analysis on Kempf-Koodli's Security Scheme for Fast Mobile IPv6

NASA Astrophysics Data System (ADS)

You, Ilsun; Sakurai, Kouichi; Hori, Yoshiaki

Recently, the security scheme, proposed by Kempf and Koodli, has been adopted as a security standard for Fast handover for Mobile IPv6. But, it does not prevent denial of service attacks while resulting in high computation cost. More importantly, we find that it is still vulnerable to redirection attacks because it fails to secure the Unsolicited Neighbor Advertisement messages. In this paper, Kempf-Koodli's scheme is formally analyzed through BAN-logic and its weaknesses are demonstrated.

Hospital discharge summary scorecard: a quality improvement tool used in a tertiary hospital general medicine service.

PubMed

Singh, G; Harvey, R; Dyne, A; Said, A; Scott, I

2015-12-01

We assessed the impact of completion and feedback of discharge summary scorecards on the quality of discharge summaries written by interns in a general medicine service of a tertiary hospital. The scorecards significantly improved summary quality in the first three rotations of the intern year and could be readily adopted by other units as a quality improvement intervention for optimizing clinical handover to primary care providers. © 2015 Royal Australasian College of Physicians.

Searching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions.

PubMed

Johnson, Julie K; Farnan, Jeanne M; Barach, Paul; Hesselink, Gijs; Wollersheim, Hub; Pijnenborg, Loes; Kalkman, Cor; Arora, Vineet M

2012-12-01

Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk. Our aim was to demonstrate how process mapping can illustrate current handover practices between ambulatory and inpatient care settings, identify existing barriers and facilitators to effective transitions of care, and highlight potential areas for quality improvement. We conducted focus group interviews to facilitate a process mapping exercise with clinical teams in six academic health centres in the USA, Poland, Sweden, Italy, Spain and the Netherlands. At a high level, the process of patient admission to the hospital through the emergency department, inpatient care, and discharge back in the community were comparable across sites. In addition, the process maps highlighted similar barriers to providing information to primary care physicians, inaccurate or incomplete information on referral and discharge, a lack of time and priority to collaborate with counterpart colleagues, and a lack of feedback to clinicians involved in the handovers. Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.

Effects of Information Access Cost and Accountability on Medical Residents' Information Retrieval Strategy and Performance During Prehandover Preparation: Evidence From Interview and Simulation Study.

PubMed

Yang, X Jessie; Wickens, Christopher D; Park, Taezoon; Fong, Liesel; Siah, Kewin T H

2015-12-01

We aimed to examine the effects of information access cost and accountability on medical residents' information retrieval strategy and performance during prehandover preparation. Prior studies observing doctors' prehandover practices witnessed the use of memory-intensive strategies when retrieving patient information. These strategies impose potential threats to patient safety as human memory is prone to errors. Of interest in this work are the underlying determinants of information retrieval strategy and the potential impacts on medical residents' information preparation performance. A two-step research approach was adopted, consisting of semistructured interviews with 21 medical residents and a simulation-based experiment with 32 medical residents. The semistructured interviews revealed that a substantial portion of medical residents (38%) relied largely on memory for preparing handover information. The simulation-based experiment showed that higher information access cost reduced information access attempts and access duration on patient documents and harmed information preparation performance. Higher accountability led to marginally longer access to patient documents. It is important to understand the underlying determinants of medical residents' information retrieval strategy and performance during prehandover preparation. We noted the criticality of easy access to patient documents in prehandover preparation. In addition, accountability marginally influenced medical residents' information retrieval strategy. Findings from this research suggested that the cost of accessing information sources should be minimized in developing handover preparation tools. © 2015, Human Factors and Ergonomics Society.

Communication and Influencing for ED Professionals: A training programme developed in the emergency department for the emergency department.

PubMed

Rixon, Andrew; Rixon, Sascha; Addae-Bosomprah, Hansel; Ding, Mingshuang; Bell, Anthony

2016-08-01

The objective of the present study is to develop and pilot a communication and influencing skills training programme that meets ED health professionals' needs at an urban district hospital. Qualitative methods within a participatory action research framework were utilised. An interdisciplinary team guided the programme's design and development. A training needs analysis saw team meetings, interviews, focus groups and observations conducted across the ED. Thematic analysis of the data identified health professionals' communication and influencing challenges. The training needs analysis informed the training programme curriculum's development. The pilot programme involved an interdisciplinary group of seven health professionals across 5 × 2 h sessions over 3 months, followed by a post-training survey. Five themes of communication and influencing challenges were identified: participating in effective handovers, involving patients in bedside handovers, effectively communicating with interdepartmental colleagues, asking ED colleagues to do tasks and understanding ED colleagues' roles, expectations and assumptions. Based on these challenges, the formulated RESPECT model (which stands for Relationships, Expectations, Styles, Partnerships, Enquiry, Coaching and Teamwork) informed the training curriculum. The peer coaching model used in the training programme was highly regarded by participants. Communication and Influencing for ED Professionals™ (Babel Fish Group Pty Ltd, Melbourne, Victoria, Australia) addresses a gap for communication programmes developed in the ED for the ED. Future research will evaluate the programme's impact in this ED. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Resident duty hours in Canada: a survey and national statement

PubMed Central

2014-01-01

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n = 1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n = 1598). Only 52% (830) had received training in handover (n = 1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models. PMID:25559388

[Challenges in geriatric rehabilitation: the development of an integrated care pathway].

PubMed

Everink, Irma Helga Johanna; van Haastregt, Jolanda C M; Kempen, Gertrudis I J M; Dielis, Leen M J; Maessen, José M C; Schols, Jos M G A

2015-04-01

Coordination and continuity of care within geriatric rehabilitation is challenging. To tackle these challenges, an integrated care pathway within geriatric rehabilitation care (hospital, geriatric rehabilitation and follow-up care in the home situation) has been developed. The aim of this article is to expound the process of developing the integrated care pathway, and to describe and discuss the results of this process (which is the integrated care pathway). Developing the integrated care pathway was done by the guidance of the first four steps of the theoretical framework for implementation of change from Grol and Wensing: (1) development of a specific proposal for change in practice; (2) analysis of current care practice; (3) analysis of the target group and setting; and (4) development and selection of interventions/strategies for change. The organizations involved in geriatric rehabilitation argued that the integrated care pathway should focus on improving the process of care, including transfer of patients, handovers and communication between care organizations. Current practice, barriers and incentives for change were analyzed through literature research, expert consultation, and interviews with the involved caregivers and by establishing working groups of health care professionals, patients and informal caregivers. This resulted in valuable proposals for improvement of the care process, which were gathered and combined in the integrated care pathway. The integrated care pathway entails agreements on (a) the triage process in the hospital; (b) active engagement of patients and informal caregivers in the care process; (c) timely and high quality handovers; and (d) improved communication between caregivers.

Resident duty hours in Canada: a survey and national statement.

PubMed

Masterson, Mark F; Shrichand, Pankaj; Maniate, Jerry M

2014-01-01

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n=1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n=1598). Only 52% (830) had received training in handover (n=1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models.

A web-based referral system for neurosurgery--a solution to our problems?

PubMed

Choo, Melissa C; Thennakon, Shyamica; Shapey, Jonathan; Tolias, Christos M

2011-06-01

Accurate handover is very important in the running of all modern neurosurgical units. Referrals are notoriously difficult to track and review due to poor quality of written paper-based recorded information for handover (illegibility, incomplete paper trail, repetition of information and loss of patients). We have recently introduced a web-based referral system to three of our referring hospitals. To review the experience of a tertiary neurosurgical unit in using the UK's first real time online referral system and to discuss its strengths and weaknesses in comparison to the currently used written paper-based referral system. A retrospective analysis of all paper-based referrals made to our unit in March 2009, compared to 14 months' referrals through the web system. Patterns of information recorded in both systems were investigated and advantages and disadvantages of each identified. One hundred ninety-six patients were referred using the online system, 483 using the traditional method. Significant problems of illegibility and missing information were identified with the paper-based referrals. In comparison, 100% documentation was achieved with the online referral system. Only 63% penetrance in the best performing trust was found using the online system, with significant delays in responding to referrals. Traditional written paper-based referrals do not provide an acceptable level of documentation. We present our experience and difficulties implementing a web-based system to address this. Although our data are unable to show improved patient care, we believe the potential benefits of a fully integrated system may offer a solution.

78 FR 18374 - Promoting Economic Efficiency in Spectrum Use: WSRD SSG Workshop IV

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... NATIONAL SCIENCE FOUNDATION Promoting Economic Efficiency in Spectrum Use: WSRD SSG Workshop IV... important next step, the economic and policy research that is needed to promote an efficient and shared spectrum environment. Submitted by the National Science Foundation for the National Coordination Office...

Multimodal observational assessment of quality and productivity benefits from the implementation of wireless technology for out of hours working

PubMed Central

Blakey, John D; Guy, Debbie; Simpson, Carl; Fearn, Andrew; Cannaby, Sharon; Wilson, Petra

2012-01-01

Objectives The authors investigated if a wireless system of call handling and task management for out of hours care could replace a standard pager-based system and improve markers of efficiency, patient safety and staff satisfaction. Design Prospective assessment using both quantitative and qualitative methods, including interviews with staff, a standard satisfaction questionnaire, independent observation, data extraction from work logs and incident reporting systems and analysis of hospital committee reports. Setting A large teaching hospital in the UK. Participants Hospital at night co-ordinators, clinical support workers and junior doctors handling approximately 10 000 tasks requested out of hours per month. Outcome measures Length of hospital stay, incidents reported, co-ordinator call logging activity, user satisfaction questionnaire, staff interviews. Results Users were more satisfied with the new system (satisfaction score 62/90 vs 82/90, p=0.0080). With the new system over 70 h/week of co-ordinator time was released, and there were fewer untoward incidents related to handover and medical response (OR=0.30, p=0.02). Broad clinical measures (cardiac arrest calls for peri-arrest situations and length of hospital stay) improved significantly in the areas covered by the new system. Conclusions The introduction of call handling software and mobile technology over a medical-grade wireless network improved staff satisfaction with the Hospital at Night system. Improvements in efficiency and information flow have been accompanied by a reduction in untoward incidents, length of stay and peri-arrest calls. PMID:22466035

Data forwarding mechanism for supporting real-time services during relocations in UMTS systems

NASA Astrophysics Data System (ADS)

Cai, Wei; Liao, Xianglong; Zheng, Liang; Liu, Zehong

2004-04-01

To minimize the interruption during the handovers or relocations invoked by subscribers moving is a very critical factor to enhance the performance of the UMTS systems. We know that the 2G systems have been optimized to minimize the interruption of speech during handovers by two main technologies: one is the bi-casting for the DL traffic and the other is the fast radio resynchronization by the UE for the UL traffic. In the UMTS systems, we have also implemented lossless relocations for non real-time services with high reliability by data buffering in the source RNC and target RNC for the UE. However, the UMTS systems support four QoS classes traffic flow: conversational class, streaming class, interactive class and background class. The main distinguishing factor between these QoS classes is how delay sensitive the traffic is: Conversational and Streaming classes are mainly used to carry real-time traffic flows, like video telephony, interactive and background classes are mainly used by traditional Internet applications like WWW, E-mail and FTP. It"s essential to provide the solutions for supporting real-time services to meet the requirement for QoS in UMTS systems. Apparently, the Data buffering mechanism is not adapted to real-time services because of it"s delay may exceed the basic requirement for real-time services. Under this background, the paper discussed two data forwarding solutions for real-time services from the PS domain in the UMTS systems: packet duplication and Core Network bi-casting. The former mechanism does not require any new procedures, messages nor information elements. The later mechanism requires that the GGSN or SGSN is able to bi-cast the DL traffic to the target RNC according to the relocations involving two SGSNs or just involving one SGSN. It also implicitly shows that we need change procedures at the nodes SGSN, GGSN and RNC which are involved in the relocation procedure based on existing procedures that we have already designed if adopt the later solution. In a detail way, the paper analyzed the characteristic for these two solutions respectively, concentrated on the packet flows and the message flows in those nodes involved in relocations. Additionally, also gave out the impact on present transport technologies in the wireless communication systems. However we shall minimize the impact of evolution of transport mechanism and utilize the resource efficiently according to the general requirements for QoS in UMTS systems.

Beauty is in the Eye of the Beholder: A Tale of Strategic Context and Operational Art in Iraq, 2004-2008

DTIC Science & Technology

2012-05-17

throughout Iraq to cities such as Tal Afar, Baghdad, Mosul, Baqubah, and Ar Ramadi. However, in their attempt to control Anbar Province, al Qaeda in Iraq ...conflicts only grew stronger and by the beginning of 2006, Iraq was on the verge of civil war due to systematic terrorist attacks by al Qaeda in Iraq and...sec. Middle East, http://www.nytimes.com/2011/ 12 /16/world/middleeast/panetta-in-baghdad-for- iraq -military-handover- ceremony.html?pagewanted=all

Apollo Quality Program.

PubMed

Sibal, Anupam; Dewan, Shaveta; Uberoi, R S; Kar, Sujoy; Loria, Gaurav; Fernandes, Clive; Yatheesh, G; Sharma, Karan

2012-01-01

Ensuring patient safety is a vital step for any hospital in achieving the best clinical outcomes. The Apollo Quality Program aimed at standardization of processes for clinical handovers, medication safety, surgical safety, patient identification, verbal orders, hand washing compliance and falls prevention across the hospitals in the Group. Thirty-two hospitals across the Group in settings varying from rural to semi urban, urban and metropolitan implemented the program and over a period of one year demonstrated a visible improvement in the compliance to processes for patient safety translating into better patient safety statistics.

Supporting structures for team situation awareness and decision making: insights from four delivery suites.

PubMed

Mackintosh, Nicola; Berridge, Emma-Jane; Freeth, Della

2009-02-01

'Human factors' (non-technical skills such as communication and teamwork) have been strongly implicated in adverse events during labour and delivery. The importance of shared 'situation awareness' between team members is highlighted as a key factor in patient safety. Arising from an ethnographic study of safety culture in the delivery suites of four UK hospitals, the aim of this study is to describe the main mechanisms supporting team situation awareness (TSA) and examine contrasting configurations of supports. Stage I: 177 hours of lightly structured non-participant observation (sensitizing concepts: safety culture, non-technical skills, teamwork and decision making) analysed to identify a core organizing concept, main supporting categories and preliminary conceptual models. Stage II: (approximately 11 months after first observations) 104 hours of observation to test and elaborate stage I analyses. Handover, whiteboard use and a coordinator role emerged as the key processes facilitating work and team coordination. The interplay between these supporting processes and the contextual features of each site promoted or inhibited TSA. Three configurations of supports for TSA were evident. These are described. Context configurations of supporting mechanisms and artefacts influence TSA, with implications for the maintenance of patient safety on delivery suites. A balanced model of supports for TSA is commended. Examining contrasting configurations helps reveal how local mechanisms or organizational, environmental and temporal factors might be manipulated to improve TSA.

Received signal strength and local terrain profile data for radio network planning and optimization at GSM frequency bands.

PubMed

Popoola, Segun I; Atayero, Aderemi A; Faruk, Nasir

2018-02-01

The behaviour of radio wave signals in a wireless channel depends on the local terrain profile of the propagation environments. In view of this, Received Signal Strength (RSS) of transmitted signals are measured at different points in space for radio network planning and optimization. However, these important data are often not publicly available for wireless channel characterization and propagation model development. In this data article, RSS data of a commercial base station operating at 900 and 1800 MHz were measured along three different routes of Lagos-Badagry Highway, Nigeria. In addition, local terrain profile data of the study area (terrain elevation, clutter height, altitude, and the distance of the mobile station from the base station) are extracted from Digital Terrain Map (DTM) to account for the unique environmental features. Statistical analyses and probability distributions of the RSS data are presented in tables and graphs. Furthermore, the degree of correlations (and the corresponding significance) between the RSS and the local terrain parameters were computed and analyzed for proper interpretations. The data provided in this article will help radio network engineers to: predict signal path loss; estimate radio coverage; efficiently reuse limited frequencies; avoid interferences; optimize handover; and adjust transmitted power level.

High-Efficiency Promoter-Dependent Transduction by Adeno-Associated Virus Type 6 Vectors in Mouse Lung

PubMed Central

HALBERT, CHRISTINE L.; LAM, SIU-LING; MILLER, A. DUSTY

2014-01-01

The transduction efficiency of adeno-associated virus (AAV) vectors in various somatic tissues has been shown to depend heavily on the AAV type from which the vector capsid proteins are derived. Among the AAV types studied, AAV6 efficiently transduces cells of the airway epithelium, making it a good candidate for the treatment of lung diseases such as cystic fibrosis. Here we have evaluated the effects of various promoter sequences on transduction rates and gene expression levels in the lung. Of the strong viral promoters examined, the Rous sarcoma virus (RSV) promoter performed significantly better than a human cytomegalovirus (CMV) promoter in the airway epithelium. However, a hybrid promoter consisting of a CMV enhancer, β-actin promoter and splice donor, and a β-globin splice acceptor (CAG promoter) exhibited even higher expression than either of the strong viral promoters alone, showing a 38-fold increase in protein expression over the RSV promoter. In addition, we show that vectors containing either the RSV or CAG promoter expressed well in the nasal and tracheal epithelium. Transduction rates in the 90% range were achieved in many airways with the CAG promoter, showing that with the proper AAV capsid proteins and promoter sequences, highly efficient transduction can be achieved. PMID:17430088

Preparing medical students for clinical practice: easing the transition.

PubMed

Teagle, Alexandra R; George, Maria; Gainsborough, Nicola; Haq, Inam; Okorie, Michael

2017-08-01

The transition from medical student to junior doctor is a challenge; the UK General Medical Council has issued guidance emphasizing the importance of adequate preparation of medical students for clinical practice. This study aimed to determine whether a junior doctor-led simulation-based course is an effective way of preparing final year medical students for practice as a junior doctor.We piloted a new 'preparation for practice' course for final year medical students prior to beginning as Foundation Year 1 (first year of practice) doctors. The course ran over three days and consisted of four simulated stations: ward round, prescribing, handover, and lessons learnt. Quantitative and qualitative feedback was obtained.A total of 120 students attended (40 on each day) and feedback was collected from 95 of them. Using a scale of 1 (lowest) to 5 (highest), feedback was positive, with 99% and 96% rating 4 or 5 for the overall quality of the program and the relevance of the program content, respectively. A score of 5 was awarded by 67% of students for the ward round station; 58% for the handover station; 71% for the prescribing station, and 35% for the lessons learnt station. Following the prescribing station, students reported increased confidence in their prescribing.Preparation for practice courses and simulation are an effective and enjoyable way of easing the transition from medical student to junior doctor. Together with 'on-the-job' shadowing time, such programs can be used to improve students' confidence, competence, and ultimately patient safety and quality of care.

Investment feasibility tracking: the importance of measuring and tracking the success level of the project during commercialization phase

NASA Astrophysics Data System (ADS)

Saputra, Y. A.; Setyaningtyas, V. E. D.; Latiffianti, E.; Wijaya, S. H.; Ladamay, O. S. A.

2018-04-01

Measuring project success level is a challenging activity. This area of works has attracted many researchers to look deeper into the method of measurement, success factor identification, risk management, and many others relevant topics. However, the project management scope is limited until the project handover stage. After a project handover, the control of a project management changes from Project Management Team to the project owner/commercialization team. From an investor’s point of view, the success of a project delivery needs to be followed by the success of commercialization phase. This paper aims to present an approach on how we track and measure the progress and success level of a project investment in the commercialization phase. This is an interesting topic which probably often being forgotten in many practical case. Our proposed concept modify Freeman and Beale concept by estimating the variance between the Planned Net Present Value / Annual Worth (as it is in the Feasibility Study Document) and the Actual Net Present Value / Annual Worth (until the point time of evaluation). The gap will lead us to the next analysis and give us some important information, especially exposing whether our project investment performs better than the planning or underperformed. Some corrective actions can be suggested based on the provided information. Practical cases to exercise the concept is also provided and discussed; one case in a property sector in the middle of commercialization phase, and another case in a Power Plant investment approaching the end of commercialization phase.

Organizational culture: an important context for addressing and improving hospital to community patient discharge.

PubMed

Hesselink, Gijs; Vernooij-Dassen, Myrra; Pijnenborg, Loes; Barach, Paul; Gademan, Petra; Dudzik-Urbaniak, Ewa; Flink, Maria; Orrego, Carola; Toccafondi, Giulio; Johnson, Julie K; Schoonhoven, Lisette; Wollersheim, Hub

2013-01-01

Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown. To explore aspects of organizational culture to develop a deeper understanding of the discharge process. A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data. In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses. Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices. On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.

Development of a prehospital vital signs chart sharing system.

PubMed

Nakada, Taka-aki; Masunaga, Naohisa; Nakao, Shota; Narita, Maiko; Fuse, Takashi; Watanabe, Hiroaki; Mizushima, Yasuaki; Matsuoka, Tetsuya

2016-01-01

Physiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival. Fifty trauma patients, transferred to a level I trauma center in Japan, were studied. The primary outcome variable was the number of prehospital vital signs shared with the trauma center prior to hospital arrival. The prehospital vital signs chart sharing system significantly increased the number of prehospital vital signs, including blood pressure, heart rate, and oxygen saturation, shared with the in-hospital team at a remote trauma center prior to patient arrival at the hospital (P < .0001). There were significant differences in prehospital vital signs during ambulance transfer between patients who had severe bleeding and non-severe bleeding within 24 hours after injury onset. Vital signs data collected during ambulance transfer via patient monitors could be automatically converted to easily visible patient charts and effectively shared with the remote trauma center prior to hospital arrival. The prehospital vital signs chart sharing system increased the number of precise vital signs shared prior to patient arrival at the hospital, which can potentially contribute to better trauma care without increasing labor and reduce information loss during clinical handover. Copyright © 2015 Elsevier Inc. All rights reserved.

A Reduced Duty Hours Model for Senior Internal Medicine Residents: A Qualitative Analysis of Residents' Experiences and Perceptions.

PubMed

Mathew, Rebecca; Gundy, Serena; Ulic, Diana; Haider, Shariq; Wasi, Parveen

2016-09-01

To assess senior internal medicine residents' experience of the implementation of a reduced duty hours model with night float, the transition from the prior 26-hour call system, and the new model's effects on resident quality of life and perceived patient safety in the emergency department and clinical teaching unit at McMaster University. Qualitative data were collected during May 2013-July 2014, through resident focus groups held prior to implementation of a reduced duty hours model and 10 to 12 months postimplementation. Data analysis was guided by a constructivist grounded theory based in a relativist paradigm. Transcripts were coded; codes were collapsed into themes. Thematic analysis revealed five themes. Residents described reduced fatigue in the early morning, counterbalanced with worsened long-term fatigue on night float blocks; anticipation of negative impacts of the loss of distributed on-call experience and on-call shift volume; an urgency to sleep postcall in anticipation of consecutive night float shifts accompanied by conflicting role demands to stay postcall for care continuity; increased handover frequency accompanied by inaccurate/incomplete communication of patients' issues; and improvement in the senior resident experience on the clinical teaching unit, with increased ownership over patient care and improved relationships with junior housestaff. A reduced duty hours model with night float has potential to improve residents' perceived fatigue on call and care continuity on the clinical teaching unit. This must be weighed against increased handover frequency and loss of the postcall day, which may negatively affect patient care and resident quality of life.

Developing a medical emergency team running sheet to improve clinical handoff and documentation.

PubMed

Mardegan, Karen; Heland, Melodie; Whitelock, Tifany; Millar, Robert; Jones, Daryl

2013-12-01

During medical emergency team (MET) and cardiac arrest calls, a scribe usually records events on a running sheet. There is more agreement on what data should be recorded in cardiac arrest calls than for MET calls. In addition, handoff (handover) from ward staff to the arriving MET may be variable. In a quality improvement project, a novel MET running sheet was developed to document events and therapies administered during MET calls. Key characteristics of the form were improved form layout, increased space for event documentation, and prompts to assist handoff to the arriving MET using the Identity Situation, Background, Assessment, Request (ISBAR) format. Ward nurses commonly involved in MET activation were surveyed to assess their perceptions of the new MET running sheet. Files of 100 consecutive MET calls were reviewed to assess compliance. Of 109 nurses invited to complete the survey, 103 did so (94.5% response rate). Overall, 87 (84.5%) of the 103 respondents agreed or strongly agreed that the new MET running sheet was better than the previous form for documenting MET management, and 58 (57.4%) of 101 respondents agreed or strongly agreed that it assisted handoff. The form was completed in 91 of a sample of 100 consecutive MET calls. Areas of less complete documentation included aspects of the ISBAR handover to the arriving MET and notification of the next of kin and usual clinicians at the completion of the call. The MET running sheet, tailored to the clinical events that occur during episodes of MET review, may assist handoff from ward nurses to the arriving MET and event documentation.

Investigating the sustainability of outcomes in a chronic disease treatment programme.

PubMed

Bailie, Ross S; Robinson, Gary; Kondalsamy-Chennakesavan, Srinivas N; Halpin, Stephen; Wang, Zhiqiang

2006-09-01

This study examines trends in chronic disease outcomes from initiation of a specialised chronic disease treatment programme through to incorporation of programme activities into routine service delivery. We reviewed clinical records of 98 participants with confirmed renal disease or hypertension in a remote indigenous community health centre in Northern Australia. For each participant the review period spanned an initial three years while participating in a specialised cardiovascular and renal disease treatment programme and a subsequent three years following withdrawal of the treatment programme. Responsibility for care was incorporated into the comprehensive primary care service which had been recently redeveloped to implement best practice care plans. The time series analysis included at least six measures prior to handover of the specialised programme and six following handover. Main outcome measures were trends in blood pressure (BP) control, and systolic and diastolic BP. We found an improvement in BP control in the first 6-12 months of the programme, followed by a steady declining trend. There was no significant difference in this trend between the pre- compared to the post-programme withdrawal period. This finding was consistent for control at levels below 130/80 and 140/90, and for trends in mean systolic and diastolic BP. Investigation of the sustainability of programme outcomes presents major challenges for research design. Sustained success in the management of chronic disease through primary care services requires better understanding of the causal mechanisms related to clinical intervention, the basis upon which they can be 'institutionalised' in a given context, and the extent to which they require regular revitalisation to maintain their effect.

Verification of the Solar Dynamics Observatory High Gain Antenna Pointing Algorithm Using Flight Data

NASA Technical Reports Server (NTRS)

Bourkland, Kristin L.; Liu, Kuo-Chia

2011-01-01

The Solar Dynamics Observatory (SDO) is a NASA spacecraft designed to study the Sun. It was launched on February 11, 2010 into a geosynchronous orbit, and uses a suite of attitude sensors and actuators to finely point the spacecraft at the Sun. SDO has three science instruments: the Atmospheric Imaging Assembly (AIA), the Helioseismic and Magnetic Imager (HMI), and the Extreme Ultraviolet Variability Experiment (EVE). SDO uses two High Gain Antennas (HGAs) to send science data to a dedicated ground station in White Sands, New Mexico. In order to meet the science data capture budget, the HGAs must be able to transmit data to the ground for a very large percentage of the time. Each HGA is a dual-axis antenna driven by stepper motors. Both antennas transmit data at all times, but only a single antenna is required in order to meet the transmission rate requirement. For portions of the year, one antenna or the other has an unobstructed view of the White Sands ground station. During other periods, however, the view from both antennas to the Earth is blocked for different portions of the day. During these times of blockage, the two HGAs take turns pointing to White Sands, with the other antenna pointing out to space. The HGAs handover White Sands transmission responsibilities to the unblocked antenna. There are two handover seasons per year, each lasting about 72 days, where the antennas hand off control every twelve hours. The non-tracking antenna slews back to the ground station by following a ground commanded trajectory and arrives approximately 5 minutes before the formerly tracking antenna slews away to point out into space. The SDO Attitude Control System (ACS) runs at 5 Hz, and the HGA Gimbal Control Electronics (GCE) run at 200 Hz. There are 40 opportunities for the gimbals to step each ACS cycle, with a hardware limitation of no more than one step every three GCE cycles. The ACS calculates the desired gimbal motion for tracking the ground station or for slewing, and sends the command to the GCE at 5 Hz. This command contains the number of gimbals steps for that ACS cycle, the direction of motion, the spacing of the steps, and the delay before taking the first step. The AIA and HMI instruments are sensitive to spacecraft jitter. Pre-flight analysis showed that jitter from the motion of the HGAs was a cause of concern. Three jitter mitigation techniques were developed to overcome the effects of jitter from different sources. The first method is the random step delay, which avoids gimbal steps hitting a cadence on a jitter-critical mode by pseudo-randomly delaying the first gimbal step in an ACS cycle. The second method of jitter mitigation is stagger stepping, which forbids the two antennas from taking steps during the same ACS cycle in order to avoid constructively adding jitter from two antennas. The third method is the inclusion of an instrument No Step Request (NSR), which allows the instruments to request a stoppage in gimbal stepping during the times when they are taking images. During the commissioning phase of the mission, a jitter test was performed onboard the spacecraft. Various sources of jitter, such as the reaction wheels, the High Gain Antenna motors, and the motion of the instrument filter wheels, were examined to determine the level of their effect on the instruments. During the HGA portion of the test, the jitter amplitudes from the single step of a gimbal were examined, as well as the amplitudes due to the execution of various gimbal rates. These jitter levels are compared with the gimbal jitter allocations for each instrument. Additionally, the jitter test provided insight into a readback delay that exists with the GCE. Pre-flight analysis suggested that gimbal steps scheduled to occur during the later portion of an ACS cycle would not be read during that cycle, resulting in a delay in the telemetered current gimbal position. Flight data from the jitter test confirmed this expectation. Analysis is presentehat shows the readback delay does not have a negative impact on gimbal control. The decision was made to consider implementing two of the jitter mitigation techniques on board the spacecraft: stagger stepping and the NSR. Flight data from two sets of handovers, one set without jitter mitigation and the other with mitigation enabled, were examined. The trajectory of the predicted handover was compared with the measured trajectory for the two cases, showing that tracking was not negatively impacted with the addition of the jitter mitigation techniques. Additionally, the individual gimbal steps were examined, and it was confirmed that the stagger stepping and NSRs worked as designed. An Image Quality Test was performed to determine the amount of cumulative jitter from the reaction wheels, HGAs, and instruments during various combinations of typical operations. In this paper, the flight results are examined from a test where the HGAs are following the path of a nominal handover with stagger stepping on and HMI NSRs enabled. In this case, the reaction wheels are moving at low speed and the instruments are taking pictures in their standard sequence. The flight data shows the level of jitter that the instruments see when their shutters are open. The HGA-induced jitter is well within the jitter requirement when the stagger step and NSR mitigation options are enabled. The SDO HGA pointing algorithm was designed to achieve nominal antenna pointing at the ground station, perform slews during handover season, and provide three HGA-induced jitter mitigation options without compromising pointing objectives. During the commissioning phase, flight data sets were collected to verify the HGA pointing algorithm and demonstrate its jitter mitigation capabilities.

21 CFR 558.62 - Arsanilic acid.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Indications for use Limitations Sponsor (i) 45 to 90 1. Growing chickens: For growth promotion and feed...) .......do 015565 (iii) Erythromycin 4.6 Chickens; growth promotion and feed efficiency; improving.... 012487 (iv) Erythromycin 4.6 to 18.5 Chickens; growth promotion and feed efficiency; improving...

Fuzzy logic control for camera tracking system

NASA Technical Reports Server (NTRS)

Lea, Robert N.; Fritz, R. H.; Giarratano, J.; Jani, Yashvant

1992-01-01

A concept utilizing fuzzy theory has been developed for a camera tracking system to provide support for proximity operations and traffic management around the Space Station Freedom. Fuzzy sets and fuzzy logic based reasoning are used in a control system which utilizes images from a camera and generates required pan and tilt commands to track and maintain a moving target in the camera's field of view. This control system can be implemented on a fuzzy chip to provide an intelligent sensor for autonomous operations. Capabilities of the control system can be expanded to include approach, handover to other sensors, caution and warning messages.

STS-105 Flight Day 5 Highlights

NASA Technical Reports Server (NTRS)

2001-01-01

On this fifth day of the STS-105 mission, the transfer of supplies from the Leonardo Multipurpose Logistics Module to the International Space Station (ISS) and the handover of control of the ISS from the Expedition 2 crew (Yuriy Usachev, Jim Voss, and Susan Helms) to the Expedition 3 crew (Frank Culbertson, Jr., Mikhail Turin, and Vladimir Dezhurov) continue. Commanders Usachev and Culbertson answer questions about the ISS in an on-orbit interview, and the Expedition 3 crewmembers give a video tour of their new sleeping quarters on the ISS. The north Pacific Ocean and the United States Pacific northwest are seen from space.

Interim Cryogenic Propulsion Stage (ICPS) Handover Signing

NASA Image and Video Library

2017-10-26

Meeting in the Launch Control Center of NASA's Kennedy Space Center in Florida, officials of the agency's Spacecraft/Payload Integration and Evolution (SPIE) organization formally turn over processing of the Space Launch System (SLS) rocket's Interim Cryogenic Propulsion Stage (ICPS) to the center's Ground Systems Development and Operations (GSDO) directorate. The ICPS is the first integrated piece of flight hardware to arrive in preparation for the uncrewed Exploration Mission-1. With the Orion attached, the ICPS sits atop the SLS rocket and will provide the spacecraft with the additional thrust needed to travel tens of thousands of miles beyond the Moon.

Better Targeting, Better Efficiency for Wide-Scale Neuronal Transduction with the Synapsin Promoter and AAV-PHP.B

PubMed Central

Jackson, Kasey L.; Dayton, Robert D.; Deverman, Benjamin E.; Klein, Ronald L.

2016-01-01

Widespread genetic modification of cells in the central nervous system (CNS) with a viral vector has become possible and increasingly more efficient. We previously applied an AAV9 vector with the cytomegalovirus/chicken beta-actin (CBA) hybrid promoter and achieved wide-scale CNS transduction in neonatal and adult rats. However, this method transduces a variety of tissues in addition to the CNS. Thus we studied intravenous AAV9 gene transfer with a synapsin promoter to better target the neurons. We noted in systematic comparisons that the synapsin promoter drives lower level expression than does the CBA promoter. The engineered adeno-associated virus (AAV)-PHP.B serotype was compared with AAV9, and AAV-PHP.B did enhance the efficiency of expression. Combining the synapsin promoter with AAV-PHP.B could therefore be advantageous in terms of combining two refinements of targeting and efficiency. Wide-scale expression was used to model a disease with widespread pathology. Vectors encoding the amyotrophic lateral sclerosis (ALS)-related protein transactive response DNA-binding protein, 43 kDa (TDP-43) with the synapsin promoter and AAV-PHP.B were used for efficient CNS-targeted TDP-43 expression. Intracerebroventricular injections were also explored to limit TDP-43 expression to the CNS. The neuron-selective promoter and the AAV-PHP.B enhanced gene transfer and ALS disease modeling in adult rats. PMID:27867348

Better Targeting, Better Efficiency for Wide-Scale Neuronal Transduction with the Synapsin Promoter and AAV-PHP.B.

PubMed

Jackson, Kasey L; Dayton, Robert D; Deverman, Benjamin E; Klein, Ronald L

2016-01-01

Widespread genetic modification of cells in the central nervous system (CNS) with a viral vector has become possible and increasingly more efficient. We previously applied an AAV9 vector with the cytomegalovirus/chicken beta-actin (CBA) hybrid promoter and achieved wide-scale CNS transduction in neonatal and adult rats. However, this method transduces a variety of tissues in addition to the CNS. Thus we studied intravenous AAV9 gene transfer with a synapsin promoter to better target the neurons. We noted in systematic comparisons that the synapsin promoter drives lower level expression than does the CBA promoter. The engineered adeno-associated virus (AAV)-PHP.B serotype was compared with AAV9, and AAV-PHP.B did enhance the efficiency of expression. Combining the synapsin promoter with AAV-PHP.B could therefore be advantageous in terms of combining two refinements of targeting and efficiency. Wide-scale expression was used to model a disease with widespread pathology. Vectors encoding the amyotrophic lateral sclerosis (ALS)-related protein transactive response DNA-binding protein, 43 kDa (TDP-43) with the synapsin promoter and AAV-PHP.B were used for efficient CNS-targeted TDP-43 expression. Intracerebroventricular injections were also explored to limit TDP-43 expression to the CNS. The neuron-selective promoter and the AAV-PHP.B enhanced gene transfer and ALS disease modeling in adult rats.

Hands on + hands free: simulated on-call interaction.

PubMed

Fisher, James; Martin, Richard; Tate, David

2014-10-01

In hospital, doctors and nurses frequently discuss acutely unwell patients via the telephone. Telephone communication can be challenging, yet medical students receive little training in how to conduct such interactions. We aimed to provide a simple, innovative, simulation session to address this learning need for third-year medical students at Newcastle University. Groups of students were given a pager and a supervising tutor. Students responded to a 'bleep' from a nurse practitioner in a different room, who role-played a ward nurse concerned about a patient. Speakerphones were used, allowing the entire conversation to be audible. After the call, a student-led debriefing session took place. After the debriefing another student 'held' the bleep and a different scenario ensued. Following a resuscitation scenario, students made telephone contact with the medical registrar to hand over information pertaining to the case. Before and after the session, students rated their confidence in telephone interaction and handover using a 10-point Likert scale. Students also completed a feedback questionnaire. Fifty-four students attended the session. A statistically significant improvement in student confidence in telephone communication and handover was seen after the session. Free-text feedback highlighted that students had not received teaching on this previously, and that they welcomed opportunities to practise such skills within a controlled, safe environment. Simulation training can be costly, but speakerphones are cheap and readily available. Given the frequency of telephone interaction in hospital, we believe all medical students should receive telephone communication training. Locally, our department has now incorporated these teaching methods into simulation sessions elsewhere in the curriculum. Medical students receive little training in how to conduct [telephone] interactions. © 2014 John Wiley & Sons Ltd.

Nurses' shift reports: a systematic literature search and critical review of qualitative field studies.

PubMed

Buus, Niels; Hoeck, Bente; Hamilton, Bridget Elizabeth

2017-10-01

To identify reporting practices that feature in studies of nurses' shift reports across diverse nursing specialities. The objectives were to perform an exhaustive systematic literature search and to critically review the quality and findings of qualitative field studies of nurses' shift reports. Nurses' shift reports are routine occurrences in healthcare organisations that are viewed as crucial for patient outcomes, patient safety and continuity of care. Studies of communication between nurses attend primarily to 1:1 communication and analyse the adequacy and accuracy of patient information and feature handovers at the bedside. Still, verbal reports between groups of nurses about patients are commonplace. Shift reports are obvious sites for studying the situated accomplishment of professional nursing at the group level. This review is focused exclusively on qualitative field research for nuanced and contextualised insights into nurses' everyday shift reporting practices. The study is a systematic literature search and critical review of qualitative field analyses of nurses' shift reports. We searched in the databases CIHAHL, PubMed and PsycINFO and identified and reviewed 19 articles published 1992-2014. Data were systematically extracted using criteria for the evaluation of qualitative research reports. The studies described shift report practices and identified several factors contributing to distribution of clinical knowledge. Shift report practices were described as highly conventionalised and locally situated, but with occasional opportunities for improvisation and negotiation between nurses. Finally, shift reports were described as multifunctional meetings, with individual and social effects for nurses and teams. Innovations in between-shift communications can benefit from this analysis, by providing for the many functions of handovers that are revealed in field studies. Leaders and practising nurses may consider what are the best opportunities for nurses to work up clinical knowledge and negotiate care. © 2016 John Wiley & Sons Ltd.

Factors contributing to the process of intensive care patient discharge: an ethnographic study informed by activity theory.

PubMed

Lin, Frances; Chaboyer, Wendy; Wallis, Marianne; Miller, Anne

2013-08-01

Patient flow from intensive care to acute care units is often problematic and many discharges from intensive care to acute care are unsuccessful on the first attempt. The aim of this study was to explore the factors that influence intensive care patient discharge. This ethnographic study was undertaken in an Australian metropolitan tertiary hospital that had a 14-bed level 3 intensive care unit. Intensive care and acute care unit medical and nursing staff, and other hospital staff who were involved in the intensive care patient discharge process participated in this study. A total of 28 discharges were observed, and 56 one on one interviews were conducted. Data collection techniques including direct observations, semi-structured interviews, and collection of existing documents were used. Activity theory was the theoretical framework that underpinned this study. Three patient activity systems were identified: intensive care patient discharge activity, acute care unit accepting patient activity, and hospital bed management activity. Analysis of the interactions among these activity systems revealed conflicting objects (goals), communication breakdowns, and teamwork issues. Discharge delay was found to be a significant problem, which was associated with limited acute care unit bed availability. Strategies to improve acute care unit bed availability are needed. Routine after-hours ICU discharge could raise patient safety concerns which need to be considered. All team members' input in discharge decision making should be encouraged. Problems identified in clinical handover call for actions to change the handover practice. Activity theory successfully guided the study by providing a practical and descriptive framework for the study, facilitating the understanding of the interrelationships among the activity systems. Copyright © 2012 Elsevier Ltd. All rights reserved.

CoAP-Based Mobility Management for the Internet of Things

PubMed Central

Chun, Seung-Man; Kim, Hyun-Su; Park, Jong-Tae

2015-01-01

Most of the current mobility management protocols such as Mobile IP and its variants standardized by the IETF may not be suitable to support mobility management for Web-based applications in an Internet of Things (IoT) environment. This is because the sensor nodes have limited power capacity, usually operating in sleep/wakeup mode in a constrained wireless network. In addition, sometimes the sensor nodes may act as the server using the CoAP protocol in an IoT environment. This makes it difficult for Web clients to properly retrieve the sensing data from the mobile sensor nodes in an IoT environment. In this article, we propose a mobility management protocol, named CoMP, which can effectively retrieve the sensing data of sensor nodes while they are moving. The salient feature of CoMP is that it makes use of the IETF CoAP protocol for mobility management, instead of using Mobile IP. Thus CoMP can eliminates the additional signaling overhead of Mobile IP, provides reliable mobility management, and prevents the packet loss. CoMP employs a separate location management server to keep track of the location of the mobile sensor nodes. In order to prevent the loss of important sensing data during movement, a holding mode of operation has been introduced. All the signaling procedures including discovery, registration, binding and holding have been designed by extending the IETF CoAP protocol. The numerical analysis and simulation have been done for performance evaluation in terms of the handover latency and packet loss. The results show that the proposed CoMP is superior to previous mobility management protocols, i.e., Mobile IPv4/v6 (MIPv4/v6), Hierarchical Mobile IPv4/v6 (HMIPv4/v6), in terms of the handover latency and packet loss. PMID:26151214

Level of consciousness on admission to a Heart Attack Centre is a predictor of survival from out-of-hospital cardiac arrest.

PubMed

Deakin, Charles D; Fothergill, Rachael; Moore, Fionna; Watson, Lynne; Whitbread, Mark

2014-07-01

The relationship between the neurological status at the time of handover from the ambulance crew to a Heart Attack Centre (HAC) in patients who have achieved return of spontaneous circulation (ROSC) and subsequent outcome, in the context of current treatment standards, is unknown. A retrospective review of all patients treated by London Ambulance Service (LAS) from 1(st) April 2011 to 31(st) March 2013 admitted to a HAC in Greater London was undertaken. Neurological status (A - alert; V - responding to voice; P - responding to pain; U - unresponsive) recorded by the ambulance crew on handover was compared with length of hospital stay and survival to hospital discharge. A total of 475 sequential adult cardiac arrests of presumed cardiac origin, achieving ROSC on admission to a HAC were identified. Outcome data was available for 452 patients, of whom 253 (56.0%) survived to discharge. Level of consciousness on admission to the HAC was a predictor of duration of hospital stay (P<0.0001) and survival to hospital discharge (P<0.0001). Of those presenting with a shockable rhythm, 32.3% (120/371) were 'A' or 'V', compared with 9.1% (9/99) of those with non-shockable rhythms (P<0.001). Patients with shockable rhythms achieving ROSC are more likely to be conscious (A or V) compared with those with non-shockable rhythms. Most patients who are conscious on admission to the HAC will survive, compared with approximately half of those who are unconscious (P or U), suggesting that critical care is generally appropriate at all levels of consciousness if ROSC has been achieved. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Program Director Perceptions of Proficiency in the Core Entrustable Professional Activities.

PubMed

Pearlman, R Ellen; Pawelczak, Melissa; Yacht, Andrew C; Akbar, Salaahuddin; Farina, Gino A

2017-10-01

The Association of American Medical Colleges describes 13 core entrustable professional activities (EPAs) that every graduating medical student should be expected to perform proficiently on day 1 of residency, regardless of chosen specialty. Studies have shown wide variability in program director (PD) confidence in interns' abilities to perform these core EPAs. Little is known regarding comparison of United States Medical Licensing Examination (USMLE) scores with proficiency in EPAs. We determined if PDs from a large health system felt confident in their postgraduate year 1 residents' abilities to perform the 13 core EPAs, and compared perceived EPA proficiency with USMLE Step 1 and Step 2 scores. The PDs were asked to rate their residents' proficiency in each EPA and to provide residents' USMLE scores. Timing coincided with the reporting period for resident milestones. Surveys were completed on 204 of 328 residents (62%). PDs reported that 69% of residents (140 of 204) were prepared for EPA 4 (orders/prescriptions), 61% (117 of 192) for EPA 7 (form clinical questions), 68% (135 of 198) for EPA 8 (handovers), 63% (116 of 185) for EPA 11 (consent), and 38% (49 of 129) for EPA 13 (patient safety). EPA ratings and USMLE 1 and 2 were negatively correlated ( r (101) = -0.23, P  = .031). PDs felt that a significant percentage of residents were not adequately prepared in order writing, forming clinical questions, handoffs, informed consent, and promoting a culture of patient safety. We found no positive association between USMLE scores and EPA ratings.

Sustainability: the elusive dimension of international health projects.

PubMed

Edwards, Nancy C; Roelofs, Susan M

2006-01-01

The Canada-China Yunnan Maternal and Child Health Project (1997-2003) sought to improve the quality of village life and promote development of productivity and social prosperity in Yunnan province, China. The project targeted grassroots maternal and child health workers: new and in-service village doctors; traditional village midwives; doctors at township health centres; doctors at county maternal and child health hospitals; and provincial health staff. Ten impoverished counties (population 2.2 million) in Yunnan province with high proportions of ethnic minority populations. There were three major innovations: training grassroots maternal and child health workers in participatory and community-based approaches and clinical skills; designing a model comprehensive referral system including provision of basic equipment; and introducing participatory monitoring and evaluation methods. Strategies to support sustainability were built into the project from the outset. Over 4,000 village, township, and county health workers received training. Maternal, infant, and under-five mortality rates declined over 30% in project counties. Project innovations were disseminated throughout the province, into other donor-funded initiatives, and integrated into national health projects by local partners. Maintaining the long-term benefits of international health interventions depends on sustaining innovations beyond short project timelines. Achieving sustainability poses a conundrum to implementing agencies. Three mechanisms influenced uptake in the Yunnan project: maintaining a good fit between core project elements and the existing health system; developing adequate organizational supports; and creating a handover plan from the outset. This project highlights some of the ways in which sustainability can be operationalized.

Usage Pattern Differences and Similarities of Mobile Electronic Medical Records Among Health Care Providers

PubMed Central

Kim, Junetae; Kim, Jeong Hoon; Kim, Woo Sung

2017-01-01

Background Recently, many hospitals have introduced mobile electronic medical records (mEMRs). Although numerous studies have been published on the usability or usage patterns of mEMRs through user surveys, investigations based on the real data usage are lacking. Objective Asan Medical Center, a tertiary hospital in Seoul, Korea, implemented an mEMR program in 2010. On the basis of the mEMR usage log data collected over a period of 4.5 years, we aimed to identify a usage pattern and trends in accordance with user occupation and to disseminate the factors that make the mEMR more effective and efficient. Methods The mEMR log data were collected from March 2012 to August 2016. Descriptive analyses were completed according to user occupation, access time, services, and wireless network type. Specifically, analyses targeted were as follows: (1) the status of the mEMR usage and distribution of users, (2) trends in the number of users and usage amount, (3) 24-hour usage patterns, and (4) trends in service usage based on user occupations. Linear regressions were performed to model the relationship between the time, access frequency, and the number of users. The differences between the user occupations were examined using Student t tests for categorical variables. Results Approximately two-thirds of the doctors and nurses used the mEMR. The number of logs studied was 7,144,459. Among 3859 users, 2333 (60.46%) users were nurses and 1102 (28.56%) users were doctors. On average, the mEMR was used 1044 times by 438 users per day. The number of users and amount of access logs have significantly increased since 2012 (P<.001). Nurses used the mEMR 3 times more often than doctors. The use of mEMR by nurses increased by an annual average of 51.5%, but use by doctors decreased by an annual average of 7.7%. For doctors, the peak usage periods were observed during 08:00 to 09:00 and 17:00 to 18:00, which were coincident with the beginning of ward rounds. Conversely, the peak usage periods for the nurses were observed during 05:00 to 06:00, 12:00 to 13:00, and 20:00 to 21:00, which effectively occurred 1 or 2 hours before handover. In more than 80% of all cases, the mEMR was accessed via a nonhospital wireless network. Conclusions The usage patterns of the mEMR differed between doctors and nurses according to their different workflows. In both occupations, mEMR was highly used when personal computer access was limited and the need for patient information was high, such as during ward rounds or handover periods. PMID:29237579

Simpler ISS Flight Control Communications and Log Keeping via Social Tools and Techniques

NASA Technical Reports Server (NTRS)

Scott, David W.; Cowart, Hugh; Stevens, Dan

2012-01-01

The heart of flight operations control involves a) communicating effectively in real time with other controllers in the room and/or in remote locations and b) tracking significant events, decisions, and rationale to support the next set of decisions, provide a thorough shift handover, and troubleshoot/improve operations. International Space Station (ISS) flight controllers speak with each other via multiple voice circuits or loops, each with a particular purpose and constituency. Controllers monitor and/or respond to several loops concurrently. The primary tracking tools are console logs, typically kept by a single operator and not visible to others in real-time. Information from telemetry, commanding, and planning systems also plays into decision-making. Email is very secondary/tertiary due to timing and archival considerations. Voice communications and log entries supporting ISS operations have increased by orders of magnitude because the number of control centers, flight crew, and payload operations have grown. This paper explores three developmental ground system concepts under development at Johnson Space Center s (JSC) Mission Control Center Houston (MCC-H) and Marshall Space Flight Center s (MSFC) Payload Operations Integration Center (POIC). These concepts could reduce ISS control center voice traffic and console logging yet increase the efficiency and effectiveness of both. The goal of this paper is to kindle further discussion, exploration, and tool development.

Notes from a field hospital south of Mosul.

PubMed

Quinn V, John M; Amouri, Omar F; Reed, Pete

2018-03-06

This short letter from the field is offered as a rapid communiqué of the emergency medical situation in Mosul and surrounding areas on the eve of the final onslaught to liberate the city. This letter is based on emergency medical work at two World Health Organization (WHO) and Ministry of Health (MoH) Iraq lead Role II+ Field Hospital facilities south of Mosul City from April to June 2017; these facilities are currently and temporarily managed and administered by private medical industry until full handover to MoH Iraq, with WHO support and expert facilitation. The prominence of non-state actors in the conflict, using hybrid warfare tactics that maximize casualties, makes health security a particular challenge for the global community. This challenge requires health leaders and other actors in the region to set clear strategic goals that support public health of the many millions displaced, maimed and affected by the war. Whether in clinical medicine, development, peace and stability operations, or global health diplomacy, the shared values and conviction to best serve vulnerable communities and mitigate morbidity must embrace the lessons of evidenced based practice derived from military medical experience. WHO is leading the charge in disaster response for the conflict in Iraq, and many challenges remain. This might also include developing a new process in emergency medical response that utilizes private contracting to improve efficiency in delivery and overall sustainability.

75 FR 29993 - Department of Commerce: Trade Promotion Coordinating Committee Renewable Energy and Energy...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... Coordinating Committee Renewable Energy and Energy Efficiency Export Strategy To Support the National Export... Trade Promotion Coordinating Committee's (TPCC) Renewable Energy and Energy Efficiency Working Group is developing a U.S. Renewable Energy and Energy Efficiency Export Strategy (the Strategy) to guide U.S...

The application of Aronson's taxonomy to medication errors in nursing.

PubMed

Johnson, Maree; Young, Helen

2011-01-01

Medication administration is a frequent nursing activity that is prone to error. In this study of 318 self-reported medication incidents (including near misses), very few resulted in patient harm-7% required intervention or prolonged hospitalization or caused temporary harm. Aronson's classification system provided an excellent framework for analysis of the incidents with a close connection between the type of error and the change strategy to minimize medication incidents. Taking a behavioral approach to medication error classification has provided helpful strategies for nurses such as nurse-call cards on patient lockers when patients are absent and checking of medication sign-off by outgoing and incoming staff at handover.

Predictors of Hospital Nurses' Safety Practices: Work Environment, Workload, Job Satisfaction, and Error Reporting.

PubMed

Chiang, Hui-Ying; Hsiao, Ya-Chu; Lee, Huan-Fang

Nurses' safety practices of medication administration, prevention of falls and unplanned extubations, and handover are essentials to patient safety. This study explored the prediction between such safety practices and work environment factors, workload, job satisfaction, and error-reporting culture of 1429 Taiwanese nurses. Nurses' job satisfaction, error-reporting culture, and one environmental factor of nursing quality were found to be major predictors of safety practices. The other environment factors related to professional development and participation in hospital affairs and nurses' workload had limited predictive effects on the safety practices. Increasing nurses' attention to patient safety by improving these predictors is recommended.

Mobile user environment and satellite diversity for NGSO S-PCN's

NASA Technical Reports Server (NTRS)

Werner, Markus; Bischl, Hermann; Lutz, Erich

1995-01-01

The performance of satellite diversity under the influence of the mobile user environment is analyzed. To this end, a digital channel model is presented which takes into account the elevation angle as well as the user mobility in a given environment. For different LEO and MEO systems and for varying mobile user environments, some crucial benefits and drawbacks of satellite diversity are discussed. Specifically, the important GW service area concept is introduced. The conclusions are validated by numerical results from computer simulations. Globalstar (LEO) and Inmarsat (MEO) are compared in terms of visibility, service availability and equivalent handover complexity for different environments and user mobility.

Serotype-dependent transduction efficiencies of recombinant adeno-associated viral vectors in monkey neocortex

PubMed Central

Gerits, Annelies; Vancraeyenest, Pascaline; Vreysen, Samme; Laramée, Marie-Eve; Michiels, Annelies; Gijsbers, Rik; Van den Haute, Chris; Moons, Lieve; Debyser, Zeger; Baekelandt, Veerle; Arckens, Lutgarde; Vanduffel, Wim

2015-01-01

Abstract. Viral vector-mediated expression of genes (e.g., coding for opsins and designer receptors) has grown increasingly popular. Cell-type specific expression is achieved by altering viral vector tropism through crosspackaging or by cell-specific promoters driving gene expression. Detailed information about transduction properties of most recombinant adeno-associated viral vector (rAAV) serotypes in macaque cortex is gradually becoming available. Here, we compare transduction efficiencies and expression patterns of reporter genes in two macaque neocortical areas employing different rAAV serotypes and promoters. A short version of the calmodulin-kinase-II (CaMKIIα0.4) promoter resulted in reporter gene expression in cortical neurons for all tested rAAVs, albeit with different efficiencies for spread: rAAV2/5>>rAAV2/7>rAAV2/8>rAAV2/9>>rAAV2/1 and proportion of transduced cells: rAAV2/1>rAAV2/5>rAAV2/7=rAAV2/9>rAAV2/8. In contrast to rodent studies, the cytomegalovirus (CMV) promoter appeared least efficient in macaque cortex. The human synapsin-1 promoter preceded by the CMV enhancer (enhSyn1) produced homogeneous reporter gene expression across all layers, while two variants of the CaMKIIα promoter resulted in different laminar transduction patterns and cell specificities. Finally, differences in expression patterns were observed when the same viral vector was injected in two neocortical areas. Our results corroborate previous findings that reporter-gene expression patterns and efficiency of rAAV transduction depend on serotype, promoter, cortical layer, and area. PMID:26839901

A Significant Increase of RNAi Efficiency in Human Cells by the CMV Enhancer with a tRNAlys Promoter

PubMed Central

Weiwei, Ma; Zhenhua, Xie; Feng, Liu; Hang, Ning; Yuyang, Jiang

2009-01-01

RNA interference (RNAi) is the process of mRNA degradation induced by double-stranded RNA in a sequence-specific manner. Different types of promoters, such as U6, H1, tRNA, and CMV, have been used to control the inhibitory effect of RNAi expression vectors. In the present study, we constructed two shRNA expression vectors, respectively, controlled by tRNAlys and CMV enhancer-tRNAlys promoters. Compared to the vectors with tRNAlys or U6 promoter, the vector with a CMV enhancer-tRNAlys promoter silenced pokemon more efficiently on both the mRNA and the protein levels. Meanwhile, the silencing of pokemon inhibited the proliferation of MCF7 cells, but the induction of apoptosis of MCF7 cells was not observed. We conclude that the CMV enhancer-tRNAlys promoter may be a powerful tool in driving intracellular expression of shRNA which can efficiently silence targeted gene. PMID:19859553

18 CFR 39.8 - Delegation to a Regional Entity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... agreement promotes effective and efficient administration of Bulk-Power System reliability. (d) The... Interconnection-wide basis promotes effective and efficient administration of Bulk-Power System reliability and... THE ELECTRIC RELIABILITY ORGANIZATION; AND PROCEDURES FOR THE ESTABLISHMENT, APPROVAL, AND ENFORCEMENT...

78 FR 77574 - Protection System Maintenance Reliability Standard

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

... protection system component type, except that the maintenance program for all batteries associated with the... Electric System reliability and promoting efficiency through consolidation [of protection system-related... ITC that PRC-005-2 promotes efficiency by consolidating protection system maintenance requirements...

People with Disabilities. Federal Programs Could Work Together More Efficiently To Promote Employment. Report to the Chairman, Subcommittee on Employer-Employee Relations, Committee on Economic and Educational Opportunities. House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

This study identified federal programs designed to assist people with disabilities, with a special emphasis on programs promoting employment. The study focused on the extent to which information, eligibility, and services were coordinated under these programs and the efficiency of federal programs in promoting employment among people with…

[The Promotion of Resources Integration in Long-Term Care Service: The Experience of Taipei City Hospital].

PubMed

Wu, Meng-Ping; Huang, Chao-Ming; Sun, Wen-Jung; Shih, Chih-Yuan; Hsu, Su-Hsuan; Huang, Sheng-Jean

2018-02-01

The home-based medical care integrated plan under Taiwan National Health Insurance has changed from paying for home-based medical care, home-based nursing, home-based respiratory treatment, and palliative care to paying for a single, continuous home-based care service package. Formerly, physician-visit regulations limited home visits for home-based nursing to providing medical related assessments only. This limitation not only did not provide practical assistance to the public but also caused additional problems for those with mobility problems or who faced difficulties in making visits hospital. This 2016 change in regulations opens the door for doctors to step out their 'ivory tower', while offering the public more options to seek medical assistance in the hope that patients may change their health-seeking behavior. The home-based concept that underlies the medical service system is rooted deeply in the community in order to set up a sound, integrated model of community medical care. It is a critical issue to proceed with timely job handover confirmation with the connecting team and to provide patients with continuous-care services prior to discharge through the discharge-planning service and the connection with the connecting team. This is currently believed to be the only continuous home-based medical care integrated service model in the world. This model not only connects services such as health literacy, rehabilitation, home-based medical care, home-based nursing, community palliative care, and death but also integrates community resources, builds community resources networks, and provides high quality community care services.

Expedition 7 Crew Interview: Ed Lu

NASA Technical Reports Server (NTRS)

2003-01-01

Ed Lu of Expedition Seven is seen during a pre-launch interview. He explains why he became interested in space flight. He states that this is a different type of mission and gives his reaction to the Columbia Space Shuttle tragedy. The handover of Expedition six is explained by Ed Lu. The challenges of this mission are also described by Lu. These challenges include working with a crew member reduction from three to two, and the conservation of clothing and consumables. Ed Lu talks about what it is like to work with commander Yuri Malenchenko in space. Finally, Ed Lu states that he will continue scientific experiments in space on calcium loss in bones.

Space-Based Information Infrastructure Architecture for Broadband Services

NASA Technical Reports Server (NTRS)

Price, Kent M.; Inukai, Tom; Razdan, Rajendev; Lazeav, Yvonne M.

1996-01-01

This study addressed four tasks: (1) identify satellite-addressable information infrastructure markets; (2) perform network analysis for space-based information infrastructure; (3) develop conceptual architectures; and (4) economic assessment of architectures. The report concludes that satellites will have a major role in the national and global information infrastructure, requiring seamless integration between terrestrial and satellite networks. The proposed LEO, MEO, and GEO satellite systems have satellite characteristics that vary widely. They include delay, delay variations, poorer link quality and beam/satellite handover. The barriers against seamless interoperability between satellite and terrestrial networks are discussed. These barriers are the lack of compatible parameters, standards and protocols, which are presently being evaluated and reduced.

Engineering evaluations and studies. Report for Ku-band studies, exhibit A

NASA Technical Reports Server (NTRS)

Dodds, J. G.; Huth, G. K.; Maronde, R. G.; Roberts, D.

1981-01-01

System performance aspects of the Ku band radar communication hardware and investigations into the Ku band/payload interfaces are discussed. The communications track problem caused by the excessive signal dynamic range at the servo input was investigated. The management/handover logic is discussed and a simplified description of the transmitter enable logic function is presented. Output noise produced by a voltage-controlled oscillator chip used in the SPA return-link channel 3 mid-bit detector is discussed. The deployed assembly (DA) and EA-2 critical design review data are evaluated. Cross coupling effects on antenna servo stability were examined. A series of meetings on the acceptance test specification for the deployed assembly is summarized.

Transfer-of-Care Communication: Nursing Best Practices.

PubMed

Chard, Robin; Makary, Martin A

2015-10-01

The successful and safe transfer of the patient from one phase of care to another is contingent on optimal communication by all team members. Nurses are often in a natural leadership position to improve safe practices during hand overs. A holistic understanding of the patient allows the perioperative nurse the opportunity to identify issues and choose a nursing diagnosis based on key elements of a patient's needs and goals--information that should be relayed during patient transfers. This article reviews best practices in transfer-of-care communication to enable perioperative RNs to take an active, leading role in hand-over processes. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Simian virus 40 major late promoter: an upstream DNA sequence required for efficient in vitro transcription.

PubMed Central

Brady, J; Radonovich, M; Thoren, M; Das, G; Salzman, N P

1984-01-01

We have previously identified an 11-base DNA sequence, 5'-G-G-T-A-C-C-T-A-A-C-C-3' (simian virus 40 [SV40] map position 294 to 304), which is important in the control of SV40 late RNA expression in vitro and in vivo (Brady et al., Cell 31:625-633, 1982). We report here the identification of another domain of the SV40 late promoter. A series of mutants with deletions extending from SV40 map position 0 to 300 was prepared by nuclease BAL 31 treatment. The cloned templates were then analyzed for efficiency and accuracy of late SV40 RNA expression in the Manley in vitro transcription system. Our studies showed that, in addition to the promoter domain near map position 300, there are essential DNA sequences between nucleotide positions 74 and 95 that are required for efficient expression of late SV40 RNA. Included in this SV40 DNA sequence were two of the six GGGCGG SV40 repeat sequences and an 11-nucleotide segment which showed strong homology with the upstream sequences required for the efficient in vitro and in vivo expression of the histone H2A gene. This upstream promoter sequence supported transcription with the same efficiency even when it was moved 72 nucleotides closer to the major late cap site. In vitro promoter competition analysis demonstrated that the upstream promoter sequence, independent of the 294 to 304 promoter element, is capable of binding polymerase-transcription factors required for SV40 late gene transcription. Finally, we show that DNA sequences which control the specificity of RNA initiation at nucleotide 325 lie downstream of map position 294. Images PMID:6321950

Low Cost Efficient Deliverying Video Surveillance Service to Moving Guard for Smart Home.

PubMed

Gualotuña, Tatiana; Macías, Elsa; Suárez, Álvaro; C, Efraín R Fonseca; Rivadeneira, Andrés

2018-03-01

Low-cost video surveillance systems are attractive for Smart Home applications (especially in emerging economies). Those systems use the flexibility of the Internet of Things to operate the video camera only when an intrusion is detected. We are the only ones that focus on the design of protocols based on intelligent agents to communicate the video of an intrusion in real time to the guards by wireless or mobile networks. The goal is to communicate, in real time, the video to the guards who can be moving towards the smart home. However, this communication suffers from sporadic disruptions that difficults the control and drastically reduces user satisfaction and operativity of the system. In a novel way, we have designed a generic software architecture based on design patterns that can be adapted to any hardware in a simple way. The implanted hardware is of very low economic cost; the software frameworks are free. In the experimental tests we have shown that it is possible to communicate to the moving guard, intrusion notifications (by e-mail and by instant messaging), and the first video frames in less than 20 s. In addition, we automatically recovered the frames of video lost in the disruptions in a transparent way to the user, we supported vertical handover processes and we could save energy of the smartphone's battery. However, the most important thing was that the high satisfaction of the people who have used the system.

Design and Application of an Electronic Logbook for Space System Integration and Test Operations

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

Kavelaars, Alicia T.

In the highly technological aerospace world paper is still widely used to document space system integration and test (I&T) operations. E-Logbook is a new technology designed to substitute the most commonly used paper logbooks in space system I&T, such as the connector mate/demate logbook, the flight hardware and flight software component installation logbook, the material mix record logbook and the electronic ground support equipment validation logbook. It also includes new logbook concepts, such as the shift logbook, which optimizes management oversight and the shift hand-over process, and the configuration logbook, which instantly reports on the global I&T state of themore » space system before major test events or project reviews. The design of E-Logbook focuses not only on a reliable and efficient relational database, but also on an ergonomic human-computer interactive (HCI) system that can help reduce human error and improve I&T management and oversight overall. E-Logbook has been used for the I&T operation of the Gamma-ray Large Area Space Telescope (GLAST) Large Area Telescope (LAT) at the Stanford Linear Accelerator Center (SLAC). More than 41,000 records have been created for the different I&T logbooks, with no data having been corrupted or critically lost. 94% of the operators and 100% of the management exposed to E-Logbook prefer it to paper logbooks and recommend its use in the aerospace industry.« less

Low Cost Efficient Deliverying Video Surveillance Service to Moving Guard for Smart Home

PubMed Central

Gualotuña, Tatiana; Fonseca C., Efraín R.; Rivadeneira, Andrés

2018-01-01

Low-cost video surveillance systems are attractive for Smart Home applications (especially in emerging economies). Those systems use the flexibility of the Internet of Things to operate the video camera only when an intrusion is detected. We are the only ones that focus on the design of protocols based on intelligent agents to communicate the video of an intrusion in real time to the guards by wireless or mobile networks. The goal is to communicate, in real time, the video to the guards who can be moving towards the smart home. However, this communication suffers from sporadic disruptions that difficults the control and drastically reduces user satisfaction and operativity of the system. In a novel way, we have designed a generic software architecture based on design patterns that can be adapted to any hardware in a simple way. The implanted hardware is of very low economic cost; the software frameworks are free. In the experimental tests we have shown that it is possible to communicate to the moving guard, intrusion notifications (by e-mail and by instant messaging), and the first video frames in less than 20 s. In addition, we automatically recovered the frames of video lost in the disruptions in a transparent way to the user, we supported vertical handover processes and we could save energy of the smartphone's battery. However, the most important thing was that the high satisfaction of the people who have used the system. PMID:29494551

Study on Enhanceing Mechanisim and Policy on Energy Efficiency of Electrical Motor System in China

NASA Astrophysics Data System (ADS)

Liu, Ren; Zhao, Yuejin; Liu, Meng; Chen, Lili; Yang, Ming

2017-12-01

Motor is a kind of terminal energy-consumption equipment with the maximum power consumption in China every year; compared with international advanced level, the technical innovation of motor equipment, speed regulating system, drive system and automatic intelligent control technique in China still lag behind relatively; the standard technical service support system of motor system is not complete, the energy conserving transformation mode needs to be innovated, and the market development mechanism of motor industry is not perfect, etc. This paper analyzes the promotion mechanism and policy on energy efficiency of the motor system in China in recent years, studies the demonstration cases of successful promotion of high-efficiency motor, standard labeling, financial finance and tax policy, and puts forward suggestions on promotion of high-efficiency motor in China.

Efficient, Glucose Responsive, and Islet-Specific Transgene Expression by a Modified Rat Insulin Promoter

PubMed Central

Chai, Renjie; Chen, Shuyuan; Ding, Jiahuan; Grayburn, Paul A

2009-01-01

This study was done to improve efficiency and islet specificity of the rat insulin promoter (RIP). Various rat insulin promoter lengths were prepared and tested in vitro to drive luciferase reporter gene expression in INS1-cells, alpha-cells, acinar cells, ductal cells, and fibroblasts. The CMV promoter was used as a positive control. In addition, the DsRed reporter gene was administered in vivo to rat pancreas by ultrasound-targeted microbubble destruction (UTMD). Confocal microscopy was used to detect the presence and distribution of DsRed within the pancreas after UTMD. A modified RIP3.1 promoter, which includes portions of the insulin gene after its transcription start site is 5-fold more active in INS-1 cells than the full length RIP promoter or the CMV promoter. RIP3.1 is regulated by glucose level and various islet transcription factors in vitro, and exhibits activity in alpha-cells, but not exocrine cells. In vivo delivery of RIP3.1-DsRed resulted in expression of DsRed protein in beta-cells, and to a lesser extent alpha cells under normal glucose conditions. No DsRed signal was present in exocrine pancreas under RIP3.1. A modified rat insulin promoter, RIP3.1, efficiently and specifically directs gene expression to endocrine pancreas. PMID:19727136

Staff perceptions of best practice for information transfer about multitrauma patients on discharge from the emergency department: a focus group study.

PubMed

Calleja, Pauline; Aitken, Leanne; Cooke, Marie

2016-10-01

To understand: (1) staff perceptions of best practice for information transfer for multitrauma patients on discharge from the emergency department; (2) what information should be conveyed at transfer and (3) how information is transferred. Information transfer for multitrauma patients is an integral factor for continuity of care, safety, quality assurance and patient outcomes; however, this has not been the focus of previous studies. This was a qualitative study using focus group interviews. Data were collected during focus group interviews across five clinical areas. Themes were derived from the data with consensus from three data coders. Purposive sampling was used and included staff caring for trauma patients during patient transition out of the emergency department. Participants were representatives of the emergency department, perioperative care, intensive care unit, high dependency care unit and the trauma service unit. Twenty-six registered nurses and two medical officers participated. Five focus group interviews were held. Themes emerged from the data including 'Variability', 'Continuity' and 'Putting the pieces together'. The first three themes were all influenced by the fourth theme of 'Values/Context'. Considered together these themes influenced staff perception of the quality of information transfer for multitrauma patients on discharge from the emergency department. Staff perceived best practice for information transfer to be clear, concise, relevant documentation that travelled with the patient and interactive communication at handover that adhered to agreed principles and a minimum data set specific to trauma patients. Clinicians involved in handover need to actively listen, avoiding 'doing' at the same time, be aware of essential questions to ask about the patient. An agreed expectation between different clinical areas needs to exist about information transfer to reduce variability. The minimum data required to provide ongoing safe care for multitrauma patients are identified. © 2016 John Wiley & Sons Ltd.

A Baculovirus Immediate-Early Gene, ie1, Promoter Drives Efficient Expression of a Transgene in Both Drosophila melanogaster and Bombyx mori

PubMed Central

Masumoto, Mika; Ohde, Takahiro; Shiomi, Kunihiro; Yaginuma, Toshinobu; Niimi, Teruyuki

2012-01-01

Many promoters have been used to drive expression of heterologous transgenes in insects. One major obstacle in the study of non-model insects is the dearth of useful promoters for analysis of gene function. Here, we investigated whether the promoter of the immediate-early gene, ie1, from the Bombyx mori nucleopolyhedrovirus (BmNPV) could be used to drive efficient transgene expression in a wide variety of insects. We used a piggyBac-based vector with a 3xP3-DsRed transformation marker to generate a reporter construct; this construct was used to determine the expression patterns driven by the BmNPV ie1 promoter; we performed a detailed investigation of the promoter in transgene expression pattern in Drosophila melanogaster and in B. mori. Drosophila and Bombyx belong to different insect orders (Diptera and Lepidoptera, respectively); however, and to our surprise, ie1 promoter-driven expression was evident in several tissues (e.g., prothoracic gland, midgut, and tracheole) in both insects. Furthermore, in both species, the ie1 promoter drove expression of the reporter gene from a relatively early embryonic stage, and strong ubiquitous ie1 promoter-driven expression continued throughout the larval, pupal, and adult stages by surface observation. Therefore, we suggest that the ie1 promoter can be used as an efficient expression driver in a diverse range of insect species. PMID:23152896

75 FR 50032 - Self-Regulatory Organizations; The Depository Trust Company; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... Change To Promote Efficiencies Within the Legal Notice System August 10, 2010. Pursuant to Section 19(b... promotes efficiencies within the Legal Notice System (``LENS''). II. Self-Regulatory Organization's... distribution of legal notices. At that time, notices were made available through an electronic format through...

21 CFR 558.248 - Erythromycin thiocyanate.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18.5 Chickens; growth promotion and feed efficiency ,061623 (ii) 9.25 to 18.5 Turkeys; growth promotion and feed efficiency For turkeys not over 12 weeks of age ,061623 (iii) 9.25 to 64.75 Swine...; withdraw 24 h before slaughter 3. Turkeys; as an aid in the prevention of chronic respiratory disease...

21 CFR 558.248 - Erythromycin thiocyanate.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18.5 Chickens; growth promotion and feed efficiency ,061623 (ii) 9.25 to 18.5 Turkeys; growth promotion and feed efficiency For turkeys not over 12 weeks of age ,061623 (iii) 9.25 to 64.75 Swine...; withdraw 24 h before slaughter 3. Turkeys; as an aid in the prevention of chronic respiratory disease...

21 CFR 558.248 - Erythromycin.

Code of Federal Regulations, 2014 CFR

2014-04-01

...; growth promotion and feed efficiency ,061623 (ii) 9.25 to 18.5 Turkeys; growth promotion and feed efficiency For turkeys not over 12 weeks of age ,061623 (iii) 9.25 to 64.75 Swine; increase in weight gain... before slaughter 3. Turkeys; as an aid in the prevention of chronic respiratory disease during periods of...

76 FR 11737 - Fisheries of the Northeastern United States; Monkfish; Amendment 5

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

... proposed rule also proposes three management measures in Amendment 5 to promote efficiency and reduce waste: Automatic days-at- sea (DAS) adjustment for trip limit overages; authorization to land monkfish heads; and... intended to promote efficiency and reduce waste in the monkfish fishery. First, a measure is being proposed...

Can cooperative behaviors promote evacuation efficiency?

NASA Astrophysics Data System (ADS)

Cheng, Yuan; Zheng, Xiaoping

2018-02-01

This study aims to get insight into the question whether cooperative behaviors can promote the evacuation efficiency during an evacuation process. In this work, cooperative behaviors and evacuation efficiency have been examined in detail by using a cellular automata model with behavioral extension. The simulation results show that moderate cooperative behaviors can result in the highest evacuation efficiency. It is found that in a mixture of cooperative and competitive individuals, more cooperative people will lead to relatively high evacuation efficiency, and the larger subgroup will play a leading role. This work can also provide some new insights for the study of cooperative behaviors and evacuation efficiency which can be a scientific decision-making basis for emergency response involving large-scale crowd evacuation in emergencies.

Flexbus — an attractive technical solution for small missions

NASA Astrophysics Data System (ADS)

Settelmeyer, Eckard; Lampen, Martin; Hartmann, Ralf; Lippner, Gerhard

1996-11-01

Responding to the demand for a 'faster, cheaper, better' implementation of space related services, Domier Satellitensysteme GmbH has established and exercised an approach for the development and production of satellites and the corresponding ground equipment for small missions, referred to as Flexbus. It allows to support space service customers starting from mission engineering via design, development and manufacturing of the necessary hardware, the launch service and ending with the hand-over of the operational system. Flexbus harmonises a modular component concept with a sound design and development approach, as a whole providing the means to offer high quality products in a fairly short time and for competitive pricing. This paper will outline the major features of the Flexbus approach and describe application examples.

Elexbus — An attractive technical solution for small mission opportunities

NASA Astrophysics Data System (ADS)

Seltelmeyer, Eckard; Lampen, Martin; Hartmann, Ralf; Lippncr, Gerhard

Responding to the demand for a 'faster, cheaper, better' implementation of space related services. Dornier Satellitensysteme GmbH has established and exercised an approach for the development and production of satellites and the corresponding ground equipment for small missions, referred to as Flexbus. It allows to support space service customers starting from mission engineering via design, development and manufacturing of the necessary hardware, the launch service and ending with the hand-over of the operational system. Flexbus harmonises a modular component concept with a sound design and development approach, as a whole providing the means to offer high quality products in a fairly short time and for competitive pricing. This paper will outline the major features of the Flexbus approach and describe application examples.

KSC-2009-2301

NASA Image and Video Library

2009-03-25

CAPE CANAVERAL, Fla. – NASA's Kennedy Space Center management host a ceremony near Launch Pad 39B to mark the handover of Mobile Launcher Platform-1 (behind them) from NASA's Space Shuttle Program to the Constellation Program for the Ares I-X flight test targeted for this summer. Seated are (left) Shuttle Launch Director Mike Leinbach and (right) Pepper E. Phillips, director of the Constellation Project Office, and Brett Raulerson, manager of MLP Operations with United Space Alliance. At the podium is Rita Willcoxon, director of Launch Vehicle Processing at Kennedy. Constructed in 1964, the mobile launchers used in Apollo/Saturn operations were modified for use in shuttle operations. With cranes, umbilical towers and swing arms removed, the mobile launchers were renamed Mobile Launcher Platforms, or MLPs. Photo credit: NASA/Kim Shiflett

Document handover of ISS Flight Control room to new Flight Control Room in old MCC

NASA Image and Video Library

2006-10-06

JSC2006-E-43860 (6 Oct. 2006)--- International Space Station flight controllers have this area as their new home with increased technical capabilities, more workspace and a long, distinguished history. The newly updated facility is just down the hall from its predecessor at NASA's Johnson Space Center, Houston. Known as Flight Control Room 1, it was first used to control a space flight 38 years ago, the mission of Apollo 7 launched Oct. 11, 1968. It was one of two control rooms for NASA's manned missions. The room it replaces in its new ISS role, designated the Blue Flight Control Room, had been in operation since the first station component was launched in 1998.

The JCMT as operated by the East Asian Observatory: a brief (but thrilling) history

NASA Astrophysics Data System (ADS)

Dempsey, Jessica T.; Ho, Paul T. P.; Walther, Craig; Friberg, Per; Bell, Graham S.; Parsons, Harriet; Chen, Ming-Tang

2016-07-01

The newly formed East Asian Observatory assumed operations of the James Clerk Maxwell Telescope in March of 2015. In just three weeks, the facility needed to run up completely mothballed observatory operations, introduce the telescope to a vast new scientist base with no familiarity with the facility, and create a non-existent science program. The handover to the EAO has since been a succession of challenging time-lines, and nearly unique problems requiring novel solutions. The results, however, have been spectacular, with subscription rates at unprecedented levels, a new series of Large Programs underway, as well as an exciting Future Instrumentation Project that together promises to keep JCMT at the forefront of wide-field submillimeter astronomy for the next decade.

[The national Dutch Institute for Healthcare Improvement guidelines 'Preoperative trajectory': the essentials].

PubMed

Wolff, André P; Boermeester, Marja; Janssen, Ingrid; Pols, Margreet; Damen, Johan

2010-01-01

In view of the shortcomings of the organisation of the perioperative process that have been ascertained by the Dutch Health Inspectorate (IGZ), the Inspectorate has requested hospitals and care professionals to implement measures to improve this situation. In response to the IGZ's first report, the Dutch Institute for Healthcare Improvement (CBO) has developed the national, multiprofessional guidelines entitled 'Preoperative Trajectory' which were published in January 2010. Implementation of these guidelines should improve communication between professionals and lead to standardization and transparency of the preoperative patient care process, with uniform handovers and clear responsibilities. These guidelines are the first to provide recommendations at process of care level which are intended to increase patient safety and reduce the risk of damage to patients.

Poly(ADP-ribose) polymerase 1 escorts XPC to UV-induced DNA lesions during nucleotide excision repair

PubMed Central

Robu, Mihaela; Shah, Rashmi G.; Purohit, Nupur K.; Zhou, Pengbo; Naegeli, Hanspeter

2017-01-01

Xeroderma pigmentosum C (XPC) protein initiates the global genomic subpathway of nucleotide excision repair (GG-NER) for removal of UV-induced direct photolesions from genomic DNA. The XPC has an inherent capacity to identify and stabilize at the DNA lesion sites, and this function is facilitated in the genomic context by UV-damaged DNA-binding protein 2 (DDB2), which is part of a multiprotein UV–DDB ubiquitin ligase complex. The nuclear enzyme poly(ADP-ribose) polymerase 1 (PARP1) has been shown to facilitate the lesion recognition step of GG-NER via its interaction with DDB2 at the lesion site. Here, we show that PARP1 plays an additional DDB2-independent direct role in recruitment and stabilization of XPC at the UV-induced DNA lesions to promote GG-NER. It forms a stable complex with XPC in the nucleoplasm under steady-state conditions before irradiation and rapidly escorts it to the damaged DNA after UV irradiation in a DDB2-independent manner. The catalytic activity of PARP1 is not required for the initial complex formation with XPC in the nucleoplasm but it enhances the recruitment of XPC to the DNA lesion site after irradiation. Using purified proteins, we also show that the PARP1–XPC complex facilitates the handover of XPC to the UV-lesion site in the presence of the UV–DDB ligase complex. Thus, the lesion search function of XPC in the genomic context is controlled by XPC itself, DDB2, and PARP1. Our results reveal a paradigm that the known interaction of many proteins with PARP1 under steady-state conditions could have functional significance for these proteins. PMID:28760956

Poly(ADP-ribose) polymerase 1 escorts XPC to UV-induced DNA lesions during nucleotide excision repair.

PubMed

Robu, Mihaela; Shah, Rashmi G; Purohit, Nupur K; Zhou, Pengbo; Naegeli, Hanspeter; Shah, Girish M

2017-08-15

Xeroderma pigmentosum C (XPC) protein initiates the global genomic subpathway of nucleotide excision repair (GG-NER) for removal of UV-induced direct photolesions from genomic DNA. The XPC has an inherent capacity to identify and stabilize at the DNA lesion sites, and this function is facilitated in the genomic context by UV-damaged DNA-binding protein 2 (DDB2), which is part of a multiprotein UV-DDB ubiquitin ligase complex. The nuclear enzyme poly(ADP-ribose) polymerase 1 (PARP1) has been shown to facilitate the lesion recognition step of GG-NER via its interaction with DDB2 at the lesion site. Here, we show that PARP1 plays an additional DDB2-independent direct role in recruitment and stabilization of XPC at the UV-induced DNA lesions to promote GG-NER. It forms a stable complex with XPC in the nucleoplasm under steady-state conditions before irradiation and rapidly escorts it to the damaged DNA after UV irradiation in a DDB2-independent manner. The catalytic activity of PARP1 is not required for the initial complex formation with XPC in the nucleoplasm but it enhances the recruitment of XPC to the DNA lesion site after irradiation. Using purified proteins, we also show that the PARP1-XPC complex facilitates the handover of XPC to the UV-lesion site in the presence of the UV-DDB ligase complex. Thus, the lesion search function of XPC in the genomic context is controlled by XPC itself, DDB2, and PARP1. Our results reveal a paradigm that the known interaction of many proteins with PARP1 under steady-state conditions could have functional significance for these proteins.

Crisis averted: How consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis.

PubMed

Evangelista, Eloisa; Lee, Stuart; Gallagher, Angela; Peterson, Violeta; James, Jo; Warren, Narelle; Henderson, Kathryn; Keppich-Arnold, Sandra; Cornelius, Luke; Deveny, Elizabeth

2016-08-01

When mental health crisis situations in the community are poorly handled, it can result in physical and emotional injuries. The purpose of this study was to ascertain the experiences and opinions of consumers about the way police and mental health services worked together, specifically via the Alfred Police and Clinical Early Response (A-PACER) model, to assist people experiencing a mental health crisis. Semi-structured in-depth interviews were conducted with 12 mental health consumers who had direct contact with the A-PACER team between June 2013 and March 2015. The study highlighted that people who encountered the A-PACER team generally valued and saw the benefit of a joint police-mental health clinician team response to a mental health crisis situation in the community. In understanding what worked well in how the A-PACER team operated, consumers perspectives can be summarized into five themes: communication and de-escalation, persistence of the A-PACER team, providing a quick response and working well under pressure, handover of information, and A-PACER helped consumers achieve a preferred outcome. All consumers acknowledged the complementary roles of the police officer and mental health clinician, and described the A-PACER team's supportive approach as critical in gaining their trust, engagement and in de-escalating the crises. Further education and training for police officers on how to respond to people with a mental illness, increased provision of follow-up support to promote rehabilitation and prevent future crises, and measures to reduce public scrutiny for the consumer when police responded, were proposed opportunities for improvement. © 2016 Australian College of Mental Health Nurses Inc.

Championing mental health at work: emerging practice from innovative projects in the UK.

PubMed

Robinson, Mark; Tilford, Sylvia; Branney, Peter; Kinsella, Karina

2014-09-01

This paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based 'business champions' to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment. First, the paper identifies key policy drivers for interventions around mental health and employment, summarizes evidence review findings and describes the range of activities within three projects. The role of the 'business champion' emerged as crucial to these interventions and therefore, secondly, the paper examines how champions' potential to make a difference depends on the work settings and their existing roles, skills and motivation. In particular, champions can proactively coordinate project strands, embed the project, encourage participation, raise awareness, encourage changes to work procedures and strengthen networks and partnerships. The paper explores how these processes can facilitate changes in organizational culture. Challenges of implementation are identified, including achieving leverage with senior management, handover of ownership to fellow employees, assessing impact and sustainability. Finally, implications for policy and practice are discussed, and conclusions drawn concerning the roles of champions within different workplace environments. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Isolation and functional characterization of TIF-IB, a factor that confers promoter specificity to mouse RNA polymerase I.

PubMed

Schnapp, A; Clos, J; Hädelt, W; Schreck, R; Cvekl, A; Grummt, I

1990-03-25

The murine ribosomal gene promoter contains two cis-acting control elements which operate in concert to promote efficient and accurate transcription initiation by RNA polymerase I. The start site proximal core element which is indispensable for promoter recognition by RNA polymerase I (pol I) encompasses sequences from position -39 to -1. An upstream control element (UCE) which is located between nucleotides -142 and -112 stimulates the efficiency of transcription initiation both in vivo and in vitro. Here we report the isolation and functional characterization of a specific rDNA binding protein, the transcription initiation factor TIF-IB, which specifically interacts with the core region of the mouse ribosomal RNA gene promoter. Highly purified TIF-IB complements transcriptional activity in the presence of two other essential initiation factors TIF-IA and TIF-IC. We demonstrate that the binding efficiency of purified TIF-IB to the core promoter is strongly enhanced by the presence in cis of the UCE. This positive effect of upstream sequences on TIF-IB binding is observed throughout the purification procedure suggesting that the synergistic action of the two distant promoter elements is not mediated by a protein different from TIF-IB. Increasing the distance between both control elements still facilitates stable factor binding but eliminates transcriptional activation. The results demonstrate that TIF-IB binding to the rDNA promoter is an essential early step in the assembly of a functional transcription initiation complex. The subsequent interaction of TIF-IB with other auxiliary transcription initiation factors, however, requires the correct spacing between the UCE and the core promoter element.

Proposing a Master's Programme on Participatory Integrated Assessment of Energy Systems to Promote Energy Access and Energy Efficiency in Southern Africa

ERIC Educational Resources Information Center

Kiravu, Cheddi; Diaz-Maurin, François; Giampietro, Mario; Brent, Alan C.; Bukkens, Sandra G.F.; Chiguvare, Zivayi; Gasennelwe-Jeffrey, Mandu A.; Gope, Gideon; Kovacic, Zora; Magole, Lapologang; Musango, Josephine Kaviti; Ruiz-Rivas Hernando, Ulpiano; Smit, Suzanne; Vázquez Barquero, Antonio; Yunta Mezquita, Felipe

2018-01-01

Purpose: This paper aims to present a new master's programme for promoting energy access and energy efficiency in Southern Africa. Design/methodology/approach: A transdisciplinary approach called "participatory integrated assessment of energy systems" (PARTICIPIA) was used for the development of the curriculum. This approach is based on…

Plant growth-promoting bacteria as inoculants in agricultural soils

PubMed Central

de Souza, Rocheli; Ambrosini, Adriana; Passaglia, Luciane M.P.

2015-01-01

Abstract Plant-microbe interactions in the rhizosphere are the determinants of plant health, productivity and soil fertility. Plant growth-promoting bacteria (PGPB) are bacteria that can enhance plant growth and protect plants from disease and abiotic stresses through a wide variety of mechanisms; those that establish close associations with plants, such as the endophytes, could be more successful in plant growth promotion. Several important bacterial characteristics, such as biological nitrogen fixation, phosphate solubilization, ACC deaminase activity, and production of siderophores and phytohormones, can be assessed as plant growth promotion (PGP) traits. Bacterial inoculants can contribute to increase agronomic efficiency by reducing production costs and environmental pollution, once the use of chemical fertilizers can be reduced or eliminated if the inoculants are efficient. For bacterial inoculants to obtain success in improving plant growth and productivity, several processes involved can influence the efficiency of inoculation, as for example the exudation by plant roots, the bacterial colonization in the roots, and soil health. This review presents an overview of the importance of soil-plant-microbe interactions to the development of efficient inoculants, once PGPB are extensively studied microorganisms, representing a very diverse group of easily accessible beneficial bacteria. PMID:26537605

Advanced purification of petroleum refinery wastewater by catalytic vacuum distillation.

PubMed

Yan, Long; Ma, Hongzhu; Wang, Bo; Mao, Wei; Chen, Yashao

2010-06-15

In our work, a new process, catalytic vacuum distillation (CVD) was utilized for purification of petroleum refinery wastewater that was characteristic of high chemical oxygen demand (COD) and salinity. Moreover, various common promoters, like FeCl(3), kaolin, H(2)SO(4) and NaOH were investigated to improve the purification efficiency of CVD. Here, the purification efficiency was estimated by COD testing, electrolytic conductivity, UV-vis spectrum, gas chromatography-mass spectrometry (GC-MS) and pH value. The results showed that NaOH promoted CVD displayed higher efficiency in purification of refinery wastewater than other systems, where the pellucid effluents with low salinity and high COD removal efficiency (99%) were obtained after treatment, and the corresponding pH values of effluents varied from 7 to 9. Furthermore, environment estimation was also tested and the results showed that the effluent had no influence on plant growth. Thus, based on satisfied removal efficiency of COD and salinity achieved simultaneously, NaOH promoted CVD process is an effective approach to purify petroleum refinery wastewater. Copyright 2010 Elsevier B.V. All rights reserved.

Efficient expression of green fluorescent protein (GFP) mediated by a chimeric promoter in Chlamydomonas reinhardtii

NASA Astrophysics Data System (ADS)

Wu, Jinxia; Hu, Zhangli; Wang, Chaogang; Li, Shuangfei; Lei, Anping

2008-08-01

To improve the expression efficiency of exogenous genes in Chlamydomonas reinhardtii, a high efficient expression vector was constructed. Green fluorescent protein (GFP) was expressed in C. reinhardtii under the control of promoters: RBCS2 and HSP70A-RBCS2. Efficiency of transformation and expression were compared between two transgenic algae: RBCS2 mediated strain Tran-I and HSP70A-RBCS2 mediated strain Tran-II. Results show that HSP70A-RBCS2 could improve greatly the transformation efficiency by approximately eightfold of RBCS2, and the expression efficiency of GFP in Tran-II was at least double of that in Tran-I. In addition, a threefold increase of GFP in Tran-II was induced by heat shock at 40°C. All of the results demonstrated that HSP70A-RBCS2 was more efficient than RBCS2 in expressing exogenous gene in C. reinhardtii.

Clinician-Driven Design of VitalPAD–An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit

PubMed Central

Flohr, Luisa; Beaudry, Shaylene; Johnson, K Taneille; West, Nicholas; Burns, Catherine M; Ansermino, J Mark; Dumont, Guy A; Wensley, David; Skippen, Peter

2018-01-01

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings. PMID:29552425

Introduction of a junior doctors' handbook: an essential guide for new doctors

PubMed Central

Ross, Daniella; Petrie, Claire; Tully, Vicki

2016-01-01

The transition period for new junior doctors is a daunting and challenging time, as vast amounts of information specific to each hospital, ward, and job must be learnt while maintaining patient care standards.[1] In NHS Tayside, Scotland, tips and guidance for each job are informally handed over from previous junior doctors to the next, resulting in an unreliable and unsustainable handover of information. Time must then be spent by new doctors learning the intricacies and practicalities of their new job, rather than spending time focusing on patient care. Our aim was to improve this transition period for new junior doctors to NHS Tayside through the creation and implementation of a junior doctors' handbook, which would provide information and practical advice on day to day life as a junior doctor. We hoped to implement this project by August 2015 to coincide with the arrival of these new doctors to NHS Tayside. Through repeat PDSA cycles we created a sustainable and reliable junior doctors' handbook, containing a centralised hub of information for doctors that was accessible through our health board's website. The junior doctors' handbook has been a highly beneficial resource that has been praised for its detailed information on all aspects of day to day life for doctors in NHS Tayside. Feedback also demonstrated that doctors felt the junior doctors' handbook had improved their efficiency. Our hope is that this project can continue to be developed within our hospital, but also to be used as an idea outside our health board to improve the transition period for new doctors on a wider scale. PMID:26893891

Clinician-Driven Design of VitalPAD-An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit.

PubMed

Flohr, Luisa; Beaudry, Shaylene; Johnson, K Taneille; West, Nicholas; Burns, Catherine M; Ansermino, J Mark; Dumont, Guy A; Wensley, David; Skippen, Peter; Gorges, Matthias

2018-01-01

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings.

Integrating the Technology Acceptance Model and Diffusion of Innovation: Factors Promoting Interest in Energy Efficient and Renewable Energy Technologies at Military Installations, Federal Facilities and Land-Grant Universities

ERIC Educational Resources Information Center

Dudik, C. E. Jane

2017-01-01

Energy managers are tasked with identifying energy savings opportunities and promoting energy independence. Energy-efficient (EE) and renewable-energy (RE) technology demonstrations enable energy managers to evaluate new energy technologies and adopt those that appear most effective. This study examined whether energy technology demonstrations…

The production of consuming less: Energy efficiency, climate change, and light bulbs in North Carolina

NASA Astrophysics Data System (ADS)

Thoyre, Autumn

In this research, I have analyzed the production of consuming less electricity through a case study of promotions of compact fluorescent light bulbs (CFLs). I focused on the CFL because it has been heavily promoted by environmentalists and electricity companies as a key tool for solving climate change, yet such promotions appear counter-intuitive. The magnitude of CFL promotions by environmentalists is surprising because CFLs can only impact less than 1% of U.S. greenhouse gas emissions. CFL promotions by electricity providers are surprising given such companies' normal incentives to sell more of their product. I used political ecological and symbolic interactionist theories, qualitative methods of data collection (including interviews, participant-observation, texts, and images), and a grounded theory analysis to understand this case. My findings suggest that, far from being a self-evident technical entity, energy efficiency is produced as an idea, a part of identities, a resource, and a source of value through social, political, and economic processes. These processes include identity formation and subjectification; gender-coded household labor; and corporate appropriation of household value resulting from environmental governance. I show how environmentalists use CFLs to make and claim neoliberal identities, proposing the concept of green neoliberal identity work as a mechanism through which neoliberal ideologies are translated into practices. I analyze how using this seemingly easy energy efficient technology constitutes labor that is gendered in ways that reflect and reproduce inequalities. I show how electricity companies have used environmental governance to valorize and appropriate home energy efficiency as an accumulation strategy. I conclude by discussing the symbolic power of CFLs, proposing a theory of green obsolescence, and framing the production of energy efficiency as a global production network. I found that promoting energy efficiency involves consuming less energy by consuming more technologies. This research contributes to understandings of how environmentalists become laboring subjects in an era of neoliberalism and how energy companies are responding to the threat of climate change by turning mitigation into an opportunity for profit.

The rise of homosexuality and the dawn of communism in Hong Kong film: 1993-1998.

PubMed

Grossman, A

2000-01-01

I have designed this essay as a general overview of the self-evident trend towards queer subject matter in the past decade in Hong Kong film, a trend that not only coincides historically with the 1997 handover to the Mainland but also frequently comes equipped with parent-child relationships that can be read as allegories for the colony's future as the "child" to its mother country. Queerness in HK films has both alternated between and combined indigenous forms of queerness and the imported Western variety; by charting courses through internationalized concepts of homosexuality, HK films have posited their queerness not only as an existential allegory of (post)colonialism but also as a claim (or hope) for a utopian sexuality cum utopian international politics.

Public open space for disaster mitigation in Tangerang housing estates

NASA Astrophysics Data System (ADS)

Winandari, M. I. R.

2018-01-01

Public open space in housing estates plays an important role particularly in disaster mitigation. In some housing, there are indications of shape and use of space changes post-handover to local government. The aim of this study is to explore the relationship between public open space condition and management related to disaster mitigation in Tangerang housing estates. Multiple case study method is used to analyse of 2 housing cases. Aspects of access and boundaries were used to evaluate the cases. The results showed that gated community housing type should have more than 1 access to facilitate evacuation by considering the farthest unit to the housing gate. This is necessary to provide open spaces that are easily accessible from all units as the first evacuation site during and post disaster.

Document handover of ISS Flight Control room to new Flight Control Room in old MCC

NASA Image and Video Library

2006-10-06

JSC2006-E-43863 (6 Oct. 2006)--- International Space Station flight controllers have this area as their new home with increased technical capabilities, more workspace and a long, distinguished history. The newly updated facility is just down the hall from its predecessor at NASA's Johnson Space Center, Houston. This view is toward the rear of the "new" room. Known as Flight Control Room 1, it was first used to control a space flight 38 years ago, the mission of Apollo 7 launched Oct. 11, 1968. It was one of two control rooms for NASA's manned missions. The room it replaces in its new ISS role, designated the Blue Flight Control Room, had been in operation since the first station component was launched in 1998.

A new system for digital image acquisition, storage and presentation in an accident and emergency department

PubMed Central

Clegg, G; Roebuck, S; Steedman, D

2001-01-01

Objectives—To develop a computer based storage system for clinical images—radiographs, photographs, ECGs, text—for use in teaching, training, reference and research within an accident and emergency (A&E) department. Exploration of methods to access and utilise the data stored in the archive. Methods—Implementation of a digital image archive using flatbed scanner and digital camera as capture devices. A sophisticated coding system based on ICD 10. Storage via an "intelligent" custom interface. Results—A practical solution to the problems of clinical image storage for teaching purposes. Conclusions—We have successfully developed a digital image capture and storage system, which provides an excellent teaching facility for a busy A&E department. We have revolutionised the practice of the "hand-over meeting". PMID:11435357

Towards the Engineering of Dependable P2P-Based Network Control — The Case of Timely Routing Control Messages

NASA Astrophysics Data System (ADS)

Tutschku, Kurt; Nakao, Akihiro

This paper introduces a methodology for engineering best-effort P2P algorithms into dependable P2P-based network control mechanism. The proposed method is built upon an iterative approach consisting of improving the original P2P algorithm by appropriate mechanisms and of thorough performance assessment with respect to dependability measures. The potential of the methodology is outlined by the example of timely routing control for vertical handover in B3G wireless networks. In detail, the well-known Pastry and CAN algorithms are enhanced to include locality. By showing how to combine algorithmic enhancements with performance indicators, this case study paves the way for future engineering of dependable network control mechanisms through P2P algorithms.

Ribozyme Mediated gRNA Generation for In Vitro and In Vivo CRISPR/Cas9 Mutagenesis.

PubMed

Lee, Raymond Teck Ho; Ng, Ashley Shu Mei; Ingham, Philip W

2016-01-01

CRISPR/Cas9 is now regularly used for targeted mutagenesis in a wide variety of systems. Here we report the use of ribozymes for the generation of gRNAs both in vitro and in zebrafish embryos. We show that incorporation of ribozymes increases the types of promoters and number of target sites available for mutagenesis without compromising mutagenesis efficiency. We have tested this by comparing the efficiency of mutagenesis of gRNA constructs with and without ribozymes and also generated a transgenic zebrafish expressing gRNA using a heat shock promoter (RNA polymerase II-dependent promoter) that was able to induce mutagenesis of its target. Our method provides a streamlined approach to test gRNA efficiency as well as increasing the versatility of conditional gene knock out in zebrafish.

48 CFR 23.703 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE...) Implement cost-effective contracting preference programs promoting energy-efficiency, water conservation... energy-efficiency and water conservation. (3) Eliminate or reduce the generation of hazardous waste and...

48 CFR 23.703 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE...) Implement cost-effective contracting preference programs promoting energy-efficiency, water conservation... energy-efficiency and water conservation. (3) Eliminate or reduce the generation of hazardous waste and...

48 CFR 23.703 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE...) Implement cost-effective contracting preference programs promoting energy-efficiency, water conservation... energy-efficiency and water conservation. (3) Eliminate or reduce the generation of hazardous waste and...

48 CFR 23.703 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE...) Implement cost-effective contracting preference programs promoting energy-efficiency, water conservation... energy-efficiency and water conservation. (3) Eliminate or reduce the generation of hazardous waste and...

The construction of a synthetic Escherichia coli trp promoter and its use in the expression of a synthetic interferon gene.

PubMed Central

Windass, J D; Newton, C R; De Maeyer-Guignard, J; Moore, V E; Markham, A F; Edge, M D

1982-01-01

An 82 base pair DNA fragment has been synthesised which contains the E. coli trp promoter and operator sequences and also encodes the first Shine Dalgarno sequence of the trp operon. This DNA fragment is flanked by EcoRI and ClaI/TaqI cohesive ends and is thus easy to clone, transfer between vector systems and couple to genes to drive their expression. It has been cloned into plasmid pAT153, producing a convenient trp promoter vector. We have also joined the fragment to a synthetic IFN-alpha 1 gene, using synthetic oligonucleotides to generate a completely natural, highly efficient bacterial translation initiation signal on the promoter proximal side of the IFN gene. Plasmids carrying this construction enable E. coli cells to express IFN-alpha 1 almost constitutively and with significantly higher efficiency than from a lacUV5 promoter based system. Images PMID:6184675

Improved methods of AAV-mediated gene targeting for human cell lines using ribosome-skipping 2A peptide

PubMed Central

Karnan, Sivasundaram; Ota, Akinobu; Konishi, Yuko; Wahiduzzaman, Md; Hosokawa, Yoshitaka; Konishi, Hiroyuki

2016-01-01

The adeno-associated virus (AAV)-based targeting vector has been one of the tools commonly used for genome modification in human cell lines. It allows for relatively efficient gene targeting associated with 1–4-log higher ratios of homologous-to-random integration of targeting vectors (H/R ratios) than plasmid-based targeting vectors, without actively introducing DNA double-strand breaks. In this study, we sought to improve the efficiency of AAV-mediated gene targeting by introducing a 2A-based promoter-trap system into targeting constructs. We generated three distinct AAV-based targeting vectors carrying 2A for promoter trapping, each targeting a GFP-based reporter module incorporated into the genome, PIGA exon 6 or PIGA intron 5. The absolute gene targeting efficiencies and H/R ratios attained using these vectors were assessed in multiple human cell lines and compared with those attained using targeting vectors carrying internal ribosome entry site (IRES) for promoter trapping. We found that the use of 2A for promoter trapping increased absolute gene targeting efficiencies by 3.4–28-fold and H/R ratios by 2–5-fold compared to values obtained with IRES. In CRISPR-Cas9-assisted gene targeting using plasmid-based targeting vectors, the use of 2A did not enhance the H/R ratios but did upregulate the absolute gene targeting efficiencies compared to the use of IRES. PMID:26657635

Energy efficiency public service advertising campaign

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

Gibson-Grant, Amanda

The Advertising Council (“the Ad Council”) and The United States Department of Energy (DOE) created and launched a national public service advertising campaign designed to promote energy efficiency. The objective of the Energy Efficiency campaign was to redefine how consumers approach energy efficiency by showing that saving energy can save homeowners money.

5S rRNA Promoter for Guide RNA Expression Enabled Highly Efficient CRISPR/Cas9 Genome Editing in Aspergillus niger.

PubMed

Zheng, Xiaomei; Zheng, Ping; Zhang, Kun; Cairns, Timothy C; Meyer, Vera; Sun, Jibin; Ma, Yanhe

2018-04-30

The CRISPR/Cas9 system is a revolutionary genome editing tool. However, in eukaryotes, search and optimization of a suitable promoter for guide RNA expression is a significant technical challenge. Here we used the industrially important fungus, Aspergillus niger, to demonstrate that the 5S rRNA gene, which is both highly conserved and efficiently expressed in eukaryotes, can be used as a guide RNA promoter. The gene editing system was established with 100% rates of precision gene modifications among dozens of transformants using short (40-bp) homologous donor DNA. This system was also applicable for generation of designer chromosomes, as evidenced by deletion of a 48 kb gene cluster required for biosynthesis of the mycotoxin fumonisin B1. Moreover, this system also facilitated simultaneous mutagenesis of multiple genes in A. niger. We anticipate that the use of the 5S rRNA gene as guide RNA promoter can broadly be applied for engineering highly efficient eukaryotic CRISPR/Cas9 toolkits. Additionally, the system reported here will enable development of designer chromosomes in model and industrially important fungi.

A Mobility Management Using Follow-Me Cloud-Cloudlet in Fog-Computing-Based RANs for Smart Cities.

PubMed

Chen, Yuh-Shyan; Tsai, Yi-Ting

2018-02-06

Mobility management for supporting the location tracking and location-based service (LBS) is an important issue of smart city by providing the means for the smooth transportation of people and goods. The mobility is useful to contribute the innovation in both public and private transportation infrastructures for smart cities. With the assistance of edge/fog computing, this paper presents a fully new mobility management using the proposed follow-me cloud-cloudlet (FMCL) approach in fog-computing-based radio access networks (Fog-RANs) for smart cities. The proposed follow-me cloud-cloudlet approach is an integration strategy of follow-me cloud (FMC) and follow-me edge (FME) (or called cloudlet). A user equipment (UE) receives the data, transmitted from original cloud, into the original edge cloud before the handover operation. After the handover operation, an UE searches for a new cloud, called as a migrated cloud, and a new edge cloud, called as a migrated edge cloud near to UE, where the remaining data is migrated from the original cloud to the migrated cloud and all the remaining data are received in the new edge cloud. Existing FMC results do not have the property of the VM migration between cloudlets for the purpose of reducing the transmission latency, and existing FME results do not keep the property of the service migration between data centers for reducing the transmission latency. Our proposed FMCL approach can simultaneously keep the VM migration between cloudlets and service migration between data centers to significantly reduce the transmission latency. The new proposed mobility management using FMCL approach aims to reduce the total transmission time if some data packets are pre-scheduled and pre-stored into the cache of cloudlet if UE is switching from the previous Fog-RAN to the serving Fog-RAN. To illustrate the performance achievement, the mathematical analysis and simulation results are examined in terms of the total transmission time, the throughput, the probability of packet loss, and the number of control messages.

A Mobility Management Using Follow-Me Cloud-Cloudlet in Fog-Computing-Based RANs for Smart Cities

PubMed Central

Tsai, Yi-Ting

2018-01-01

Mobility management for supporting the location tracking and location-based service (LBS) is an important issue of smart city by providing the means for the smooth transportation of people and goods. The mobility is useful to contribute the innovation in both public and private transportation infrastructures for smart cities. With the assistance of edge/fog computing, this paper presents a fully new mobility management using the proposed follow-me cloud-cloudlet (FMCL) approach in fog-computing-based radio access networks (Fog-RANs) for smart cities. The proposed follow-me cloud-cloudlet approach is an integration strategy of follow-me cloud (FMC) and follow-me edge (FME) (or called cloudlet). A user equipment (UE) receives the data, transmitted from original cloud, into the original edge cloud before the handover operation. After the handover operation, an UE searches for a new cloud, called as a migrated cloud, and a new edge cloud, called as a migrated edge cloud near to UE, where the remaining data is migrated from the original cloud to the migrated cloud and all the remaining data are received in the new edge cloud. Existing FMC results do not have the property of the VM migration between cloudlets for the purpose of reducing the transmission latency, and existing FME results do not keep the property of the service migration between data centers for reducing the transmission latency. Our proposed FMCL approach can simultaneously keep the VM migration between cloudlets and service migration between data centers to significantly reduce the transmission latency. The new proposed mobility management using FMCL approach aims to reduce the total transmission time if some data packets are pre-scheduled and pre-stored into the cache of cloudlet if UE is switching from the previous Fog-RAN to the serving Fog-RAN. To illustrate the performance achievement, the mathematical analysis and simulation results are examined in terms of the total transmission time, the throughput, the probability of packet loss, and the number of control messages. PMID:29415510

Simulation Training Versus Real Time Console Training for New Flight Controllers

NASA Technical Reports Server (NTRS)

Heaton, Amanda

2010-01-01

For new flight controllers, the two main learning tools are simulations and real time console performance training. These benefit the new flight controllers in different ways and could possibly be improved. Simulations: a) Allow for mistakes without serious consequences. b) Lets new flight controllers learn the working style of other new flight controllers. c) Lets new flight controllers eventually begin to feel like they have mastered the sim world, so therefore they must be competent in the real time world too. Real time: a) Shows new flight controllers some of the unique problems that develop and have to be accounted for when dealing with certain payloads or systems. b) Lets new flight controllers experience handovers - gathering information from the previous shift on what the room needs to be aware of and what still needs to be done. c) Gives new flight controllers confidence that they can succeed in the position they are training for when they can solve real anomalies. How Sims could be improved and more like real-time ops for the ISS Operations Controller position: a) Operations Change Requests to review. b) Fewer anomalies (but still more than real time for practice). c) Payload Planning Manager Handover sheet for the E-1 and E-3 reviews. d) Flight note in system with at least one comment to verify for the E-1 and E-3 reviews How the real time console performance training could be improved for the ISS Operations Controller position: a) Schedule the new flight controller to be on console for four days but with a different certified person each day. This will force them to be the source of knowledge about every OCR in progress, everything that has happened in those few days, and every activity on the timeline. Constellation program flight controllers will have to learn entirely from simulations, thereby losing some of the elements that they will need to have experience with for real time ops. It may help them to practice real time console performance training in the International Space Station or Space Shuttle to gather some general anomaly resolution and day-to-day task management skills.

Research on the technical requirements standards of high efficiency precipitator in power industries for assessment

NASA Astrophysics Data System (ADS)

Jin, Huang; Ling, Lin; Jun, Guo; Jianguo, Li; Yongzhong, Wang

2017-11-01

Facing the increasingly severe situation of air pollution, China are now positively promoting the evaluation of high efficiency air pollution control equipments and the research of the relative national standards. This paper showed the significance and the effect of formulating the technical requirements of high efficiency precipitator equipments for assessment national standards in power industries as well as the research thoughts and principle of these standards. It introduce the qualitative and quantitative evaluation requirements of high efficiency precipitators using in power industries and the core technical content such as testing, calculating, evaluation methods and so on. The implementation of a series of national standards is in order to lead and promote the production and application of high efficiency precipitator equipments in the field of the prevention of air pollution in national power industries.

48 CFR 23.202 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Energy and Water Efficiency and Renewable Energy 23.202 Policy. The Government's policy is to acquire supplies and services that promote energy and water efficiency, advance the use of renewable...

Integration of promoters, inverted repeat sequences and proteomic data into a model for high silencing efficiency of coeliac disease related gliadins in bread wheat

PubMed Central

2013-01-01

Background Wheat gluten has unique nutritional and technological characteristics, but is also a major trigger of allergies and intolerances. One of the most severe diseases caused by gluten is coeliac disease. The peptides produced in the digestive tract by the incomplete digestion of gluten proteins trigger the disease. The majority of the epitopes responsible reside in the gliadin fraction of gluten. The location of the multiple gliadin genes in blocks has to date complicated their elimination by classical breeding techniques or by the use of biotechnological tools. As an approach to silence multiple gliadin genes we have produced 38 transgenic lines of bread wheat containing combinations of two endosperm-specific promoters and three different inverted repeat sequences to silence three fractions of gliadins by RNA interference. Results The effects of the RNA interference constructs on the content of the gluten proteins, total protein and starch, thousand seed weights and SDSS quality tests of flour were analyzed in these transgenic lines in two consecutive years. The characteristics of the inverted repeat sequences were the main factor that determined the efficiency of silencing. The promoter used had less influence on silencing, although a synergy in silencing efficiency was observed when the two promoters were used simultaneously. Genotype and the environment also influenced silencing efficiency. Conclusions We conclude that to obtain wheat lines with an optimum reduction of toxic gluten epitopes one needs to take into account the factors of inverted repeat sequences design, promoter choice and also the wheat background used. PMID:24044767

Effect of IAA on in vitro growth and colonization of Nostoc in plant roots

PubMed Central

Hussain, Anwar; Shah, Syed T.; Rahman, Hazir; Irshad, Muhammad; Iqbal, Amjad

2015-01-01

Nostoc is widely known for its ability to fix atmospheric nitrogen and the establishment of symbiotic relationship with a wide range of plants from various taxonomic groups. Several strains of Nostoc produce phytohormones that promote growth of its plant partners. Nostoc OS-1 was therefore selected for study because of the presence of putative ipdC gene that encodes a key enzyme to produce Indole-3-acetic acid (IAA). The results indicated that both cellular and released IAA was found high with increasing incubation time and reached to a peak value (i.e., 21 pmol mg-1ch-a) on the third week as determined by UPLC-ESI-MS/MS. Also the Nostoc OS-1 strain efficiently colonized the roots and promoted the growth of rice as well as wheat under axenic conditions and induced ipdC gene that suggested the possible involvement of IAA in these phenotypes. To confirm the impact of IAA on root colonization efficiency and plant promoting phenotypes of Nostoc OS-1, an ipdC knockout mutant was generated by homologous recombinant method. The amount of releasing IAA, in vitro growth, root colonization, and plant promoting efficiency of the ipdC knockout mutant was observed significantly lower than wild type strain under axenic conditions. Importantly, these phenotypes were restored to wild-type levels when the ipdC knockout mutant was complemented with wild type ipdC gene. These results together suggested that ipdC and/or synthesized IAA of Nostoc OS-1 is required for its efficient root colonization and plant promoting activity. PMID:25699072

Efficient Windows Collaborative

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

Nils Petermann

2010-02-28

The project goals covered both the residential and commercial windows markets and involved a range of audiences such as window manufacturers, builders, homeowners, design professionals, utilities, and public agencies. Essential goals included: (1) Creation of 'Master Toolkits' of information that integrate diverse tools, rating systems, and incentive programs, customized for key audiences such as window manufacturers, design professionals, and utility programs. (2) Delivery of education and outreach programs to multiple audiences through conference presentations, publication of articles for builders and other industry professionals, and targeted dissemination of efficient window curricula to professionals and students. (3) Design and implementation of mechanismsmore » to encourage and track sales of more efficient products through the existing Window Products Database as an incentive for manufacturers to improve products and participate in programs such as NFRC and ENERGY STAR. (4) Development of utility incentive programs to promote more efficient residential and commercial windows. Partnership with regional and local entities on the development of programs and customized information to move the market toward the highest performing products. An overarching project goal was to ensure that different audiences adopt and use the developed information, design and promotion tools and thus increase the market penetration of energy efficient fenestration products. In particular, a crucial success criterion was to move gas and electric utilities to increase the promotion of energy efficient windows through demand side management programs as an important step toward increasing the market share of energy efficient windows.« less

Efficiency of printed materials in worksite health promotion.

PubMed

Kishchuk, N; Anbar, F; O'Loughlin, J; Masson, P; Sacks-Silver, G

1991-01-01

Printed health promotion materials are widely believed to be an efficient means of achieving basic health promotion objectives, such as increasing knowledge of risk factors. This study examined the efficiency of cardiovascular health promotion leaflets in reaching employees in a heterogeneous sample of worksites. Two types of distribution were used: copies of the leaflets were either made available centrally or distributed to each individual employee. Interviews were conducted with 272 employees in six worksites. Respondents were asked whether they recognized, had read, and had learned something from the leaflets. Only one-quarter of respondents recognized the leaflets and only 14% stated that they had learned something. The efficiency of the leaflets was therefore much lower than expected. Z-tests for proportions showed that recognition, reading, and learning were significantly greater among those employees who had been given individual copies of the material. Among those who had been given individual copies, 45% reported recognizing the leaflet, 36% reading it, and 23% learning something from it. Among those who had only central access, the respective scores were 11%, 7% and 6%. These results suggest that the potential cost-effectiveness of printed materials such as leaflets and brochures should be weighed against alternative forms of intervention, given specific program objectives and characteristics of the target population. They also suggest that the cost and effort required in organizing the distribution of individual copies may be recouped in greater penetration.

Networking to improve end of life care.

PubMed

McGivern, Gerry

2009-01-01

Network organisations are increasingly common in healthcare. This paper describes an example of clinically led networking, which improved end of life care (EOLC) in care homes, differentiating between a 'network' as a formal entity and the more informal process of 'networking'. The paper begins with a brief discussion of networks and their development in healthcare, then an overview of EOLC policy, the case setting and methods. The paper describes four key features of this networking; (1) how it enabled discussions and implemented processes to help people address difficult taboos about dying; (2) how personal communication and 'distributed leadership' facilitated learning; (3) how EOLC occasionally lapsed during the handover of patient care, where personal relationship and communication were weaker; and (4) how successful learning and sharing of best practice was fragile and could be potentially undermined by wider financial pressures in the NHS.

Effects of extended work shifts on employee fatigue, health, satisfaction, work/family balance, and patient safety.

PubMed

Estryn-Béhar, Madeleine; Van der Heijden, Beatrice I J M

2012-01-01

12-hour shifts are quickly spreading in Europe. From our multivariate analysis concerning 25,924 European nurses, including twenty explanatory variables simultaneously, we found that work schedule itself is not a major determinant factor. Nurses aim to choose or accept night shifts or 12-hour shift in order to reduce their work/home conflicts, however, at the expense of the patient's safety, as well as their own health and safety. Therefore, it is important to develop measures, such as extended child care, association of nurses to the elaboration of their rota, 9- or 10-hour shifts in the afternoon, allowing naps during night shifts, and reduction of changing shifts with short notice. Work schedules must be organized in order to allow time for shift handover, social support and team building.

The design and networking of dynamic satellite constellations for global mobile communication systems

NASA Technical Reports Server (NTRS)

Cullen, Cionaith J.; Benedicto, Xavier; Tafazolli, Rahim; Evans, Barry

1993-01-01

Various design factors for mobile satellite systems, whose aim is to provide worldwide voice and data communications to users with hand-held terminals, are examined. Two network segments are identified - the ground segment (GS) and the space segment (SS) - and are seen to be highly dependent on each other. The overall architecture must therefore be adapted to both of these segments, rather than each being optimized according to its own criteria. Terrestrial networks are grouped and called the terrestrial segment (TS). In the SS, of fundamental importance is the constellation altitude. The effect of the altitude on decisions such as constellation design choice and on network aspects like call handover statistics are fundamental. Orbit resonance is introduced and referred to throughout. It is specifically examined for its useful properties relating to GS/SS connectivities.

Does multi-functionality affect technical efficiency? A non-parametric analysis of the Scottish dairy industry.

PubMed

Barnes, A P

2006-09-01

Recent policy changes within the Common Agricultural Policy have led to a shift from a solely production-led agriculture towards the promotion of multi-functionality. Conversely, the removal of production-led supports would indicate that an increased concentration on production efficiencies would seem a critical strategy for a country's future competitiveness. This paper explores the relationship between the 'multi-functional' farming attitude desired by policy makers and its effect on technical efficiency within Scottish dairy farming. Technical efficiency scores are calculated by applying the non-parametric data envelopment analysis technique and then measured against causes of inefficiency. Amongst these explanatory factors is a constructed score of multi-functionality. This research finds that, amongst other factors, a multi-functional attitude has a significant positive effect on technical efficiency. Consequently, this seems to validate the promotion of a multi-functional approach to farming currently being championed by policy-makers.

Industrial Energy Efficiency Practices in Indonesia: Lesson Learned from Astra Green Energy (AGen) Award

NASA Astrophysics Data System (ADS)

Telaga, A. S.; Hartanto, I. D.

2017-03-01

Many countries have used award system to promote energy efficiency practices in industry. The award system has been found to have significant impact to increase energy conservation and sustainability adoption in companies. Astra International (AI) as a holding company of more than 200 companies also organised Astra green energy (AGen) award to all affiliated companies (AFFCO) in Astra group. The event has been used to share energy efficiency best practices among AFFCO in Astra group. AFFCOs of Astra International are among the biggest and the leader in their industrial sectors Therefore, analyses from AFFO’s energy efficiency case studies represents current practices in Indonesia industrial sectors. Analyses are divided into industry, building, and renewable energy. The results from analyses found that AFFCOs already aware of energy conservation and have implemented projects to promote energy efficiency. However, the AFFCOs do not optimally use monitoring data for energy reduction.

[Research on resources chemistry of Chinese medicinal materials and resources recycling utilization ways and goals and tasks].

PubMed

Duan, Jin-ao; Su, Shu-lan; Guo, Sheng; Jiang, Shu; Liu, Pei; Yan, Hui; Qian, Da-wei; Zhu, Hua-xu; Tang, Yu-ping; Wu, Qi-nan

2015-09-01

The objects of research on the resources chemistry of Chinese medicinal materials (RCCMM) are promotion of efficient production, rational utilization and improving quality of CMM and natural products. The development of TCM cause depends on the efficient utilization and sustainable development of CMM, hinges on the technologies and methods for using and discovering medicinal biological resources, stand or fall on the extension of industy chains, detailed utilizaion of resource chemical components by multi-way, multi-level. All of these may help to the recycling utilization and sound development of RCMM. In this article, five respects were discussed to the RCCMM researches and resources recycling utilization ways and goals and tasks. First, based on the principle of resource scarcity, discovering or replacing CMM resources, protecting the rare or endangered species or resources. Second, based on the multifunctionality of CMM, realizing the value-added and value compensation, and promoting the utilization efficiency through systermatic and detailed exploitation and utilization. Third, based on the resource conservation and environment-friendly, reducing raw material consumption, lowering cost, promoting recycling utilization and elevating utilization efficiency. Fourth, based on the stratege of turning harm into good, using the invasive alien biological resources by multi-ways and enriching the medicial resources. Fifth, based on the method of structure modification of chemical components, exploring and enhancing the utility value of resouces chemical substances. These data should provide references and attention for improving the utilization efficiency, promoting the development of recycling economy, and changing the mode of economic growth of agriculture and industry of CMM fundamentally.

TALE factors poise promoters for activation by Hox proteins.

PubMed

Choe, Seong-Kyu; Ladam, Franck; Sagerström, Charles G

2014-01-27

Hox proteins form complexes with TALE cofactors from the Pbx and Prep/Meis families to control transcription, but it remains unclear how Hox:TALE complexes function. Examining a Hoxb1b:TALE complex that regulates zebrafish hoxb1a transcription, we find maternally deposited TALE proteins at the hoxb1a promoter already during blastula stages. These TALE factors recruit histone-modifying enzymes to promote an active chromatin profile at the hoxb1a promoter and also recruit RNA polymerase II (RNAPII) and P-TEFb. However, in the presence of TALE factors, RNAPII remains phosphorylated on serine 5 and hoxb1a transcription is inefficient. By gastrula stages, Hoxb1b binds together with TALE factors to the hoxb1a promoter. This triggers P-TEFb-mediated transitioning of RNAPII to the serine 2-phosphorylated form and efficient hoxb1a transcription. We conclude that TALE factors access promoters during early embryogenesis to poise them for activation but that Hox proteins are required to trigger efficient transcription. Copyright © 2014 Elsevier Inc. All rights reserved.

Men's Sheds function and philosophy: towards a framework for future research and men's health promotion.

PubMed

Wilson, Nathan J; Cordier, Reinie; Doma, Kenji; Misan, Gary; Vaz, Sharmila

2015-08-01

The Men's Shed movement supports a range of men's health promotion initiatives. This paper examines whether a Men's Shed typology could inform future research and enable more efficient and targeted health promotion activities through Men's Sheds. The International Men's Shed Survey consisted of a cross-sectional exploration of sheds, their members, and health and social activities. Survey data about shed 'function' and 'philosophy' were analysed using descriptive and inferential statistics. A framework of Men's Sheds based on function and philosophy demonstrated that most sheds serve a primary utility function, a secondary social function, but most importantly a primary social opportunity philosophy. Sheds with a primary health philosophy participated in fewer health promotion activities when compared with sheds without a primary health philosophy. In addition to the uniform health promotion resources distributed by the Men's Shed associations, specific health promotion activities, such as prostate education, are being initiated from an individual shed level. This framework can potentially be used to enable future research and health promotion activities to be more efficiently and effectively targeted. SO WHAT? Men experience poorer health and well being outcomes than women. This framework offers a novel approach to providing targeted health promotion activities to men in an environment where it is okay to talk about men's health.

A smartphone-enabled communication system to improve hospital communication: usage and perceptions of medical trainees and nurses on general internal medicine wards.

PubMed

Wu, Robert; Lo, Vivian; Morra, Dante; Appel, Eva; Arany, Teri; Curiale, Beth; Ryan, Joanne; Quan, Sherman

2015-02-01

There is increasing interest in the use of information and communication technologies to improve how clinicians communicate in hospital settings. We implemented a communication system with support for physician handover and secure messaging on 2 general internal medicine wards. We measured usage and surveyed physicians and nurses on perceptions of the system's effects on communication. Between May 2011 and August 2012, a clinical teaching team received, on average, 14.8 messages per day through the system. Messages were typically sent as urgent (69.1%) and requested a text reply (76.5%). For messages requesting a text reply, 8.6% did not receive a reply. For those messages that did receive a reply, the median response time was 2.3 minutes, and 84.5% of messages received a reply within 15 minutes. Of those who completed the survey, 95.3% were medical residents (82 of 86) and 81.7% were nurses (83 of 116). Medical trainees (82.8%) and nursing staff (78.3%) agreed or strongly agreed that the system helped to speed up their daily work tasks. Overall, 67.1% of the trainees and 73.2% of nurses agreed or strongly agreed that the system made them more accountable in their clinical roles. Only 35.8% of physicians and 26.3% of nurses agreed or strongly agreed that the system was useful for communicating complex issues. In summary, with a system designed to improve communication, we found that there was high uptake and that users perceived that the system improved efficiency and accountability but was not appropriate for communicating complex issues. © 2014 Society of Hospital Medicine.

The Economics of Inequality: The Value of Early Childhood Education

ERIC Educational Resources Information Center

Heckman, James J.

2011-01-01

Educational equity is often discussed as a moral issue. Another way to think about equity is as a way to promote productivity and economic efficiency. Traditionally, equity and efficiency are viewed as competing goals. One can be fair in devising a policy, but often what is fair is not economically efficient. Conversely, what is efficient may not…

76 FR 70831 - Proposed Information Collection (Survey of Veteran Enrollees (Quality and Efficiency of VA Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-15

... of Veteran Enrollees (Quality and Efficiency of VA Health Care)) Activity; Comment Request AGENCY... of Veteran Enrollees (Quality and Efficiency of VA Health Care), VA Form 10-21088. OMB Control Number... will be used to collect data that is necessary to promote quality and efficient delivery of health care...

77 FR 3841 - Proposed Information Collection (Survey of Veteran Enrollees (Quality and Efficiency of VA Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-25

... of Veteran Enrollees (Quality and Efficiency of VA Health Care)) Activities Under OMB Review AGENCY... of Veteran Enrollees (Quality and Efficiency of VA Health Care), VA Form 10-21088. OMB Control Number... will be used to collect data that is necessary to promote quality and efficient delivery of health care...

[Evaluating the efficiency of basic public health service project in Beijing rural areas based on data envelopment analysis].

PubMed

Zhang, Gui-lin; Pan, Xi-long

2013-04-18

To measure the efficiency changes of basic public health service in Beijing rural areas and to provide some suggestions for the basic public health service project throughout China. In the study, stratified random samples from 32 township health centers (THCs) were measured by data envelopment analysis (DEA) model with the panel data from 2007 to 2009. (1) The average total efficiency score of samples was 0.972. The TE non-efficient THCs were with excess in all input indicators and insufficient outputs in technology management, health promotion and chronic disease management. (2) The total factor productivity (TFP) from 2007 to 2008 increased 8.8%, which was attributed to technology change. The TFP decreased by 6.6% from 2008 to 2009, but the technical efficiency increased by 3.3%. There is room for improvemrnt in the basic public health service project in Beijing rural areas. Scale efficiency should be improved and the common development of technical efficiency and technology progress promoted in order to increase the project outputs.

Herpes simplex virus mutant generation and dual-detection methods for gaining insight into latent/lytic cycles in vivo.

PubMed

Sawtell, Nancy M; Thompson, Richard L

2014-01-01

Two important components to a useful strategy to examine viral gene regulation in vivo are (1) a highly efficient protocol to generate viral mutants that limits undesired mutation and retains full replication competency in vivo and (2) an efficient system to detect and quantify viral promoter activity in rare cells in vivo. Our strategy and protocols for generating, characterizing, and employing HSV viral promoter/reporter mutants in vivo are provided in this two-part chapter.

The hTERT Promoter Enhances the Antitumor Activity of an Oncolytic Adenovirus under a Hypoxic Microenvironment

PubMed Central

Hashimoto, Yuuri; Tazawa, Hiroshi; Teraishi, Fuminori; Kojima, Toru; Watanabe, Yuichi; Uno, Futoshi; Yano, Shuya; Urata, Yasuo; Kagawa, Shunsuke; Fujiwara, Toshiyoshi

2012-01-01

Hypoxia is a microenvironmental factor that contributes to the invasion, progression and metastasis of tumor cells. Hypoxic tumor cells often show more resistance to conventional chemoradiotherapy than normoxic tumor cells, suggesting the requirement of novel antitumor therapies to efficiently eliminate the hypoxic tumor cells. We previously generated a tumor-specific replication-competent oncolytic adenovirus (OBP-301: Telomelysin), in which the human telomerase reverse transcriptase (hTERT) promoter drives viral E1 expression. Since the promoter activity of the hTERT gene has been shown to be upregulated by hypoxia, we hypothesized that, under hypoxic conditions, the antitumor effect of OBP-301 with the hTERT promoter would be more efficient than that of the wild-type adenovirus 5 (Ad5). In this study, we investigated the antitumor effects of OBP-301 and Ad5 against human cancer cells under a normoxic (20% oxygen) or a hypoxic (1% oxygen) condition. Hypoxic condition induced nuclear accumulation of the hypoxia-inducible factor-1α and upregulation of hTERT promoter activity in human cancer cells. The cytopathic activity of OBP-301 was significantly higher than that of Ad5 under hypoxic condition. Consistent with their cytopathic activity, the replication of OBP-301 was significantly higher than that of Ad5 under the hypoxic condition. OBP-301-mediated E1A was expressed within hypoxic areas of human xenograft tumors in mice. These results suggest that the cytopathic activity of OBP-301 against hypoxic tumor cells is mediated through hypoxia-mediated activation of the hTERT promoter. Regulation of oncolytic adenoviruses by the hTERT promoter is a promising antitumor strategy, not only for induction of tumor-specific oncolysis, but also for efficient elimination of hypoxic tumor cells. PMID:22720091

Fe2P as a novel efficient catalyst promoter in Pd/C system for formic acid electro-oxidation in fuel cells reaction

NASA Astrophysics Data System (ADS)

Wang, Fulong; Xue, Huaiguo; Tian, Zhiqun; Xing, Wei; Feng, Ligang

2018-01-01

Developing catalyst promoter for Pd/C catalyst is significant for the catalytic ability improvement in energy transfer related electrochemical reactions. Herein, we demonstrate Fe2P as an efficient catalyst promoter in Pd/C catalyst system for formic acid electro-oxidation in fuel cells reactions. Adding Fe2P in the Pd/C catalyst system greatly increases the performances for formic acid oxidation by 3-4 times; the CO stripping technique displays two kinds of active sites formation in the Pd-Fe2P/C catalyst system coming from the interaction of Pd, Fe2P and Pd oxide species and both are more efficient for formic acid and CO-species electrooxidation. The smaller charge transfer resistance and Tafel slope for formic acid oxidation indicate the improvements in kinetics by Fe2P in the Pd-Fe2P/C system. The nanostructured hybrid units of Pd, Fe2P and carbon are evidently visible in the high resolution microscopy images and XPS technique confirmes the electronic effect in the catalyst system. The promotion effect of Fe2P in the catalyst system arising from the structure, composition and electronic effect changes is discussed with the help from multiple physical and electrochemical techniques. It is concluded that Fe2P as a significant catalyst promoter will have potential application in energy transfer related electrochemical reactions.

STRONTIUM AS AN EFFICIENT PROMOTER FOR SUPPORTED PALLADIUM HYDROGENATION CATALYSTS

EPA Science Inventory

The effect of strontium promotion is studied for a series of supported palladium catalysts such as Pd/zeolite-β, Pd/Al₂O₃, Pd/SiO₂, Pd/hydrotalcite and Pd/MgO. Strontium is found to be an effective promoter for enhancing the metal area, perce...

7 CFR 1215.8 - Industry information.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POPCORN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Popcorn Promotion, Research, and Consumer Information Order Definitions § 1215.8... of new markets, new marketing strategies, or increased efficiency for the popcorn industry, or...

7 CFR 1215.8 - Industry information.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POPCORN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Popcorn Promotion, Research, and Consumer Information Order Definitions § 1215.8... of new markets, new marketing strategies, or increased efficiency for the popcorn industry, or...

7 CFR 1215.8 - Industry information.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POPCORN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Popcorn Promotion, Research, and Consumer Information Order Definitions § 1215.8... of new markets, new marketing strategies, or increased efficiency for the popcorn industry, or...

7 CFR 1215.8 - Industry information.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POPCORN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Popcorn Promotion, Research, and Consumer Information Order Definitions § 1215.8... of new markets, new marketing strategies, or increased efficiency for the popcorn industry, or...

Structure-activity correlation in transfection promoted by pyridinium cationic lipids.

PubMed

Parvizi-Bahktar, P; Mendez-Campos, J; Raju, L; Khalique, N A; Jubeli, E; Larsen, H; Nicholson, D; Pungente, M D; Fyles, T M

2016-03-21

The efficiency of the transfection of a plasmid DNA encoding a galactosidase promoted by a series of pyridinium lipids in mixtures with other cationic lipids and neutral lipids was assessed in CHO-K1 cells. We identify key molecular parameters of the lipids in the mixture - clog P, lipid length, partial molar volume - to predict the morphology of the lipid-DNA lipoplex and then correlate these same parameters with transfection efficiency in an in vitro assay. We define a Transfection Index that provides a linear correlation with normalized transfection efficiency over a series of 90 different lipoplex compositions. We also explore the influence of the same set of molecular parameters on the cytotoxicity of the formulations.

The Impact of Multimedia and Redundancy on the Efficiency of History Presentations

ERIC Educational Resources Information Center

Leach, Adam

2012-01-01

The use of educational technology to create classroom presentations is already commonplace in American history classes. Therefore, this study focuses on how multimedia presentations can promote efficient instruction specifically, can the employment of the multimedia and redundancy principles (Mayer, 2009) improve the efficiency of student learning…

Sustainable Schools: Making Energy Efficiency a Lifestyle Priority

ERIC Educational Resources Information Center

Purnell, Ken; Sinclair, Mark; Gralton, Anna

2004-01-01

Promoting efficient energy use in schools that consequently reduces greenhouse gas emissions is the purpose of a residential Energy Efficiency in Schools (EEIS) program reported on in this paper. Research on this program aligns with one of the "key "overarching" sustainability issues", set out in the "Learning for…

Achieving shared efficiencies through cooperative implementation : commercial vehicle electronic screening

DOT National Transportation Integrated Search

1999-01-01

This brochure discusses how electronic screening of commercial vehicles can aid both state agencies and motor carriers. Benefits include: enhancing enforcement, increasing operations efficiency reducing pollution levels, promotes economic viability a...

Achieving shared efficiencies through cooperative implementation : commercial vehicle electronic screening

DOT National Transportation Integrated Search

1999-01-01

This brochure discusses how electronic screening of commercial vehicles can aid both state agencies and motor carriers. Benefits include: enhancing enforcement, increasing operations efficiency reducing pollution levels, promoting economic viability ...

ICI Showcase House Prototype

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

None

2009-02-16

Building Science Corporation collaborated with ICI Homes in Daytona Beach, FL on a 2008 prototype Showcase House that demonstrates the energy efficiency and durability upgrades that ICI currently promotes through its in-house efficiency program called EFactor.

Energy Efficiency Programs in K-12 Schools: A Guide to Developing and Implementing Greenhouse Gas Reduction Programs. Local Government Climate and Energy Strategy Series

ERIC Educational Resources Information Center

US Environmental Protection Agency, 2011

2011-01-01

Saving energy through energy efficiency improvements can cost less than generating, transmitting, and distributing energy from power plants, and provides multiple economic and environmental benefits. Local governments can promote energy efficiency in their jurisdictions by developing and implementing strategies that improve the efficiency of…

[Water-saving mechanisms of intercropping system in improving cropland water use efficiency].

PubMed

Zhang, Feng-Yun; Wu, Pu-Te; Zhao, Xi-Ning; Cheng, Xue-Feng

2012-05-01

Based on the multi-disciplinary researches, and in terms of the transformation efficiency of surface water to soil water, availability of cropland soil water, crop canopy structure, total irrigation volume needed on a given area, and crop yield, this paper discussed the water-saving mechanisms of intercropping system in improving cropland water use efficiency. Intercropping system could promote the full use of cropland water by plant roots, increase the water storage in root zone, reduce the inter-row evaporation and control excessive transpiration, and create a special microclimate advantageous to the plant growth and development. In addition, intercropping system could optimize source-sink relationship, provide a sound foundation for intensively utilizing resources temporally and spatially, and increase the crop yield per unit area greatly without increase of water consumption, so as to promote the crop water use efficiency effectively.

Efficient genome editing of wild strawberry genes, vector development and validation.

PubMed

Zhou, Junhui; Wang, Guoming; Liu, Zhongchi

2018-03-25

The clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 system is an effective genome editing tool for plant and animal genomes. However, there are still few reports on the successful application of CRISPR-Cas9 to horticultural plants, especially with regard to germ-line transmission of targeted mutations. Here, we report high-efficiency genome editing in the wild strawberry Fragaria vesca and its successful application to mutate the auxin biosynthesis gene TAA1 and auxin response factor 8 (ARF8). In our CRISPR system, the Arabidopsis U6 promoter AtU6-26 and the wild strawberry U6 promoter FveU6-2 were each used to drive the expression of sgRNA, and both promoters were shown to lead to high-efficiency genome editing in strawberry. To test germ-line transmission of the edited mutations and new mutations induced in the next generation, the progeny of the primary (T0) transgenic plants carrying the CRISPR construct was analysed. New mutations were detected in the progeny plants at a high efficiency, including large deletions between the two PAM sites. Further, T1 plants harbouring arf8 homozygous knockout mutations grew considerably faster than wild-type plants. The results indicate that our CRISPR vectors can be used to edit the wild strawberry genome at a high efficiency and that both sgRNA design and appropriate U6 promoters contribute to the success of genomic editing. Our results open up exciting opportunities for engineering strawberry and related horticultural crops to improve traits of economic importance. © 2018 The Authors. Plant Biotechnology Journal published by Society for Experimental Biology and The Association of Applied Biologists and John Wiley & Sons Ltd.

Heteroduplex DNA Position Defines the Roles of the Sgs1, Srs2, and Mph1 Helicases in Promoting Distinct Recombination Outcomes

PubMed Central

Mitchel, Katrina; Lehner, Kevin; Jinks-Robertson, Sue

2013-01-01

The contributions of the Sgs1, Mph1, and Srs2 DNA helicases during mitotic double-strand break (DSB) repair in yeast were investigated using a gap-repair assay. A diverged chromosomal substrate was used as a repair template for the gapped plasmid, allowing mismatch-containing heteroduplex DNA (hDNA) formed during recombination to be monitored. Overall DSB repair efficiencies and the proportions of crossovers (COs) versus noncrossovers (NCOs) were determined in wild-type and helicase-defective strains, allowing the efficiency of CO and NCO production in each background to be calculated. In addition, the products of individual NCO events were sequenced to determine the location of hDNA. Because hDNA position is expected to differ depending on whether a NCO is produced by synthesis-dependent-strand-annealing (SDSA) or through a Holliday junction (HJ)–containing intermediate, its position allows the underlying molecular mechanism to be inferred. Results demonstrate that each helicase reduces the proportion of CO recombinants, but that each does so in a fundamentally different way. Mph1 does not affect the overall efficiency of gap repair, and its loss alters the CO-NCO by promoting SDSA at the expense of HJ–containing intermediates. By contrast, Sgs1 and Srs2 are each required for efficient gap repair, strongly promoting NCO formation and having little effect on CO efficiency. hDNA analyses suggest that all three helicases promote SDSA, and that Sgs1 and Srs2 additionally dismantle HJ–containing intermediates. The hDNA data are consistent with the proposed role of Sgs1 in the dissolution of double HJs, and we propose that Srs2 dismantles nicked HJs. PMID:23516370

New methods for tightly regulated gene expression and highly efficient chromosomal integration of cloned genes for Methanosarcina species

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

Guss, Adam M.; Rother, Michael; Zhang, Jun Kai

A highly efficient method for chromosomal integration of cloned DNA into Methanosarcina spp. was developed utilizing the site-specific recombination system from the Streptomyces phage φC31. Host strains expressing the φC31 integrase gene and carrying an appropriate recombination site can be transformed with non-replicating plasmids carrying the complementary recombination site at efficiencies similar to those obtained with self-replicating vectors. We have also constructed a series of hybrid promoters that combine the highly expressed M. barkeri P mcrB promoter with binding sites for the tetracycline-responsive, bacterial TetR protein. These promoters are tightly regulated by the presence or absence of tetracycline in strainsmore » that express the tetR gene. The hybrid promoters can be used in genetic experiments to test gene essentiality by placing a gene of interest under their control. Thus, growth of strains with tetR -regulated essential genes becomes tetracycline-dependent. A series of plasmid vectors that utilize the site-specific recombination system for construction of reporter gene fusions and for tetracycline regulated expression of cloned genes are reported. These vectors were used to test the efficiency of translation at a variety of start codons. Fusions using an ATG start site were the most active, whereas those using GTG and TTG were approximately one half or one fourth as active, respectively. The CTG fusion was 95% less active than the ATG fusion.« less

New methods for tightly regulated gene expression and highly efficient chromosomal integration of cloned genes for Methanosarcina species

DOE PAGES

Guss, Adam M.; Rother, Michael; Zhang, Jun Kai; ...

2008-01-01

A highly efficient method for chromosomal integration of cloned DNA into Methanosarcina spp. was developed utilizing the site-specific recombination system from the Streptomyces phage φC31. Host strains expressing the φC31 integrase gene and carrying an appropriate recombination site can be transformed with non-replicating plasmids carrying the complementary recombination site at efficiencies similar to those obtained with self-replicating vectors. We have also constructed a series of hybrid promoters that combine the highly expressed M. barkeri P mcrB promoter with binding sites for the tetracycline-responsive, bacterial TetR protein. These promoters are tightly regulated by the presence or absence of tetracycline in strainsmore » that express the tetR gene. The hybrid promoters can be used in genetic experiments to test gene essentiality by placing a gene of interest under their control. Thus, growth of strains with tetR -regulated essential genes becomes tetracycline-dependent. A series of plasmid vectors that utilize the site-specific recombination system for construction of reporter gene fusions and for tetracycline regulated expression of cloned genes are reported. These vectors were used to test the efficiency of translation at a variety of start codons. Fusions using an ATG start site were the most active, whereas those using GTG and TTG were approximately one half or one fourth as active, respectively. The CTG fusion was 95% less active than the ATG fusion.« less

The Efficiency and Effectiveness of the K-12 Energy Technology Education Promotion Centers in Taiwan

ERIC Educational Resources Information Center

Lee, Lung-Sheng

2013-01-01

In order to promote energy literacy for graders K-12, the Ministry of Education (MOE) in Taiwan initiated a K-12 Energy Technology Education Project in September 2010. This 40-month project has one project office affiliated to a university, and 18 promotion centers affiliated to 18 schools--including 5 regional centers for upper-secondary schools…

Ti nanorod arrays with a medium density significantly promote osteogenesis and osteointegration

PubMed Central

Ning, Chengyun; Wang, Shuangying; Zhu, Ye; Zhong, Meiling; Lin, Xi; Zhang, Yu; Tan, Guoxin; Li, Mei; Yin, Zhaoyi; Yu, Peng; Wang, Xiaolan; Li, Ying; He, Tianrui; Chen, Wei; Wang, Yingjun; Mao, Chuanbin

2016-01-01

Ti implants are good candidates in bone repair. However, how to promote bone formation on their surface and their consequent perfect integration with the surrounding tissue is still a challenge. To overcome such challenge, we propose to form Ti nanorods on their surface to promote the new bone formation around the implants. Here Ti nanorod arrays (TNrs) with different densities were produced on pure Ti surfaces using an anodizing method. The influence of TNr density on the protein adsorption as well as on the adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 pre-osteoblastic cells were assessed. The TNrs were also implanted into the bone defects in rabbits to test their application in promoting bone formation and osteointegration at the implant-bone interface. TNrs with the medium density were found to show the best capability in promoting the protein adsorption from surrounding medium, which in turn efficiently enhanced osteogenic differentiation in vitro and osteointegration in vivo. Our work suggests that growing TNrs with a medium density on the surface of traditional Ti implants is an efficient and facile method for promoting bone formation and osteointegration in bone repair. PMID:26743328

Ti nanorod arrays with a medium density significantly promote osteogenesis and osteointegration

NASA Astrophysics Data System (ADS)

Ning, Chengyun; Wang, Shuangying; Zhu, Ye; Zhong, Meiling; Lin, Xi; Zhang, Yu; Tan, Guoxin; Li, Mei; Yin, Zhaoyi; Yu, Peng; Wang, Xiaolan; Li, Ying; He, Tianrui; Chen, Wei; Wang, Yingjun; Mao, Chuanbin

2016-01-01

Ti implants are good candidates in bone repair. However, how to promote bone formation on their surface and their consequent perfect integration with the surrounding tissue is still a challenge. To overcome such challenge, we propose to form Ti nanorods on their surface to promote the new bone formation around the implants. Here Ti nanorod arrays (TNrs) with different densities were produced on pure Ti surfaces using an anodizing method. The influence of TNr density on the protein adsorption as well as on the adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 pre-osteoblastic cells were assessed. The TNrs were also implanted into the bone defects in rabbits to test their application in promoting bone formation and osteointegration at the implant-bone interface. TNrs with the medium density were found to show the best capability in promoting the protein adsorption from surrounding medium, which in turn efficiently enhanced osteogenic differentiation in vitro and osteointegration in vivo. Our work suggests that growing TNrs with a medium density on the surface of traditional Ti implants is an efficient and facile method for promoting bone formation and osteointegration in bone repair.

Funding Energy Efficiency and Conservation Projects with the Clean Water State Revolving Fund

EPA Pesticide Factsheets

This fact sheet demonstrates how the CWSRF provides assistance to eligible recipients for projects promoting energy efficiency and conservation. It highlights successful projects in New York, Alabama and Maryland.

Electronic patient records in action: Transforming information into professionally relevant knowledge.

PubMed

Winman, Thomas; Rystedt, Hans

2011-03-01

The implementation of generic models for organizing information in complex institutions like those in healthcare creates a gap between standardization and the need for locally relevant knowledge. The present study addresses how this gap can be bridged by focusing on the practical work of healthcare staff in transforming information in EPRs into knowledge that is useful for everyday work. Video recording of shift handovers on a rehabilitation ward serves as the empirical case. The results show how extensive selections and reorganizations of information in EPRs are carried out in order to transform information into professionally relevant accounts. We argue that knowledge about the institutional obligations and professional ways of construing information are fundamental for these transitions. The findings point to the need to consider the role of professional knowledge inherent in unpacking information in efforts to develop information systems intended to bridge between institutional and professional boundaries in healthcare. © The Author(s) 2011.

MANEMO Routing in Practice: Protocol Selection, Expected Performance, and Experimental Evaluation

NASA Astrophysics Data System (ADS)

Tazaki, Hajime; van Meter, Rodney; Wakikawa, Ryuji; Wongsaardsakul, Thirapon; Kanchanasut, Kanchana; Dias de Amorim, Marcelo; Murai, Jun

Motivated by the deployment of post-disaster MANEMO (MANET for NEMO) composed of mobile routers and stations, we evaluate two candidate routing protocols through network simulation, theoretical performance analysis, and field experiments. The first protocol is the widely adopted Optimized Link State Routing protocol (OLSR) and the second is the combination of the Tree Discovery Protocol (TDP) with Network In Node Advertisement (NINA). To the best of our knowledge, this is the first time that these two protocols are compared in both theoretical and practical terms. We focus on the control overhead generated when mobile routers perform a handover. Our results confirm the correctness and operational robustness of both protocols. More interestingly, although in the general case OLSR leads to better results, TDP/NINA outperforms OLSR both in the case of sparse networks and in highly mobile networks, which correspond to the operation point of a large set of post-disaster scenarios.

Analysis of the interface and data transfer from ICU to normal wards in a German University Hospital.

PubMed

Vollmer, Anne-Maria; Skonetzki-Cheng, Stefan; Prokosch, Hans-Ulrich

2013-01-01

Typically general wards and intensive care units (ICU) have very different labor organizations, structures and IT-systems in Germany. There is a need for coordination, because of the different working arrangements. Our team investigated the interface between ICU and general ward and especially the respective information transfer in the University hospital in Erlangen (Bavaria, Germany). The research team used a combination of interviews, observations and the analysis of transfer records and forms as part of a methodical triangulation. We identified 41 topics, which are discussed or presented in writing during the handover. In a second step, we investigate the requirements of data transmission in expert interviews. A data transfer concept from the perspective of the nurses and physicians was developed and we formulated recommendations for improvements of process and communication for this interface. Finally the data transfer concept was evaluated by the respondents.

Expedition 7 Crew Interview: Yuri Malenchenko

NASA Technical Reports Server (NTRS)

2003-01-01

Cosmonaut Yuri Malenchenko of Expedition Seven is seen during a pre-launch interview. He begins by telling why he wanted to become a cosmonaut. Malenchenko expresses his reaction about the news of the Space Shuttle Columbia accident, and how this mission will be different from other missions. He also expresses the challenges that face Malenchenko and Ed Lu such as the crew reduction from three to two, less supplies and no space shuttle flights. Malenchenko says that he will have to work on a compressed schedule, which will make the mission even more challenging. A description of the handover of Expedition Six is given. Malenchenko and Ed Lu will be cramped in a confined space on the Soyuz Spacecraft for two days before docking, and he talks about this experience. Lastly, Malenchenko gives his thoughts on how it will be to work with Ed Lu in space, and tells of Lu's trustworthiness and reliability as a fellow crew member.

Interprofessional communication in healthcare: An integrative review.

PubMed

Foronda, Cynthia; MacWilliams, Brent; McArthur, Erin

2016-07-01

The link between miscommunication and poor patient outcomes has been well documented. To understand the current state of knowledge regarding interprofessional communication, an integrative review was performed. The review suggested that nurses and physicians are trained differently and they exhibit differences in communication styles. The distinct frustrations that nurses and physicians expressed with each other were discussed. Egos, lack of confidence, lack of organization and structural hierarchies hindered relationships and communications. Research suggested that training programs with the use of standardized tools and simulation are effective in improving interprofessional communication skills. Recommendations include education beyond communication techniques to address the broader related constructs of patient safety, valuing diversity, team science, and cultural humility. Future directions in education are to add courses in patient safety to the curriculum, use handover tools that are interprofessional in nature, practice in simulation hospitals for training, and use virtual simulation to unite the professions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shift changes, updates, and the on-call architecture in space shuttle mission control.

PubMed

Patterson, E S; Woods, D D

2001-01-01

In domains such as nuclear power, industrial process control, and space shuttle mission control, there is increased interest in reducing personnel during nominal operations. An essential element in maintaining safe operations in high risk environments with this 'on-call' organizational architecture is to understand how to bring called-in practitioners up to speed quickly during escalating situations. Targeted field observations were conducted to investigate what it means to update a supervisory controller on the status of a continuous, anomaly-driven process in a complex, distributed environment. Sixteen shift changes, or handovers, at the NASA Johnson Space Center were observed during the STS-76 Space Shuttle mission. The findings from this observational study highlight the importance of prior knowledge in the updates and demonstrate how missing updates can leave flight controllers vulnerable to being unprepared. Implications for mitigating risk in the transition to 'on-call' architectures are discussed.

An empirical analysis of the radio propagation characteristics in high-speed railway environment

NASA Astrophysics Data System (ADS)

Hu, Guoqing; Ma, Guangjin; Li, Chunlai; Xu, Yongchi; He, Jin; Yu, Ying; He, Yandong

2017-09-01

For a wireless mobile network, a profile of radio propagation characteristics is the key to study any wireless techniques, especially in High-Speed Railway (HSR) environment. Unfortunately, such a profile is not available so far, which leads manifold challenges to wireless study for HSR scenarios. In this paper, we focus on this topic, and try to obtain this profile in various kinds of HSR scenarios based on previous field tests in China. Our study reveals that the Line-Of-Sight (LOS) propagation path plays a predominant role in the HSR scenarios, which can suppress the shadow fading. Finally, we find out that each kind of small-scale fading effects has a unique profile on different wireless mobile systems for HSR scenarios. As a result, this study presents a theoretical guidance for studying any wireless techniques in HSR environment, e.g., cell handover for HSR.

Shift changes, updates, and the on-call architecture in space shuttle mission control

NASA Technical Reports Server (NTRS)

Patterson, E. S.; Woods, D. D.

2001-01-01

In domains such as nuclear power, industrial process control, and space shuttle mission control, there is increased interest in reducing personnel during nominal operations. An essential element in maintaining safe operations in high risk environments with this 'on-call' organizational architecture is to understand how to bring called-in practitioners up to speed quickly during escalating situations. Targeted field observations were conducted to investigate what it means to update a supervisory controller on the status of a continuous, anomaly-driven process in a complex, distributed environment. Sixteen shift changes, or handovers, at the NASA Johnson Space Center were observed during the STS-76 Space Shuttle mission. The findings from this observational study highlight the importance of prior knowledge in the updates and demonstrate how missing updates can leave flight controllers vulnerable to being unprepared. Implications for mitigating risk in the transition to 'on-call' architectures are discussed.

Portable ultrahigh-vacuum sample storage system for polarization-dependent total-reflection fluorescence x-ray absorption fine structure spectroscopy

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

Watanabe, Yoshihide, E-mail: e0827@mosk.tytlabs.co.jp; Nishimura, Yusaku F.; Suzuki, Ryo

A portable ultrahigh-vacuum sample storage system was designed and built to investigate the detailed geometric structures of mass-selected metal clusters on oxide substrates by polarization-dependent total-reflection fluorescence x-ray absorption fine structure spectroscopy (PTRF-XAFS). This ultrahigh-vacuum (UHV) sample storage system provides the handover of samples between two different sample manipulating systems. The sample storage system is adaptable for public transportation, facilitating experiments using air-sensitive samples in synchrotron radiation or other quantum beam facilities. The samples were transferred by the developed portable UHV transfer system via a public transportation at a distance over 400 km. The performance of the transfer system was demonstratedmore » by a successful PTRF-XAFS study of Pt{sub 4} clusters deposited on a TiO{sub 2}(110) surface.« less

Cryptanalysis and Improvement of "A Secure Password Authentication Mechanism for Seamless Handover in Proxy Mobile IPv6 Networks".

PubMed

Alizadeh, Mojtaba; Zamani, Mazdak; Baharun, Sabariah; Abdul Manaf, Azizah; Sakurai, Kouichi; Anada, Hiroaki; Anada, Hiroki; Keshavarz, Hassan; Ashraf Chaudhry, Shehzad; Khurram Khan, Muhammad

2015-01-01

Proxy Mobile IPv6 is a network-based localized mobility management protocol that supports mobility without mobile nodes' participation in mobility signaling. The details of user authentication procedure are not specified in this standard, hence, many authentication schemes have been proposed for this standard. In 2013, Chuang et al., proposed an authentication method for PMIPv6, called SPAM. However, Chuang et al.'s Scheme protects the network against some security attacks, but it is still vulnerable to impersonation and password guessing attacks. In addition, we discuss other security drawbacks such as lack of revocation procedure in case of loss or stolen device, and anonymity issues of the Chuang et al.'s scheme. We further propose an enhanced authentication method to mitigate the security issues of SPAM method and evaluate our scheme using BAN logic.

Handover aspects for a Low Earth Orbit (LEO) CDMA Land Mobile Satellite (LMS) system

NASA Technical Reports Server (NTRS)

Carter, P.; Beach, M. A.

1993-01-01

This paper addresses the problem of handoff in a land mobile satellite (LMS) system between adjacent satellites in a low earth orbit (LEO) constellation. In particular, emphasis is placed on the application of soft handoff in a direct sequence code division multiple access (DS-CDMA) LMS system. Soft handoff is explained in terms of terrestrial macroscopic diversity, in which signals transmitted via several independent fading paths are combined to enhance the link quality. This concept is then reconsidered in the context of a LEO LMS system. A two-state Markov channel model is used to simulate the effects of shadowing on the communications path from the mobile to each satellite during handoff. The results of the channel simulation form a platform for discussion regarding soft handoff, highlighting the potential merits of the scheme when applied in a LEO LMS environment.

Kids in transition: the rehab experience.

PubMed

Bruce-Barrett, Cindy; Hodinott, Alastair; Manicat-Emo, Arbelle; Flaming, Tonya; Macgregor, Daune; Hogan, Iris; Carew, Chris; Cox, Sandi

2011-01-01

Holland Bloorview Kids Rehabilitation Hospital (formerly Bloorview Kids Rehab) is Canada's largest teaching hospital for pediatric rehabilitation and the only in-patient pediatric rehabilitation centre in Ontario. SickKids is a quaternary-level academic health sciences centre. The acute care neuroscience and trauma patient population at SickKids represents the largest volume of transitioning clients between the two organizations. For years, the number of medically unnecessary days associated with patients awaiting transfer from SickKids to Holland Bloorview for off-site rehabilitation was consistently driven by inefficient processes, multiple handovers, duplicitous efforts, fragmented communication and a lack of timely or complete referral information. Recognizing this situation as a threat to access, as well as a significant risk to patient health outcomes, SickKids and Holland Bloorview embarked on an exciting partnership (Kids in Transition: The Rehab Experience) as part of a larger Ministry of Health and Long-Term Care-funded initiative, the Flo Collaborative.

Networking to improve end of life care

PubMed Central

2009-01-01

Network organisations are increasingly common in healthcare. This paper describes an example of clinically led networking, which improved end of life care (EOLC) in care homes, differentiating between a ‘network’ as a formal entity and the more informal process of ‘networking’. The paper begins with a brief discussion of networks and their development in healthcare, then an overview of EOLC policy, the case setting and methods. The paper describes four key features of this networking; (1) how it enabled discussions and implemented processes to help people address difficult taboos about dying; (2) how personal communication and ‘distributed leadership’ facilitated learning; (3) how EOLC occasionally lapsed during the handover of patient care, where personal relationship and communication were weaker; and (4) how successful learning and sharing of best practice was fragile and could be potentially undermined by wider financial pressures in the NHS. PMID:25949588

Cryptanalysis and Improvement of "A Secure Password Authentication Mechanism for Seamless Handover in Proxy Mobile IPv6 Networks"

PubMed Central

Alizadeh, Mojtaba; Zamani, Mazdak; Baharun, Sabariah; Abdul Manaf, Azizah; Sakurai, Kouichi; Anada, Hiroki; Keshavarz, Hassan; Ashraf Chaudhry, Shehzad; Khurram Khan, Muhammad

2015-01-01

Proxy Mobile IPv6 is a network-based localized mobility management protocol that supports mobility without mobile nodes’ participation in mobility signaling. The details of user authentication procedure are not specified in this standard, hence, many authentication schemes have been proposed for this standard. In 2013, Chuang et al., proposed an authentication method for PMIPv6, called SPAM. However, Chuang et al.’s Scheme protects the network against some security attacks, but it is still vulnerable to impersonation and password guessing attacks. In addition, we discuss other security drawbacks such as lack of revocation procedure in case of loss or stolen device, and anonymity issues of the Chuang et al.’s scheme. We further propose an enhanced authentication method to mitigate the security issues of SPAM method and evaluate our scheme using BAN logic. PMID:26580963

HNP renumbering support in PMIPv6

NASA Astrophysics Data System (ADS)

Yan, Zhiwei; Geng, Guanggang; Lee, Xiaodong

2015-12-01

In the basic PMIPv6 (Proxy Mobile IPv6), the MN (Mobile Node) is assigned with a 64-bit HNP (Home Network Prefix) during the initial attachment for the HoA (Home Address) configuration. During the movements of MN, this prefix is assumed to be unchanged and then the upper layer applications do not have to use the reconfigured HoA and then the handover is transparent at the IP and above layers. However, the current protocol does not specify the related operation to support the MN to timely receive the new HNP and configure the new HoA when its HNP is renumbered. In this paper, this problem is discussed and a possible solution is proposed based on some simple extensions of the basic PMIPv6. Our analysis demonstrates that the proposed scheme can effectively discover the HNP renumbering and keep lower signaling cost, compared with the basic PMIPv6.

The OMG Modelling Language (SYSML)

NASA Astrophysics Data System (ADS)

Hause, M.

2007-08-01

On July 6th 2006, the Object Management Group (OMG) announced the adoption of the OMG Systems Modeling Language (OMG SysML). The SysML specification was in response to the joint Request for Proposal issued by the OMG and INCOSE (the International Council on Systems Engineering) for a customized version of UML 2, designed to address the specific needs of system engineers. SysML is a visual modeling language that extends UML 2 in order to support the specification, analysis, design, verification and validation of complex systems. This paper will look at the background of SysML and summarize the SysML specification including the modifications to UML 2.0, along with the new requirement and parametric diagrams. It will also show how SysML artifacts can be used to specify the requirements for other solution spaces such as software and hardware to provide handover to other disciplines.

48 CFR 923.101 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 923.101 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Sustainable Acquisition 923.101 Policy. The Department has promoted energy efficient products as well as...

48 CFR 923.101 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 923.101 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Sustainable Acquisition 923.101 Policy. The Department has promoted energy efficient products as well as...

48 CFR 923.101 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 923.101 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Sustainable Acquisition 923.101 Policy. The Department has promoted energy efficient products as well as...

48 CFR 923.101 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 923.101 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Sustainable Acquisition 923.101 Policy. The Department has promoted energy efficient products as well as...

Recent Developments in Australian Gold Extraction.

ERIC Educational Resources Information Center

Thiele, Rodney B.

1995-01-01

Describes new technologies that have greatly improved the extraction efficiency of gold ore, including: altering plant layout to promote efficiency, engaging Filiblast forced oxidation and bioxidation systems, and updating the electrowinning procedure at the gold recovery stage. (JRH)

Lighting for Tomorrow: Building on the results of the first national energy-efficient lighting fixture design competition in the United States

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

Gordon, Kelly L.; Foster, Rebecca; McGowan, Terry

2005-05-09

Lighting for Tomorrow was the first residential lighting fixture design competition conducted in the United States to focus on energy-efficient light sources. Sponsored by the American Lighting Association, the Consortium for Energy Efficiency, and the U.S. Department of Energy, the competition was carried out in two phases between 2002 and 2004. Five winning fixture designs were selected from a field of 24 finalists. The paper describes the competition in detail, including its origins, sponsors, structure and rules, timeline, prizes, selection criteria, and judges. The paper describes the results of the competition, including industry response, promotion and publicity efforts, technical andmore » design innovations demonstrated by the winners, and retail placements to date. Finally, the paper offers several lessons learned that are instructive for future efforts to promote high-efficiency lighting through the design competition approach.« less

Gossip Versus Punishment: The Efficiency of Reputation to Promote and Maintain Cooperation.

PubMed

Wu, Junhui; Balliet, Daniel; Van Lange, Paul A M

2016-04-04

Prior theory suggests that reputation spreading (e.g., gossip) and punishment are two key mechanisms to promote cooperation in groups, but no behavioral research has yet examined their relative effectiveness and efficiency in promoting and maintaining cooperation. To examine these issues, we observed participants interacting in a four-round public goods game (PGG) with or without gossip and punishment options, and a subsequent two-round trust game (TG). We manipulated gossip as the option to send notes about other group members to these members' future partners, and punishment as the option to assign deduction points to reduce other group members' outcomes with a fee-to-fine ratio of 1:3. Findings revealed that in the four-round PGG, the option to gossip increased both cooperation and individual earnings, whereas the option to punish had no overall effect on cooperation (but a positive effect on cooperation in the last two rounds of the PGG) and significantly decreased individual earnings. Importantly, the initial option to gossip made people more trusting and trustworthy in the subsequent TG when gossip was no longer possible, compared to the no-gossip condition. Thus, we provide some initial evidence that gossip may be more effective and efficient than punishment to promote and maintain cooperation.

Gossip Versus Punishment: The Efficiency of Reputation to Promote and Maintain Cooperation

PubMed Central

Wu, Junhui; Balliet, Daniel; Van Lange, Paul A. M.

2016-01-01

Prior theory suggests that reputation spreading (e.g., gossip) and punishment are two key mechanisms to promote cooperation in groups, but no behavioral research has yet examined their relative effectiveness and efficiency in promoting and maintaining cooperation. To examine these issues, we observed participants interacting in a four-round public goods game (PGG) with or without gossip and punishment options, and a subsequent two-round trust game (TG). We manipulated gossip as the option to send notes about other group members to these members’ future partners, and punishment as the option to assign deduction points to reduce other group members’ outcomes with a fee-to-fine ratio of 1:3. Findings revealed that in the four-round PGG, the option to gossip increased both cooperation and individual earnings, whereas the option to punish had no overall effect on cooperation (but a positive effect on cooperation in the last two rounds of the PGG) and significantly decreased individual earnings. Importantly, the initial option to gossip made people more trusting and trustworthy in the subsequent TG when gossip was no longer possible, compared to the no-gossip condition. Thus, we provide some initial evidence that gossip may be more effective and efficient than punishment to promote and maintain cooperation. PMID:27039896

The HIP1 initiator element plays a role in determining the in vitro requirement of the dihydrofolate reductase gene promoter for the C-terminal domain of RNA polymerase II.

PubMed

Buermeyer, A B; Thompson, N E; Strasheim, L A; Burgess, R R; Farnham, P J

1992-05-01

We examined the ability of purified RNA polymerase (RNAP) II lacking the carboxy-terminal heptapeptide repeat domain (CTD), called RNAP IIB, to transcribe a variety of promoters in HeLa extracts in which endogenous RNAP II activity was inhibited with anti-CTD monoclonal antibodies. Not all promoters were efficiently transcribed by RNAP IIB, and transcription did not correlate with the in vitro strength of the promoter or with the presence of a consensus TATA box. This was best illustrated by the GC-rich, non-TATA box promoters of the bidirectional dihydrofolate reductase (DHFR)-REP-encoding locus. Whereas the REP promoter was transcribed by RNAP IIB, the DHFR promoter remained inactive after addition of RNAP IIB to the antibody-inhibited reactions. However, both promoters were efficiently transcribed when purified RNAP with an intact CTD was added. We analyzed a series of promoter deletions to identify which cis elements determine the requirement for the CTD of RNAP II. All of the promoter deletions of both DHFR and REP retained the characteristics of their respective full-length promoters, suggesting that the information necessary to specify the requirement for the CTD is contained within approximately 65 bp near the initiation site. Furthermore, a synthetic minimal promoter of DHFR, consisting of a single binding site for Sp1 and a binding site for the HIP1 initiator cloned into a bacterial vector sequence, required RNAP II with an intact CTD for activity in vitro. Since the synthetic minimal promoter of DHFR and the smallest REP promoter deletion are both activated by Sp1, the differential response in this assay does not result from upstream activators. However, the sequences around the start sites of DHFR and REP are not similar and our data suggest that they bind different proteins. Therefore, we propose that specific initiator elements are important for determination of the requirement of some promoters for the CTD.

7 CFR 955.50 - Research and development.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... promote the marketing, distribution, consumption, or efficient production of Vidalia onions. Any such project for the promotion and advertising of Vidalia onions may utilize an identifying mark which shall be...

7 CFR 955.50 - Research and development.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... promote the marketing, distribution, consumption, or efficient production of Vidalia onions. Any such project for the promotion and advertising of Vidalia onions may utilize an identifying mark which shall be...

7 CFR 955.50 - Research and development.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... promote the marketing, distribution, consumption, or efficient production of Vidalia onions. Any such project for the promotion and advertising of Vidalia onions may utilize an identifying mark which shall be...

Development of a high efficiency integration system and promoter library for rapid modification of Pseudomonas putida KT2440

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

Elmore, Joshua R.; Furches, Anna; Wolff, Gara N.

Pseudomonas putida strains are highly robust bacteria known for their ability to efficiently utilize a variety of carbon sources, including aliphatic and aromatic hydrocarbons. Recently, P. putida has been engineered to valorize the lignin stream of a lignocellulosic biomass pretreatment process. Nonetheless, when compared to platform organisms such as Escherichia coli, the toolkit for engineering P. putida is underdeveloped. Heterologous gene expression in particular is problematic. Plasmid instability and copy number variance provide challenges for replicative plasmids, while use of homologous recombination for insertion of DNA into the chromosome is slow and laborious. Furthermore, heterologous expression efforts to date typicallymore » rely on overexpression of exogenous pathways using a handful of poorly characterized promoters. In order to improve the P. putida toolkit, we developed a rapid genome integration system using the site-specific recombinase from bacteriophage Bxb1 to enable rapid, high efficiency integration of DNA into the P. putida chromosome. We also developed a library of synthetic promoters with various UP elements, -35 sequences, and -10 sequences, as well as different ribosomal binding sites. We tested these promoters using a fluorescent reporter gene, mNeonGreen, to characterize the strength of each promoter, and identified UP-element-promoter-ribosomal binding sites combinations capable of driving a ~150-fold range of protein expression levels. One additional integrating vector was developed that confers more robust kanamycin resistance when integrated at single copy into the chromosome. This genome integration and reporter systems are extensible for testing other genetic parts, such as examining terminator strength, and will allow rapid integration of heterologous pathways for metabolic engineering.« less

Promoter library-based module combination (PLMC) technology for optimization of threonine biosynthesis in Corynebacterium glutamicum.

PubMed

Wei, Liang; Xu, Ning; Wang, Yiran; Zhou, Wei; Han, Guoqiang; Ma, Yanhe; Liu, Jun

2018-05-01

Due to the lack of efficient control elements and tools, the fine-tuning of gene expression in the multi-gene metabolic pathways is still a great challenge for engineering microbial cell factories, especially for the important industrial microorganism Corynebacterium glutamicum. In this study, the promoter library-based module combination (PLMC) technology was developed to efficiently optimize the expression of genes in C. glutamicum. A random promoter library was designed to contain the putative - 10 (NNTANANT) and - 35 (NNGNCN) consensus motifs, and refined through a three-step screening procedure to achieve numerous genetic control elements with different strength levels, including fluorescence-activated cell sorting (FACS) screening, agar plate screening, and 96-well plate screening. Multiple conventional strategies were employed for further precise characterizations of the promoter library, such as real-time quantitative PCR, sodium dodecyl sulfate polyacrylamide gel electrophoresis, FACS analysis, and the lacZ reporter system. These results suggested that the established promoter elements effectively regulated gene expression and showed varying strengths over a wide range. Subsequently, a multi-module combination technology was created based on the efficient promoter elements for combination and optimization of modules in the multi-gene pathways. Using this technology, the threonine biosynthesis pathway was reconstructed and optimized by predictable tuning expression of five modules in C. glutamicum. The threonine titer of the optimized strain was significantly improved to 12.8 g/L, an approximate 6.1-fold higher than that of the control strain. Overall, the PLMC technology presented in this study provides a rapid and effective method for combination and optimization of multi-gene pathways in C. glutamicum.

Quality improvement in medical education: current state and future directions.

PubMed

Wong, Brian M; Levinson, Wendy; Shojania, Kaveh G

2012-01-01

During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education. Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals. To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open-minded behaviours so that future clinicians are primed to promote a culture of safer, higher-quality care. © Blackwell Publishing Ltd 2012.

Energy Efficient Legged Robotics at Sandia Labs

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

Buerger, Steve

Sandia is developing energy efficient actuation and drive train technologies to dramatically improve the charge life of legged robots. The work is supported by DARPA, and Sandia will demonstrate an energy efficient bipedal robot at the technology exposition section of the DARPA Robotics Challenge Finals in June, 2015. This video, the first in a series, describes early development and initial integration of the Sandia Transmission Efficient Prototype Promoting Research (STEPPR) robot.

Energy Efficient Legged Robotics at Sandia Labs

ScienceCinema

Buerger, Steve

2018-05-07

Sandia is developing energy efficient actuation and drive train technologies to dramatically improve the charge life of legged robots. The work is supported by DARPA, and Sandia will demonstrate an energy efficient bipedal robot at the technology exposition section of the DARPA Robotics Challenge Finals in June, 2015. This video, the first in a series, describes early development and initial integration of the Sandia Transmission Efficient Prototype Promoting Research (STEPPR) robot.

The Economics of Inequality: The Value of Early Childhood Education

ERIC Educational Resources Information Center

Heckman, James J.

2011-01-01

Educational equity is often discussed as a moral issue. Another way to think about equity is as a way to promote productivity and economic efficiency. Traditionally, equity and efficiency are viewed as competing goals. One can be fair in devising a policy, but it often happens that what is fair is not economically efficient. Conversely, what is…

Root Zone Cooling and Exogenous Spermidine Root-Pretreatment Promoting Lactuca sativa L. Growth and Photosynthesis in the High-temperature Season

PubMed Central

Sun, Jin; Lu, Na; Xu, Hongjia; Maruo, Toru; Guo, Shirong

2016-01-01

Root zone high-temperature stress is a major factor limiting hydroponic plant growth during the high-temperature season. The effects of root zone cooling (RZC; at 25°C) and exogenous spermidine (Spd) root-pretreatment (SRP, 0.1 mM) on growth, leaf photosynthetic traits, and chlorophyll fluorescence characteristics of hydroponic Lactuca sativa L. grown in a high-temperature season (average temperature > 30°C) were examined. Both treatments significantly promoted plant growth and photosynthesis in the high-temperature season, but the mechanisms of photosynthesis improvement in the hydroponic grown lettuce plants were different between the RZC and SRP treatments. The former improved plant photosynthesis by increasing stoma conductance (Gs) to enhance CO2 supply, thus promoting photosynthetic electron transport activity and phosphorylation, which improved the level of the photochemical efficiency of photosystem II (PSII), rather than enhancing CO2 assimilation efficiency. The latter improved plant photosynthesis by enhancing CO2 assimilation efficiency, rather than stomatal regulation. Combination of RZC and SRP significantly improved PN of lettuce plants in a high-temperature season by both improvement of Gs to enhance CO2 supply and enhancement of CO2 assimilation. The enhancement of photosynthetic efficiency in both treatments was independent of altering light-harvesting or excessive energy dissipation. PMID:27047532

Root Zone Cooling and Exogenous Spermidine Root-Pretreatment Promoting Lactuca sativa L. Growth and Photosynthesis in the High-temperature Season.

PubMed

Sun, Jin; Lu, Na; Xu, Hongjia; Maruo, Toru; Guo, Shirong

2016-01-01

Root zone high-temperature stress is a major factor limiting hydroponic plant growth during the high-temperature season. The effects of root zone cooling (RZC; at 25°C) and exogenous spermidine (Spd) root-pretreatment (SRP, 0.1 mM) on growth, leaf photosynthetic traits, and chlorophyll fluorescence characteristics of hydroponic Lactuca sativa L. grown in a high-temperature season (average temperature > 30°C) were examined. Both treatments significantly promoted plant growth and photosynthesis in the high-temperature season, but the mechanisms of photosynthesis improvement in the hydroponic grown lettuce plants were different between the RZC and SRP treatments. The former improved plant photosynthesis by increasing stoma conductance (G s) to enhance CO2 supply, thus promoting photosynthetic electron transport activity and phosphorylation, which improved the level of the photochemical efficiency of photosystem II (PSII), rather than enhancing CO2 assimilation efficiency. The latter improved plant photosynthesis by enhancing CO2 assimilation efficiency, rather than stomatal regulation. Combination of RZC and SRP significantly improved P N of lettuce plants in a high-temperature season by both improvement of G s to enhance CO2 supply and enhancement of CO2 assimilation. The enhancement of photosynthetic efficiency in both treatments was independent of altering light-harvesting or excessive energy dissipation.

β1 integrin signaling promotes neuronal migration along vascular scaffolds in the post-stroke brain.

PubMed

Fujioka, Teppei; Kaneko, Naoko; Ajioka, Itsuki; Nakaguchi, Kanako; Omata, Taichi; Ohba, Honoka; Fässler, Reinhard; García-Verdugo, José Manuel; Sekiguchi, Kiyotoshi; Matsukawa, Noriyuki; Sawamoto, Kazunobu

2017-02-01

Cerebral ischemic stroke is a main cause of chronic disability. However, there is currently no effective treatment to promote recovery from stroke-induced neurological symptoms. Recent studies suggest that after stroke, immature neurons, referred to as neuroblasts, generated in a neurogenic niche, the ventricular-subventricular zone, migrate toward the injured area, where they differentiate into mature neurons. Interventions that increase the number of neuroblasts distributed at and around the lesion facilitate neuronal repair in rodent models for ischemic stroke, suggesting that promoting neuroblast migration in the post-stroke brain could improve efficient neuronal regeneration. To move toward the lesion, neuroblasts form chain-like aggregates and migrate along blood vessels, which are thought to increase their migration efficiency. However, the molecular mechanisms regulating these migration processes are largely unknown. Here we studied the role of β1-class integrins, transmembrane receptors for extracellular matrix proteins, in these migrating neuroblasts. We found that the neuroblast chain formation and blood vessel-guided migration critically depend on β1 integrin signaling. β1 integrin facilitated the adhesion of neuroblasts to laminin and the efficient translocation of their soma during migration. Moreover, artificial laminin-containing scaffolds promoted neuroblast chain formation and migration toward the injured area. These data suggest that laminin signaling via β1 integrin supports vasculature-guided neuronal migration to efficiently supply neuroblasts to injured areas. This study also highlights the importance of vascular scaffolds for cell migration in development and regeneration. Copyright © 2017 3-V Biosciences. Published by Elsevier B.V. All rights reserved.

77 FR 14587 - FY 2012 Discretionary Livability Funding Opportunity: Alternatives Analysis Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-12

... in clean energy resources, have been key strategic goals of the Department of Transportation (DOT... promote public health. Promote equitable, affordable housing: Expand location- and energy-efficient... communities: Target Federal funding toward existing communities--through such strategies as transit- oriented...

HIV-1 Tat protein promotes formation of more-processive elongation complexes.

PubMed Central

Marciniak, R A; Sharp, P A

1991-01-01

The Tat protein of HIV-1 trans-activates transcription in vitro in a cell-free extract of HeLa nuclei. Quantitative analysis of the efficiency of elongation revealed that a majority of the elongation complexes generated by the HIV-1 promoter were not highly processive and terminated within the first 500 nucleotides. Tat trans-activation of transcription from the HIV-1 promoter resulted from an increase in processive character of the elongation complexes. More specifically, the analysis suggests that there exist two classes of elongation complexes initiating from the HIV promoter: a less-processive form and a more-processive form. Addition of purified Tat protein was found to increase the abundance of the more-processive class of elongation complex. The purine nucleoside analog, 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole (DRB) inhibits transcription in this reaction by decreasing the efficiency of elongation. Surprisingly, stimulation of transcription elongation by Tat was preferentially inhibited by the addition of DRB. Images PMID:1756726

Promoting anaerobic biogasification of corn stover through biological pretreatment by liquid fraction of digestate (LFD).

PubMed

Hu, Yun; Pang, Yunzhi; Yuan, Hairong; Zou, Dexun; Liu, Yanping; Zhu, Baoning; Chufo, Wachemo Akiber; Jaffar, Muhammad; Li, Xiujin

2015-01-01

A new biological pretreatment method by using liquid fraction of digestate (LFD) was advanced for promoting anaerobic biogasification efficiency of corn stover. 17.6% TS content and ambient temperature was appropriate for pretreatment. The results showed that C/N ratio decreased to about 30, while total lignin, cellulose, and hemicellulose (LCH) contents were reduced by 8.1-19.4% after pretreatment. 3-days pretreatment was considered to be optimal, resulting in 70.4% more biogas production, 66.3% more biomethane yield and 41.7% shorter technical digestion time compared with the untreated stover. The reductions on VS, cellulose, and hemicellulose were increased by 22.1-35.9%, 22.3-35.4%, and 19.8-27.2% for LFD-treated stovers. The promoted anaerobic biogasification efficiency was mainly attributed to the improved biodegradability due to the pre-decomposition role of the bacteria in LFD. The method proved to be an efficient and low cost approach for producing bioenergy from corn stover, meanwhile, reducing LFD discharge and minimizing its potential pollution. Copyright © 2014 Elsevier Ltd. All rights reserved.

How to handle 'poor' foodstuffs: Acclimation of the common cockle (Cerastoderma edule) to detrital diets

NASA Astrophysics Data System (ADS)

Arambalza, Udane; Ibarrola, Irrintzi; Navarro, Enrique; Urrutxurtu, Iñaki; Urrutia, Miren B.

2018-04-01

As an approach to elucidating the "value" of detritus as a food source for bivalves, we analysed the capability of the common cockle (Cerastoderma edule) to modulate feeding and digestive rates during acclimation to low and high food rations of detrital diets with either low (Juncus maritimus) or high digestibility (Enteromorpha spp.). On acclimation day 3, feeding rates were similar in cockles fed different detrita; however, the absorption rate was higher in cockles fed Enteromorpha spp. With J. maritimus, rising food rations promoted an exponential decrease in absorption efficiency, whereas with Enteromorpha spp., absorption efficiency was only marginally reduced. During acclimation, cockles improved the rate at which both detritus were assimilated by means of increasing ingestion rates while maintaining absorption efficiency. When the time-course of digestive carbohydrase activities was monitored during acclimation to either detritus or phytoplankton (Isochrysis galbana), we found that only phytoplankton promoted the induction of cellulase activity in the digestive glands of cockles. This response in cockles fed phytoplankton promoted an increase in the digestibility of Enteromorpha spp., but had no effect on the digestibility of J. maritimus.

[Rice endogenous nitrogen fixing and growth promoting bacterium Herbaspirillum seropedicae DX35].

PubMed

Wang, Xiucheng; Cao, Yanhua; Tang, Xue; Ma, Xiaotong; Gao, Jusheng; Zhang, Xiaoxia

2014-03-04

To screen efficient nitrogen fixation endophytes from rice and to analyze their growth-promoting properties. We isolated strains from the roots of rice in the field where it has a rice-rice-green manure rotation system for 30 years. Efficient strains were screened by acetylene reduction assay. Phylogenetic analysis is based on 16S rRNA gene, nifH gene and the composition of fatty acid. In addition, we also detected the ability of indole acetic acid secretion through the Salkowski colorimetric method, measured the production of siderophore through the blue plate assay and detected phosphate solubilization, to analyze the growth-promoting properties. A total of 48 strains were isolated, in which DX35 has the highest nitrogenase activity. It belongs to Herbaspirillum seropedicae after identification. Its nitrogenase activity (181.21 nmol C2H4/(mg protein x h)) was 10 times as much as the reference strain Azotobacter chroococcum ACCC10006. In addition, it also can secrete siderophore and solubilize phosphorus. Strain DX35, belonging to Herbaspirillum seropedicae, is an efficient nitrogen fixation endophytes.

Single-step generation of gene knockout-rescue system in pluripotent stem cells by promoter insertion with CRISPR/Cas9.

PubMed

Matsunaga, Taichi; Yamashita, Jun K

2014-02-07

Specific gene knockout and rescue experiments are powerful tools in developmental and stem cell biology. Nevertheless, the experiments require multiple steps of molecular manipulation for gene knockout and subsequent rescue procedures. Here we report an efficient and single step strategy to generate gene knockout-rescue system in pluripotent stem cells by promoter insertion with CRISPR/Cas9 genome editing technology. We inserted a tetracycline-regulated inducible gene promoter (tet-OFF/TRE-CMV) upstream of the endogenous promoter region of vascular endothelial growth factor receptor 2 (VEGFR2/Flk1) gene, an essential gene for endothelial cell (EC) differentiation, in mouse embryonic stem cells (ESCs) with homologous recombination. Both homo- and hetero-inserted clones were efficiently obtained through a simple selection with a drug-resistant gene. The insertion of TRE-CMV promoter disrupted endogenous Flk1 expression, resulting in null mutation in homo-inserted clones. When the inserted TRE-CMV promoter was activated with doxycycline (Dox) depletion, Flk1 expression was sufficiently recovered from the downstream genomic Flk1 gene. Whereas EC differentiation was almost completely perturbed in homo-inserted clones, Flk1 rescue with TRE-CMV promoter activation restored EC appearance, indicating that phenotypic changes in EC differentiation can be successfully reproduced with this knockout-rescue system. Thus, this promoter insertion strategy with CRISPR/Cas9 would be a novel attractive method for knockout-rescue experiments. Copyright © 2014 Elsevier Inc. All rights reserved.

Efficiency of using community organisations as catalysts for recruitment to continence promotion trials.

PubMed

Agnew, Rona; van den Heuvel, Eleanor; Tannenbaum, Cara

2013-02-01

A major challenge for determining the effectiveness of community-based continence promotion campaigns is recruitment of a representative sample of incontinent participants who have not previously sought care. To evaluate the efficiency of engaging community organisations as catalysts for recruitment of community-dwelling older women with incontinence to the 'Continence across Continents' randomised controlled trial. Seniors' and women's community-based organisations throughout the United Kingdom were solicited by telephone or email to assist recruitment for an open-label cluster randomised controlled trial testing three experimental continence promotion interventions and a control intervention for incontinent older women. Women aged 60 years and older who experienced at least weekly urinary incontinence and who had never sought treatment were eligible to participate. The response rate of the organisations and enrolment rate of eligible participants attending the continence promotion workshops were recorded. Differences in recruitment efficiency by intervention group were ascertained using analysis of variance statistics. We contacted 408 community organisations over a 1-year period. Seventy organisations (17%) agreed to host a workshop, 249 (61%) did not provide a response, and 89 (22%) refused. Workshops were administered in a group format to 61 organisations (15%); 667 women attended, 583 (87%) submitted the screening questionnaire, and 437 (66%) met eligibility criteria for inclusion. A total of 192 women consented to participate in the trial, yielding a 44% recruitment efficiency among workshop attendees known to be eligible, with no significant difference in enrolment rates between groups. However, the mean participant recruitment rate per number of attendees at each workshop was only 29%, varying substantially between groups from 19% to 37%, with the lowest rate observed for the control group. The mean annual recruitment rate expressed as the number of enrolled participants per community organisation contacted was 0.5. Reasons for women's non-response were not collected. The findings may be country specific. The recruitment rate for a continence promotion trial among older women known to be eligible and attending workshops hosted by local community organisations was high (44%). Strategies are needed to bolster community organisations' involvement in health promotion trials in general and for continence issues in particular.

Relationship between expression level of hygromycin B-resistant gene and Agrobacterium tumefaciens-mediated transformation efficiency in Beauveria bassiana JEF-007.

PubMed

Nai, Y S; Lee, M R; Kim, S; Lee, S J; Kim, J C; Yang, Y T; Kim, J S

2017-09-01

Agrobacterium tumefaciens-mediated transformation (AtMT) is an effective method for generation of entomopathogenic Beauveria bassiana transformants. However, some strains grow on the selective medium containing hygromycin B (HygB), which reduces the selection efficiency of the putative transformants. In this work, a relationship between HygB resistance gene promoter and AtMT efficiency was investigated to improve the transformant selection. Ten B. bassiana isolates were grown on 800 μg ml -1 HygB medium, but only JEF-006, -007 and -013 showed susceptibility to the antibiotics. Particularly, JEF-007 showed the most dose-dependent susceptibility. Two different Ti-Plasmids, pCeg (gpdA promoter based) and pCambia-egfp (CaMV 35S promoter based), were constructed to evaluate the promoters on the expression of HygB resistance gene (hph) at 100, 150 and 200 μg ml -1 HygB medium. Eight days after the transformation, wild type, AtMT/pCeg and AtMT/pCambia-egfp colonies were observed on 100 μg ml -1 HygB, but significantly larger numbers of colonies were counted on AtMT/pCeg plates. At higher HygB concentration (150 μg ml -1 ), only AtMT/pCeg colonies were further observed, but very few colonies were observed on the wild type and AtMT/pCambia-egfp plates. Putative transformants were subjected to PCR, RT-PCR and qRT-PCR to investigate the T-DNA insertion rate and gene expression level. Consequently, >80% of colonies showed successful AtMT transformation, and the hph expression level in AtMT/pCeg colonies was higher than that of AtMT/pCambia-egfp colonies. In the HygB-susceptible B. bassianaJEF-007, gpdA promoter works better than CaMV 35S promoter in the expression of HygB resistance gene at 150 μg ml -1 HygB, consequently improving the selection efficiency of putative transformants. These results provide useful information for determining AtMT effectiveness in B. bassiana isolates, particularly antibiotic susceptibility and the role of promoters. © 2017 The Society for Applied Microbiology.

An assessment of energy efficiency based on environmental constraints and its influencing factors in China.

PubMed

Chen, Yao; Xu, Jing-Ting

2018-05-03

The super-efficiency directional distance function (DDF) with data envelopment analysis (DEA) model (SEDDF-DEA) is more facilitative than to increase traditional method as a rise of energy efficiency in China, which is currently important energy development from Asia-pacific region countries. SEDDF-DEA is promoted as sustained total-factor energy efficiency (TFEE), value added outputs, and Malmquist-Luenberger productivity index (MLPI) to otherwise thorny environmental energy productivity problems with environmental constraint to concrete the means of regression model. This paper assesses the energy efficiency under environmental constraints using panel data covering the years of 2000-2015 in China. Considering the environmental constraints, the results showed that the average TFEE of the whole country followed an upward trend after 2006. The average MLPI score for the whole country increased by 10.57% during 2005-2010, which was mainly due to the progress made in developing and applying environmental technologies. The TFEE of the whole nation was promoted by the accumulation of capital stock, while it was suppressed by excessive production in secondary industries and foreign investment. The primary challenge for the northeast of China is to strengthen industrial transformation and upgrade traditional industries, as well as adjusting the economy and energy structure. The eastern and central regions of the country need to exploit clean- or low-energy industry to improve inefficiencies due to excessive consumption. The western region of China needs to implement renewable energy strategies to promote regional development.

Diffusion pump modification promotes self-cleansing and high efficiency

NASA Technical Reports Server (NTRS)

Buggele, A. E.

1975-01-01

Modifications eliminate contaminant substances from pump fluid during operation, which are principal causes of torpidity on evaporative surface. Diffusion pump is also acting as still. Resulting 100 percent vigorous working surface provides much greater molecular throughput and greatly improved efficiency.

History and Analysis of Growth Impacts in the Fort Drum Region 1984-1990

DTIC Science & Technology

1990-09-01

objective of this inter-governmental relations council was to strengthen the local government ability to promote efficient and economic government...the Development Authority of the North Country, which would serve as the lead agency in promoting economic development, and supported activities of...mechanism. By using existing mechanisms, the group was able to develop and distribute a brochure to promote local services such as employment training and

Evaluation of agrobacterium-mediated transformation of Agaricus bisporus using a range of promoters linked to hygromycin resistance.

PubMed

Burns, C; Leach, K M; Elliott, T J; Challen, M P; Foster, G D; Bailey, A

2006-02-01

There is interest in establishing genetic modification technologies for the cultivated mushroom Agaricus bisporus, both for improved crop characteristics and for molecular pharming. For these methods to be successful, it is necessary to establish a set of transformation systems that include robust and reliable vectors for gene manipulation. In this article, we report the evaluation of a series of promoters for driving expression of the Escherichia coli hph gene encoding hygromycin phosphotransferase. This was achieved using the Aspergillus nidulans gpdA and the A. bisporus gpdII and trp2 promoters. The Coprinus cinereus beta-tubulin promoter gave contrasting results depending on the size of promoter used, with a 393-bp region being effective, whereas the longer 453-bp fragment failed to yield any hygromycin-resistant transformants. The C. cinereus trp1 and the A. bisporus lcc1 promoters both failed to yield transformants. We also show that transformation efficiency may be improved by careful selection of both appropriate Agrobacterium strains, with AGL-1 yielding more than LBA1126 and by the choice of the binary vectors used to mobilize the DNA, with pCAMBIA vectors appearing to be more efficient than either pBIN19- or pGREEN-based systems.

Design of price incentives for adjunct policy goals in formula funding for hospitals and health services

PubMed Central

Duckett, Stephen J

2008-01-01

Background Hospital policy involves multiple objectives: efficiency of service delivery, pursuit of high quality care, promoting access. Funding policy based on hospital casemix has traditionally been considered to be only about promoting efficiency. Discussion Formula-based funding policy can be (and has been) used to pursue a range of policy objectives, not only efficiency. These are termed 'adjunct' goals. Strategies to incorporate adjunct goals into funding design must, implicitly or explicitly, address key decision choices outlined in this paper. Summary Policy must be clear and explicit about the behaviour to be rewarded; incentives must be designed so that all facilities with an opportunity to improve have an opportunity to benefit; the reward structure is stable and meaningful; and the funder monitors performance and gaming. PMID:18384694

41 CFR 102-74.100 - What are conservation programs?

Code of Federal Regulations, 2014 CFR

2014-01-01

... programs are programs that improve energy and water efficiency and promote the use of solar and other renewable energy. These programs must promote and maintain an effective source reduction activity (reducing consumption of resources such as energy, water, and paper), resource recovery activity (obtaining materials...

41 CFR 102-74.100 - What are conservation programs?

Code of Federal Regulations, 2012 CFR

2012-01-01

... programs are programs that improve energy and water efficiency and promote the use of solar and other renewable energy. These programs must promote and maintain an effective source reduction activity (reducing consumption of resources such as energy, water, and paper), resource recovery activity (obtaining materials...

41 CFR 102-74.100 - What are conservation programs?

Code of Federal Regulations, 2013 CFR

2013-07-01

... programs are programs that improve energy and water efficiency and promote the use of solar and other renewable energy. These programs must promote and maintain an effective source reduction activity (reducing consumption of resources such as energy, water, and paper), resource recovery activity (obtaining materials...

Energy Efficient Legged Robotics at Sandia Labs, Part 2

ScienceCinema

Buerger, Steve; Mazumdar, Ani; Spencer, Steve

2018-01-16

Sandia is developing energy efficient actuation and drive train technologies to dramatically improve the charge life of legged robots. The work is supported by DARPA, and Sandia will demonstrate an energy efficient bipedal robot at the technology exposition section of the DARPA Robotics Challenge Finals in June, 2015. This video, the second in a series, describes the continued development and integration of the Sandia Transmission Efficient Prototype Promoting Research (STEPPR) robot.

Energy Efficient Legged Robotics at Sandia Labs, Part 2

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

Buerger, Steve; Mazumdar, Ani; Spencer, Steve

Sandia is developing energy efficient actuation and drive train technologies to dramatically improve the charge life of legged robots. The work is supported by DARPA, and Sandia will demonstrate an energy efficient bipedal robot at the technology exposition section of the DARPA Robotics Challenge Finals in June, 2015. This video, the second in a series, describes the continued development and integration of the Sandia Transmission Efficient Prototype Promoting Research (STEPPR) robot.

Adhesion promotion via noncovalent interactions in self-healing polymers.

PubMed

Wilson, Gerald O; Caruso, Mary M; Schelkopf, Stuart R; Sottos, Nancy R; White, Scott R; Moore, Jeffrey S

2011-08-01

Dimethylnorbornene ester (DNE) is successfully used as a noncovalent adhesion promoter. DNE was confirmed to copolymerize with dicyclopentadiene (DCPD) to yield a copolymer with better adhesion to an EPON 828 epoxy matrix relative to poly(DCPD) alone. The mechanical properties of the copolymer were comparable to that of poly(DCPD) alone. An optimized blend of the monomers was encapsulated using a urea-formaldheyde microencapsulation procedure and the resulting capsules were used for in situ self-healing experiments. Improved healing efficiency was observed for samples containing the DCPD/DNE capsules under conditions in which the monomers were efficiently polymerized.

Microwave-assisted Maillard reactions for the preparation of advanced glycation end products (AGEs).

PubMed

Visentin, Sonja; Medana, Claudio; Barge, Alessandro; Giancotti, Valeria; Cravotto, Giancarlo

2010-05-21

The application of microwaves as an efficient form of volumetric heating to promote organic reactions was recognized in the mid-1980 s. It has a much longer history in the food research and industry where microwave irradiation was studied in depth to optimize food browning and the development of desirable flavours from Maillard reactions. The microwave-promoted Maillard reaction is a challenging synthetic method to generate molecular diversity in a straightforward way. In this paper we present a new rapid and efficient one-pot procedure for the preparation of pentosidine and other AGEs under microwave irradiation.

Cyclodextrin-enhanced extraction and energy transfer of carcinogens in complex oil environments.

PubMed

Serio, Nicole; Chanthalyma, Chitapom; Prignano, Lindsey; Levine, Mindy

2013-11-27

Reported herein is the use of γ-cyclodextrin for two tandem functions: (a) the extraction of carcinogenic polycyclic aromatic hydrocarbons (PAHs) from oil samples into aqueous solution and (b) the promotion of highly efficient energy transfer from the newly extracted PAHs to a high-quantum-yield fluorophore. The extraction proceeded in moderate to good efficiencies, and the resulting cyclodextrin-promoted energy transfer led to a new, brightly fluorescent signal in aqueous solution. The resulting dual-function system (extraction followed by energy transfer) has significant relevance in the environmental detection and cleanup of oil-spill-related carcinogens.

Trial Promoter: A Web-Based Tool for Boosting the Promotion of Clinical Research Through Social Media.

PubMed

Reuter, Katja; Ukpolo, Francis; Ward, Edward; Wilson, Melissa L; Angyan, Praveen

2016-06-29

Scarce information about clinical research, in particular clinical trials, is among the top reasons why potential participants do not take part in clinical studies. Without volunteers, on the other hand, clinical research and the development of novel approaches to preventing, diagnosing, and treating disease are impossible. Promising digital options such as social media have the potential to work alongside traditional methods to boost the promotion of clinical research. However, investigators and research institutions are challenged to leverage these innovations while saving time and resources. To develop and test the efficiency of a Web-based tool that automates the generation and distribution of user-friendly social media messages about clinical trials. Trial Promoter is developed in Ruby on Rails, HTML, cascading style sheet (CSS), and JavaScript. In order to test the tool and the correctness of the generated messages, clinical trials (n=46) were randomized into social media messages and distributed via the microblogging social media platform Twitter and the social network Facebook. The percent correct was calculated to determine the probability with which Trial Promoter generates accurate messages. During a 10-week testing phase, Trial Promoter automatically generated and published 525 user-friendly social media messages on Twitter and Facebook. On average, Trial Promoter correctly used the message templates and substituted the message parameters (text, URLs, and disease hashtags) 97.7% of the time (1563/1600). Trial Promoter may serve as a promising tool to render clinical trial promotion more efficient while requiring limited resources. It supports the distribution of any research or other types of content. The Trial Promoter code and installation instructions are freely available online.

Trial Promoter: A Web-Based Tool for Boosting the Promotion of Clinical Research Through Social Media

PubMed Central

Ukpolo, Francis; Ward, Edward; Wilson, Melissa L

2016-01-01

Background Scarce information about clinical research, in particular clinical trials, is among the top reasons why potential participants do not take part in clinical studies. Without volunteers, on the other hand, clinical research and the development of novel approaches to preventing, diagnosing, and treating disease are impossible. Promising digital options such as social media have the potential to work alongside traditional methods to boost the promotion of clinical research. However, investigators and research institutions are challenged to leverage these innovations while saving time and resources. Objective To develop and test the efficiency of a Web-based tool that automates the generation and distribution of user-friendly social media messages about clinical trials. Methods Trial Promoter is developed in Ruby on Rails, HTML, cascading style sheet (CSS), and JavaScript. In order to test the tool and the correctness of the generated messages, clinical trials (n=46) were randomized into social media messages and distributed via the microblogging social media platform Twitter and the social network Facebook. The percent correct was calculated to determine the probability with which Trial Promoter generates accurate messages. Results During a 10-week testing phase, Trial Promoter automatically generated and published 525 user-friendly social media messages on Twitter and Facebook. On average, Trial Promoter correctly used the message templates and substituted the message parameters (text, URLs, and disease hashtags) 97.7% of the time (1563/1600). Conclusions Trial Promoter may serve as a promising tool to render clinical trial promotion more efficient while requiring limited resources. It supports the distribution of any research or other types of content. The Trial Promoter code and installation instructions are freely available online. PMID:27357424

Au generation centres doped n+-Si: hole-injection adjustable anode for efficient organic light emission

NASA Astrophysics Data System (ADS)

Li, Y. Z.; Ran, G. Z.; Zhao, W. Q.; Qin, G. G.

2008-08-01

An organic light-emitting diode (OLED) with an n-Si-anode usually has an efficiency evidently lower than the OLED with the same structure with a p-Si-anode due to insufficient hole injection from the n-Si anode compared with the p-Si-anode. In this study, we find that introducing Au as generation centres with a suitable concentration into the n+-Si anode can enhance hole injection to match electron injection and then considerably promote the power efficiency. With optimizing Au generation centre concentration in the n+-Si anode, the OLED with a structure of n+-Si: Au/NPB/AlQ/Sm/Au reaches a highest power efficiency of 1.0 lm W-1, evidently higher than the reported highest power efficiency of 0.2 lm W-1 for its p-Si-anode counterpart. Furthermore, when the electron injection is enhanced by adopting BPhen:Cs2CO3 partly instead of AlQ as the electron transport material, and the Au generation centre concentration in the n+-Si anode is promoted correspondingly, then a highest power efficiency of 1.8 lm W-1 is reached. The role of Au generation centres in the n+-Si anode is discussed.

48 CFR 23.202 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Energy and Water Efficiency and Renewable Energy 23.202 Policy. (a) Introduction. The Government's policy is to acquire supplies and services that promote a clean energy economy that increases our Nation...

48 CFR 23.202 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Energy and Water Efficiency and Renewable Energy 23.202 Policy. (a) Introduction. The Government's policy is to acquire supplies and services that promote a clean energy economy that increases our Nation...

48 CFR 23.202 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Energy and Water Efficiency and Renewable Energy 23.202 Policy. (a) Introduction. The Government's policy is to acquire supplies and services that promote a clean energy economy that increases our Nation...

48 CFR 23.202 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Energy and Water Efficiency and Renewable Energy 23.202 Policy. (a) Introduction. The Government's policy is to acquire supplies and services that promote a clean energy economy that increases our Nation...

78 FR 59814 - Extension of Temporary Registration of Municipal Advisors

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-30

..., 2010; Steve Apfelbacher, President, National Association of Independent Public Finance Advisors, dated..., whether the action would promote efficiency, competition, and capital formation.\\29\\ In addition, Section... as the impact on efficiency, competition, and capital formation, of the amendments are measured. In...

Model-based reconstruction of synthetic promoter library in Corynebacterium glutamicum.

PubMed

Zhang, Shuanghong; Liu, Dingyu; Mao, Zhitao; Mao, Yufeng; Ma, Hongwu; Chen, Tao; Zhao, Xueming; Wang, Zhiwen

2018-05-01

To develop an efficient synthetic promoter library for fine-tuned expression of target genes in Corynebacterium glutamicum. A synthetic promoter library for C. glutamicum was developed based on conserved sequences of the - 10 and - 35 regions. The synthetic promoter library covered a wide range of strengths, ranging from 1 to 193% of the tac promoter. 68 promoters were selected and sequenced for correlation analysis between promoter sequence and strength with a statistical model. A new promoter library was further reconstructed with improved promoter strength and coverage based on the results of correlation analysis. Tandem promoter P70 was finally constructed with increased strength by 121% over the tac promoter. The promoter library developed in this study showed a great potential for applications in metabolic engineering and synthetic biology for the optimization of metabolic networks. To the best of our knowledge, this is the first reconstruction of synthetic promoter library based on statistical analysis of C. glutamicum.

The Water Efficiency Paradox, a study of Central Asia

NASA Astrophysics Data System (ADS)

Merks, Joreen; Bastiaanssen, Wim

2017-04-01

Water scarcity is a rapidly growing concern in the semi-arid areas of Central Asia. Water savings and efficiency improvement programs are promoted as a possibility to save the Aral Sea. The Aral Seas lost 92% of its volume between 1960 and 2009. Projects on rehabilitating the Aral Sea and increasing the efficiency of water use in the irrigation sector are, however, not making progress. In Central Asia, 90% of the water withdrawal is allocated to agriculture. Irrigation efficiency programs often disregard the downstream connectivity of the water flow path. Not all water being applied is consumed by crop evapotranspiration and in fact an equally great portion of water returns back into the river basin system and is reused downstream. This cascade effect implies that results in one location can induce a scarcity of water in another location. The cascade effect in the Syr Darya has been studied by means of the Aral Sea Basin Management Model (ASBMM) designed by SIC-ICWC and remote sensing data produced by UNESCO-IHE. We will demonstrate the impact of increasing irrigation efficiency locally on the overall water consumption in the basin. We will show that efficiency increases with larger areas, and that there are caps to the maximum efficiency at basin scale. Increasing efficiency is thus not self-evident. Classical solutions on promoting increase of efficiency and water savings are therefore outdated and misleads stakeholders. We will look into the misconceptions and challenges in the communication between researchers and policy makers regarding increasing efficiency.

Multimedia learning for increasing knowledge on energy efficiency and promotion of proenvironmental behavior: A study of undergraduate students in Costa Rica

NASA Astrophysics Data System (ADS)

Walsh-Zuniga, Yoselyn

Promotion of energy efficiency practices among household has been employed in many interventions with a varying degree of success, mainly on developed countries. The purpose of the study is to promote and measure knowledge of proenvironmental behavior in undergraduate students in the Costa Rica Institute of Technology. The intervention used for this purpose provided personal and altruistic information about the impact of energy consumption activities in household. People's perceptions and attitudes about behaviors that contribute and mitigate climate change were also investigated. Participants were students from undergraduate programs who are also inhabitants of the residence hall provided by the institution. The participation consisted in two surveys and a learning module. Students responded a survey before and after exposure to a learning module. Surveys focused on identifying knowledge, attitudes and intentions. The learning module provided information about three hypothetical scenarios and corresponding energy consumption estimates for each one. Participants did not significantly improve their knowledge on energy efficiency topics and did not change perceptions about the topic of climate change. Yet for both, knowledge and perceptions, participants demonstrated an average knowledge on topics associated to climate change. In addition, participants did not use technical information to explain concepts and perceptions. Another important finding was that participants wrote their responses more third-person than in first person singular or plural, meaning that, excluding themselves from the solution and the problem. Results suggest that there is an average knowledge among participants about 2.5 out of 5 points that represent a start point to design more successful interventions that promote energy efficiency behaviors. A major recommendation to improve energy efficiency behaviors is to place a greater emphasis and awareness in personal consequences of the misuse of energy in household as part of future interventions. More studies based on real consumption data along with more engaging visualizations are highly encouraged.

Efficient gusA transient expression in Porphyra yezoensis protoplasts mediated by endogenous beta-tubulin flanking sequences

NASA Astrophysics Data System (ADS)

Gong, Qianhong; Yu, Wengong; Dai, Jixun; Liu, Hongquan; Xu, Rifu; Guan, Huashi; Pan, Kehou

2007-01-01

Endogenous tubulin promoter has been widely used for expressing foreign genes in green algae, but the efficiency and feasibility of endogenous tubulin promoter in the economically important Porphyra yezoensis (Rhodophyta) are unknown. In this study, the flanking sequences of beta-tubulin gene from P. yezoensis were amplified and two transient expression vectors were constructed to determine their transcription promoting feasibility for foreign gene gusA. The testing vector pATubGUS was constructed by inserting 5'-and 3'-flanking regions ( Tub5' and Tub3') up-and down-stream of β-glucuronidase (GUS) gene ( gusA), respectively, into pA, a derivative of pCAT®3-enhancer vector. The control construct, pAGUSTub3, contains only gusA and Tub3'. These constructs were electroporated into P. yezoensis protoplasts and the GUS activities were quantitatively analyzed by spectrometry. The results demonstrated that gusA gene was efficiently expressed in P. yezoensis protoplasts under the regulation of 5'-flanking sequence of the beta-tubulin gene. More interestingly, the pATubGUS produced stronger GUS activity in P. yezoensis protoplasts when compared to the result from pBI221, in which the gusA gene was directed by a constitutive CaMV 35S promoter. The data suggest that the integration of P. yezoensis protoplast and its endogenous beta-tubulin flanking sequences is a potential novel system for foreign gene expression.

3 CFR 13502 - Executive Order 13502 of February 6, 2009. Use of Project Labor Agreements for Federal...

Code of Federal Regulations, 2010 CFR

2010-01-01

... developing by providing structure and stability to large-scale construction projects, thereby promoting the... procurement, producing labor-management stability, and ensuring compliance with laws and regulations governing... construction projects receiving Federal financial assistance, would help to promote the economical, efficient...

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

ERIC Educational Resources Information Center

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

2010-01-01

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

Assessment Rubrics: Thinking inside the Boxes

ERIC Educational Resources Information Center

Bennett, Cary

2016-01-01

Assessment rubrics are being promoted and introduced into tertiary teaching practices on the grounds that they are an efficient and reliable tool to evaluate student performance effectively and promote student learning. However, there has been little discussion on the value of using assessment rubrics in higher education. Rather, they are being…

Collaborative Efforts to Promote Emergent Literacy and Efficient Word Recognition Skills

ERIC Educational Resources Information Center

Roth, Froma P.; Troia, Gary A.

2006-01-01

In this article, 3 models of collaboration between speech-language pathologists and classroom teachers are discussed to promote emergent literacy and accurate and fluent word recognition. These models are demonstration lessons, team teaching, and consultation. A number of instructional principles are presented for emergent literacy and decoding…

77 FR 41940 - Clearing Exemption for Certain Swaps Entered Into by Cooperatives

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-17

... Act Section 4(c)(1) of the CEA provides that, in order to promote responsible economic or financial... members of the cooperative promotes greater economic efficiency and lower costs for the members. The... responsible economic and financial innovation and fair competition. The Commission requests public comment on...

7 CFR 932.45 - Production research and marketing research and development projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; and (3) Its recommendation as to promotion activity and paid advertising. (e) The committee shall, as... efficient production of California olives. Such projects may provide for any form of marketing promotion including paid advertising. The expenses of such research and projects shall be paid from funds collected...

Fleet Feedback and Fleet Efficiency Metrics

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

Singer, Mark R

The Marine Corps have 10 years of experience implementing a telematics program and several lessons to share with partner agencies. This presentation details results of a Marine Corps survey as well as methods of using telematics to promote fleet efficiency and optimize the vehicle acquisition process.

New strategy to promote conversion efficiency using high-index nanostructures in thin-film solar cells

PubMed Central

Wang, DongLin; Su, Gang

2014-01-01

Nano-scaled metallic or dielectric structures may provide various ways to trap light into thin-film solar cells for improving the conversion efficiency. In most schemes, the textured active layers are involved into light trapping structures that can provide perfect optical benefits but also bring undesirable degradation of electrical performance. Here we propose a novel approach to design high-performance thin-film solar cells. In our strategy, a flat active layer is adopted for avoiding electrical degradation, and an optimization algorithm is applied to seek for an optimized light trapping structure for the best optical benefit. As an example, we show that the efficiency of a flat a-Si:H thin-film solar cell can be promoted close to the certified highest value. It is also pointed out that, by choosing appropriate dielectric materials with high refractive index (>3) and high transmissivity in wavelength region of 350 nm–800 nm, the conversion efficiency of solar cells can be further enhanced. PMID:25418477

Pgas, a Low-pH-Induced Promoter, as a Tool for Dynamic Control of Gene Expression for Metabolic Engineering of Aspergillus niger

PubMed Central

Yin, Xian; Shin, Hyun-Dong; Li, Jianghua; Du, Guocheng; Chen, Jian

2017-01-01

ABSTRACT The dynamic control of gene expression is important for adjusting fluxes in order to obtain desired products and achieve appropriate cell growth, particularly when the synthesis of a desired product drains metabolites required for cell growth. For dynamic gene expression, a promoter responsive to a particular environmental stressor is vital. Here, we report a low-pH-inducible promoter, Pgas, which promotes minimal gene expression at pH values above 5.0 but functions efficiently at low pHs, such as pH 2.0. First, we performed a transcriptional analysis of Aspergillus niger, an excellent platform for the production of organic acids, and we found that the promoter Pgas may act efficiently at low pH. Then, a gene for synthetic green fluorescent protein (sGFP) was successfully expressed by Pgas at pH 2.0, verifying the results of the transcriptional analysis. Next, Pgas was used to express the cis-aconitate decarboxylase (cad) gene of Aspergillus terreus in A. niger, allowing the production of itaconic acid at a titer of 4.92 g/liter. Finally, we found that Pgas strength was independent of acid type and acid ion concentration, showing dependence on pH only. IMPORTANCE The promoter Pgas can be used for the dynamic control of gene expression in A. niger for metabolic engineering to produce organic acids. This promoter may also be a candidate tool for genetic engineering. PMID:28087530

Numerical variation of dark cells in normal and chemically induced hyperplastic epidermis with age of animal and efficiency of tumor promoter. [Mice

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

Klein-Szanto, A.J.P.; Slaga, T.J.

1981-11-01

The percentage of dark basal keratinocytes was quantitatively assessed in normal epidermis of Sencar mice before and after birth and in adult epidermis after topical application of several compounds of varying promoting efficiency. The percentage of dark keratinocytes reached a maximum at the 19th day of gestation (approx.40%) and fell abruptly after birth (approx.3%). Old animals exhibited a very low number of dark basal cells (0.2%). After topical application of the weak promoters resiniferotoxin, anthralin, ethylphenylpropiolate, and 12-deoxyphorbol-13-2,4,6-decatrienoate, the percentage of dark cells in young adult epidermis did not differ markedly from that in control (acetone-treated) specimens. The strong first-stagemore » promoters 4-O-methyl-12-O-tetradecanoylphorbol-13-acetate and calcium ionophore A 23187, as well as the strong complete promoter 12-deoxyphorbol-13-deoxyphorbol-13-decanoate, induced the appearance of large numbers of dark keratinocytes, in a percentage similar to that seen after 12-O-tetra-decanoylphorbol-13-acetate application (approx.20%). The similarities between the dark keratinocytes seen after topical application of 12-O-tetradecanoylphorbol-13-acetate or other strong promoters and the dark cells observed in the fetal epidermis before the onset of the adult type of epidermal keratinization indicate that potent and/or first stage tumor promoters can be identified by their ability to induce cells resembling fetal-type dedifferentiated keratinocytes.« less

Incentive pricing and cost recovery at the basin scale.

PubMed

Ward, Frank A; Pulido-Velazquez, Manuel

2009-01-01

Incentive pricing programs have potential to promote economically efficient water use patterns and provide a revenue source to compensate for environmental damages. However, incentive pricing may impose disproportionate costs and aggravate poverty where high prices are levied for basic human needs. This paper presents an analysis of a two-tiered water pricing system that sets a low price for subsistence needs, while charging a price equal to marginal cost, including environmental cost, for discretionary uses. This pricing arrangement can promote efficient and sustainable water use patterns, goals set by the European Water Framework Directive, while meeting subsistence needs of poor households. Using data from the Rio Grande Basin of North America, a dynamic nonlinear program, maximizes the basin's total net economic and environmental benefits subject to several hydrological and institutional constraints. Supply costs, environmental costs, and resource costs are integrated in a model of a river basin's hydrology, economics, and institutions. Three programs are compared: (1) Law of the River, in which water allocations and prices are determined by rules governing water transfers; (2) marginal cost pricing, in which households pay the full marginal cost of supplying treated water; (3) two-tiered pricing, in which households' subsistence water needs are priced cheaply, while discretionary uses are priced at efficient levels. Compared to the Law of the River and marginal cost pricing, two-tiered pricing performs well for efficiency and adequately for sustainability and equity. Findings provide a general framework for formulating water pricing programs that promote economically and environmentally efficient water use programs while also addressing other policy goals.

Novel efficient promoter of the mitochondrial porin, voltage-dependent anion channel (VDAC), in the genome of the Yarrowia lipolytica yeast.

PubMed

Kulanbaewa, F F; Sekova, V Yu; Isakova, E P; Deryabina, Y I; Nikolaev, A V

2016-09-01

This article presents the characteristics of the highly inducible promoter of the gene encoding the mitochondrial porin, the voltage-dependent anion channel (VDAC). This promoter is recommended for use in new genetic constructs both in basic research for assessing the adaptive strategy of lower eukaryotes under adverse conditions and in designing new highly competitive transformants producing economically important compounds (proteins, lipids, and organic acids) on its basis.

The DUSP–Ubl domain of USP4 enhances its catalytic efficiency by promoting ubiquitin exchange

PubMed Central

Clerici, Marcello; Luna-Vargas, Mark P. A.; Faesen, Alex C.; Sixma, Titia K.

2014-01-01

Ubiquitin-specific protease USP4 is emerging as an important regulator of cellular pathways, including the TGF-β response, NF-κB signalling and splicing, with possible roles in cancer. Here we show that USP4 has its catalytic triad arranged in a productive conformation. Nevertheless, it requires its N-terminal DUSP–Ubl domain to achieve full catalytic turnover. Pre-steady-state kinetics measurements reveal that USP4 catalytic domain activity is strongly inhibited by slow dissociation of ubiquitin after substrate hydrolysis. The DUSP–Ubl domain is able to enhance ubiquitin dissociation, hence promoting efficient turnover. In a mechanism that requires all USP4 domains, binding of the DUSP–Ubl domain promotes a change of a switching loop near the active site. This ‘allosteric regulation of product discharge’ provides a novel way of regulating deubiquitinating enzymes that may have relevance for other enzyme classes. PMID:25404403

Influence of calcium phosphate nanoparticles, Piriformospora indica and Glomus mosseae on growth of Zea mays

NASA Astrophysics Data System (ADS)

Rane, Mansi; Bawskar, Manisha; Rathod, Dnyaneshwar; Nagaonkar, Dipali; Rai, Mahendra

2015-12-01

In this study, the arbuscular mycorrhizal fungus (G. mosseae) and endosymbiont (P. indica) colonized Zea mays were treated with calcium phosphate nanoparticles (CaPNPs) and evaluated for their plant growth promotion efficiency. It was observed that CaPNPs in combination with both G. mosseae and P. indica are more potent plant growth promoter than independent combinations of CaPNPs + G. mosseae, CaPNPs + P. indica or CaPNPs alone. The fluorimetric studies of treated plants revealed that CaPNPs alone and in combination with P. indica can enhance vitality of Zea mays by improving chlorophyll a content and performance index of treated plants. Hence, we conclude that CaPNPs exhibit synergistic growth promotion, root proliferation and vitality improvement properties along with endosymbiotic and arbuscular mycorrhizal fungi, which after further field trials can be developed as a cost-effective nanofertilizer with pronounced efficiency.

Promoter-Based Theranostics for Prostate Cancer

DTIC Science & Technology

2016-06-01

diagnosis vector consists of the tumor-specific PEG-promoter (PEG-Prom) and cDNA of human chorionic gonadotropin β chain (βhCG) as a reporter. We...transfection efficiency. We also used CpG-free cDNA of Figure 5. pCpGfree-PEGwt-HSV1-tk-neo vector expressed functional thymidine kinase in human

Searching for Solutions. A Citizen's Guide to Hazardous Waste Management in Ohio.

ERIC Educational Resources Information Center

Clapham, Pete, Comp.

This guide was developed to promote responsible hazardous waste management by Ohio citizens, citizens who are interested in upgrading operations of existing waste facilities, oppose the development of any new landfills, and those who promote the establishment of modern, efficient facilities. Information is presented in six chapters. The hazardous…

Hydrogen-bond-driven electrophilic activation for selectivity control: scope and limitations of fluorous alcohol-promoted selective formation of 1,2-disubstituted benzimidazoles and mechanistic insight for rationale of selectivity.

PubMed

Chebolu, Rajesh; Kommi, Damodara N; Kumar, Dinesh; Bollineni, Narendra; Chakraborti, Asit K

2012-11-16

Hydrogen-bond-driven electrophilic activation for selectivity control during competitive formation of 1,2-disubstituted and 2-substituted benzimidazoles from o-phenylenediamine and aldehydes is reported. The fluorous alcohols trifluoroethanol and hexafluoro-2-propanol efficiently promote the cyclocondensation of o-phenylenediamine with aldehydes to afford selectively the 1,2-disubstituted benzimidazoles at rt in short times. A mechanistic insight is invoked by NMR, mass spectrometry, and chemical studies to rationalize the selectivity. The ability of the fluorous alcohols in promoting the reaction and controlling the selectivity can be envisaged from their better hydrogen bond donor (HBD) abilities compared to that of the other organic solvents as well as of water. Due to the better HBD values, the fluorous alcohols efficiently promote the initial bisimine formation by electrophilic activation of the aldehyde carbonyl. Subsequently the hydrogen-bond-mediated activation of the in situ-formed bisimine triggers the rearrangement via 1,3-hydride shift to form the 1,2-disubstituted benzimidazoles.

Micropropagation of Asparagus by in vitro shoot culture.

PubMed

Stajner, Nataša

2013-01-01

Asparagus officinalis is most extensively studied species within the genus Asparagus, which is well known as garden asparagus. This species is dioecious with unisexual flowers, which means that generative propagation gives roughly equal number of male and female plants. Male plants are high yielders and preferred commercially over female plants. Tissue culture techniques could efficiently promote vegetative propagation of male plants and pave the way for efficient plant breeding.This chapter describes an efficient micropropagation protocol for developing rapid growing in vitro Asparagus shoot cultures. The source of explants, inoculation, and shoot proliferation, followed by shoot propagation, rooting, and acclimatization is described. The optimal medium for Asparagus micropropagation described in this chapter is composed of MS macro- and microelements and a combination of auxins and cytokinins. Plant growth regulators NAA, kinetin, and BA were used in various concentrations. Three different media representing the whole micropropagation protocol of Asparagus are described; medium for shoot initiation, medium for shoot multiplication, and medium for root formation. By in vitro propagation of Asparagus, root initiation is difficult, but can be promoted by adding growth retardant ancymidol which also greatly promotes shoot development and suppresses callus formation.

Mechanism of protein splicing of the Pyrococcus abyssi lon protease intein

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

O'Brien, Kevin M.; Schufreider, Ann K.; McGill, Melissa A.

2010-12-17

Research highlights: {yields} The Pyrococcus abyssi lon protease intein promotes efficient protein splicing. {yields} Inteins with mutations that interfere with individual steps of splicing do not promote unproductive side reactions. {yields} The intein splices with Lys in place of the highly conserved penultimate His. {yields} The intein is flanked by a Gly-rich region at its C terminus that may increase the efficiency of the third step of splicing, Asn cyclization coupled to peptide bond cleavage. -- Abstract: Protein splicing is a post-translational process by which an intervening polypeptide, the intein, excises itself from the flanking polypeptides, the exteins, coupled tomore » ligation of the exteins. The lon protease of Pyrococcus abyssi (Pab) is interrupted by an intein. When over-expressed as a fusion protein in Escherichia coli, the Pab lon protease intein can promote efficient protein splicing. Mutations that block individual steps of splicing generally do not lead to unproductive side reactions, suggesting that the intein tightly coordinates the splicing process. The intein can splice, although it has Lys in place of the highly conserved penultimate His, and mutants of the intein in the C-terminal region lead to the accumulation of stable branched-ester intermediate.« less

Energy-Efficient Schools: Three Case Studies from Oregon.

ERIC Educational Resources Information Center

2003

This document presents case studies of three schools or districts in Oregon that have implemented steps to promote energy efficiency. Steps taken by the schools include daylighting, energy audits, special energy loans, new ventilation design, and sustainable building practices. The facilities described are Ash Creek Intermediate School in…

78 FR 13872 - Proposed Information Collection Request; Comment Request; EPA's WaterSense Program (Renewal); EPA...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-01

... profanity, threats, information claimed to be Confidential Business Information (CBI) or other information...-efficient products and use water-efficient practices. As part of strategic planning efforts, EPA encourages... Reporting Form Promotional partners 6100-09 Manufacturers (separate forms for plumbing and non- plumbing...

Impacts of Nebraska Legislative Policies on Selected Small Nebraska School Districts

ERIC Educational Resources Information Center

Cogswell, Curtis

2009-01-01

The 1997 Nebraska Legislature enacted Bill 806 to promote school consolidation, which legislators believed would lead schools to become more cost-efficient and provide a significantly larger curriculum. This legislative action begged the question: Has the move to consolidate schools made Nebraska schools more efficient while providing greater…

77 FR 56067 - Changes To Implement Derivation Proceedings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-11

... regulations is to establish a more efficient and streamlined patent system. The preamble of this notice sets... patent system, the efficient administration of the Office, and the ability of the Office to complete the... substantially same invention, thus promoting the useful arts by participating in the patent system. Facially...

Proline/pipecolinic acid-promoted copper-catalyzed P-arylation.

PubMed

Huang, Cheng; Tang, Xu; Fu, Hua; Jiang, Yuyang; Zhao, Yufen

2006-06-23

We have developed a convenient and efficient approach for P-arylation of organophosphorus compounds containing P-H. Using commercially available and inexpensive proline and pipecolinic acid as the ligands greatly improved the efficiency of the coupling reactions, so the method can provide an entry to arylphosphonates, arylphosphinates and arylphosphine oxides.

78 FR 6094 - Information Collection Request Submitted to OMB for Review and Approval; Comment Request; EPA's...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

... encompass organization-wide energy performance improvement, such as building technology upgrades, product... help EPA promote energy-efficient technologies by evaluating the efficiency of their buildings using... Leaders--Ineligible Facilities List (5900-20) ENERGY STAR Leaders--Leaders Story (5900-20) Service and...

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

Yu, Sha; Evans, Meredydd; Shi, Qing

China will account for about half of the new construction globally in the coming decade. Its floorspace doubled from 1996 to 2011, and Chinese rural buildings alone have as much floorspace as all of U.S. residential buildings. Building energy consumption has also grown, increasing by over 40% since 1990. To curb building energy demand, the Chinese government has launched a series of policies and programs. Combined, this growth in buildings and renovations, along with the policies to promote green buildings, are creating a large market for energy efficiency products and services. This report assesses the impact of China’s policies onmore » building energy efficiency and on the market for energy efficiency in the future. The first chapter of this report introduces the trends in China, drawing on both historical analysis, and detailed modeling of the drivers behind changes in floorspace and building energy demand such as economic and population growth, urbanization, policy. The analysis describes the trends by region, building type and energy service. The second chapter discusses China’s policies to promote green buildings. China began developing building energy codes in the 1980s. Over time, the central government has increased the stringency of the code requirements and the extent of enforcement. The codes are mandatory in all new buildings and major renovations in China’s cities, and they have been a driving force behind the expansion of China’s markets for insulation, efficient windows, and other green building materials. China also has several other important policies to encourage efficient buildings, including the Three-Star Rating System (somewhat akin to LEED), financial incentives tied to efficiency, appliance standards, a phasing out of incandescent bulbs and promotion of efficient lighting, and several policies to encourage retrofits in existing buildings. In the third chapter, we take “deep dives” into the trends affecting key building components. This chapter examines insulation in walls and roofs; efficient windows and doors; heating, air conditioning and controls; and lighting. These markets have seen significant growth because of the strength of the construction sector but also the specific policies that require and promote efficient building components. At the same time, as requirements have become more stringent, there has been fierce competition, and quality has at time suffered, which in turn has created additional challenges. Next we examine existing buildings in chapter four. China has many Soviet-style, inefficient buildings built before stringent requirements for efficiency were more widely enforced. As a result, there are several specific market opportunities related to retrofits. These fall into two or three categories. First, China now has a code for retrofitting residential buildings in the north. Local governments have targets of the number of buildings they must retrofit each year, and they help finance the changes. The requirements focus on insulation, windows, and heat distribution. Second, the Chinese government recently decided to increase the scale of its retrofits of government and state-owned buildings. It hopes to achieve large scale changes through energy service contracts, which creates an opportunity for energy service companies. Third, there is also a small but growing trend to apply energy service contracts to large commercial and residential buildings. This report assesses the impacts of China’s policies on building energy efficiency. By examining the existing literature and interviewing stakeholders from the public, academic, and private sectors, the report seeks to offer an in-depth insights of the opportunities and barriers for major market segments related to building energy efficiency. The report also discusses trends in building energy use, policies promoting building energy efficiency, and energy performance contracting for public building retrofits.« less

An Efficient Synthesis of Dicycloalkylacetylenes: 1,2-Dicyclopropylethyne and (cyclopropylethynyl)cyclobutane (Preprint)

DTIC Science & Technology

2008-11-05

ANSI Std. 239.18 The Distribution A : “Approved for public release; distribution unlimited.” An Efficient Synthesis of Dicycloalkylacetylenes: 1 ... synthesis of terminal/internal alkynes involve the alkynylation of alkylhalide with metal acetylide 1 or base promoted dehydrohalogenation 2 of...chloropent- 1 -yne (5, 57%) 9 and 1,8- dichlorooct- 1 -yne(9, 36%). 8 We report here an efficient and economical synthesis of dicycloalkylethynes namely

Precise Maps of RNA Polymerase Reveal How Promoters Direct Initiation and Pausing

PubMed Central

Kwak, Hojoong; Fuda, Nicholas J.; Core, Leighton J.; Lis, John T.

2014-01-01

Transcription regulation occurs frequently through promoter-associated pausing of RNA polymerase II (Pol II). We developed a Precision nuclear Run-On and sequencing assay (PRO-seq) to map the genome-wide distribution of transcriptionally-engaged Pol II at base-pair resolution. Pol II accumulates immediately downstream of promoters, at intron-exon junctions that are efficiently used for splicing, and over 3' poly-adenylation sites. Focused analyses of promoters reveal that pausing is not fixed relative to initiation sites nor is it specified directly by the position of a particular core promoter element or the first nucleosome. Core promoter elements function beyond initiation, and when optimally positioned they act collectively to dictate the position and strength of pausing. We test this ‘Complex Interaction’ model with insertional mutagenesis of the Drosophila Hsp70 core promoter. PMID:23430654

Biosynthetic burden and plasmid burden limit expression of chromosomally integrated heterologous genes (pdc, adhB) in Escherichia coli

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

Martinez, A.; York, S.W.; Yomano, L.P.

1999-10-01

Previous studies have shown an unexpectedly high nutrient requirement for efficient ethanol production by ethanologenic recombinants of Escherichia coli B such as LY01 which contain chromosomally integrated Zymomonas mobilis genes (pdc, adhB) encoding the ethanol pathway. The basis for this requirement has been identified as a media-dependent effect on the expression of the Z. mobilis genes rather than a nutritional limitation. Ethanol production was substantially increased without additional nutrients simply by increasing the level of pyruvate decarboxylase activity. This was accomplished by adding a multicopy plasmid containing pdc alone (but not adhB alone) to strain LY01, and by adding multicopymore » plasmids which express pdc and adhB from strong promoters. New strong promoters were isolated from random fragments of Z. mobilis DNA and characterized but were not used to construct integrated biocatalysts. These promoters contained regions resembling recognition sites for 3 different E. coli sigma factors: {sigma}{sup 70}, {sigma}{sup 38}, and {sigma}{sup 28}. The most effective plasmid-based promoters for fermentation were recognized by multiple sigma factors, expressed both pdc and adhB at high levels, and produced ethanol efficiently while allowing up to 80% reduction in complex nutrients as compared to LY01. The ability to utilize multiple sigma factors may be advantageous to maintain the high levels of PDC and ADH needed for efficient ethanol production throughout batch fermentation.« less

A stabilized headless measles virus attachment protein stalk efficiently triggers membrane fusion.

PubMed

Brindley, Melinda A; Suter, Rolf; Schestak, Isabel; Kiss, Gabriella; Wright, Elizabeth R; Plemper, Richard K

2013-11-01

Paramyxovirus attachment and fusion (F) envelope glycoprotein complexes mediate membrane fusion required for viral entry. The measles virus (MeV) attachment (H) protein stalk domain is thought to directly engage F for fusion promotion. However, past attempts to generate truncated, fusion-triggering-competent H-stem constructs remained fruitless. In this study, we addressed the problem by testing the hypothesis that truncated MeV H stalks may require stabilizing oligomerization tags to maintain intracellular transport competence and F-triggering activity. We engineered H-stems of different lengths with added 4-helix bundle tetramerization domains and demonstrate restored cell surface expression, efficient interaction with F, and fusion promotion activity of these constructs. The stability of the 4-helix bundle tags and the relative orientations of the helical wheels of H-stems and oligomerization tags govern the kinetics of fusion promotion, revealing a balance between H stalk conformational stability and F-triggering activity. Recombinant MeV particles expressing a bioactive H-stem construct in the place of full-length H are viable, albeit severely growth impaired. Overall, we demonstrate that the MeV H stalk represents the effector domain for MeV F triggering. Fusion promotion appears linked to the conformational flexibility of the stalk, which must be tightly regulated in viral particles to ensure efficient virus entry. While the pathways toward assembly of functional fusion complexes may differ among diverse members of the paramyxovirus family, central elements of the triggering machinery emerge as highly conserved.

Fatty acid oxidation promotes reprogramming by enhancing oxidative phosphorylation and inhibiting protein kinase C.

PubMed

Lin, Zhaoyu; Liu, Fei; Shi, Peiliang; Song, Anying; Huang, Zan; Zou, Dayuan; Chen, Qin; Li, Jianxin; Gao, Xiang

2018-02-26

Changes in metabolic pathway preferences are key events in the reprogramming process of somatic cells to induced pluripotent stem cells (iPSCs). The optimization of metabolic conditions can enhance reprogramming; however, the detailed underlying mechanisms are largely unclear. By comparing the gene expression profiles of somatic cells, intermediate-phase cells, and iPSCs, we found that carnitine palmitoyltransferase (Cpt)1b, a rate-limiting enzyme in fatty acid oxidation, was significantly upregulated in the early stage of the reprogramming process. Mouse embryonic fibroblasts isolated from transgenic mice carrying doxycycline (Dox)-inducible Yamanaka factor constructs were used for reprogramming. Various fatty acid oxidation-related metabolites were added during the reprogramming process. Colony counting and fluorescence-activated cell sorting (FACS) were used to calculate reprogramming efficiency. Fatty acid oxidation-related metabolites were measured by liquid chromatography-mass spectrometry. Seahorse was used to measure the level of oxidative phosphorylation. We found that overexpression of cpt1b enhanced reprogramming efficiency. Furthermore, palmitoylcarnitine or acetyl-CoA, the primary and final products of Cpt1-mediated fatty acid oxidation, also promoted reprogramming. In the early reprogramming process, fatty acid oxidation upregulated oxidative phosphorylation and downregulated protein kinase C activity. Inhibition of protein kinase C also promoted reprogramming. We demonstrated that fatty acid oxidation promotes reprogramming by enhancing oxidative phosphorylation and inhibiting protein kinase C activity in the early stage of the reprogramming process. This study reveals that fatty acid oxidation is crucial for the reprogramming efficiency.

Three-dimensional hollow graphene efficiently promotes electron transfer of Ag3PO4 for photocatalytically eliminating phenol

NASA Astrophysics Data System (ADS)

Song, Shaoqing; Meng, Aiyun; Jiang, Shujuan; Cheng, Bei

2018-06-01

The effective transport of photo-induced carriers over semiconductor photocatalyst is critical for enhancing the photocatalytic performance under light excitation. Although oxidized graphene (GO) and/or reduced graphene oxide (rGO) has been used as cocatalyst to promote the transfer and utilization of electrons, however, random diffusion and transfer of photo-induced charges are inevitable from all sides over these actual graphene owing to the limitation of the preparation process and theory. Herein, we utilized three-dimensional hollow carbon graphene (HCG) to promote the efficient electron transfer of Ag3PO4 in the photocatalytic process. Owing to the confinement-induced electron field of HCG, the constructed HCG-Ag3PO4 photocatalytic system demonstrated the enhanced visible-light adsorption, improved transfer of photo-induced charges, and suitable redox potentials as revealed by transient photo-current spectroscopic, surface photovoltage spectroscopy, and electron paramagnetic resonance (EPR). EPR spectra of oxygen species and gas chromatography-mass spectra exhibited high efficiency activity over HCG-Ag3PO4 with Z-scheme photocatalytic mechanism for phenol decomposition by reaction between hexanoic acid and radOH and radO2-. It is noteworthy that photocatalytic performance over optimal HCG-Ag3PO4 is 6, 3.43, 1.92 times of pristine Ag3PO4, GO-Ag3PO4, and rGO-Ag3PO4, respectively. The results may supply a novel perspective to enhance transfer of photo-induced charges for the promotion of photocatalytic technology.

[The historical background and present development of evidence-based healthcare and clinical nursing].

PubMed

Tsai, Jung-Mei

2014-12-01

Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.

Building a Genetic Manipulation Tool Box for Orchid Biology: Identification of Constitutive Promoters and Application of CRISPR/Cas9 in the Orchid, Dendrobium officinale

PubMed Central

Kui, Ling; Chen, Haitao; Zhang, Weixiong; He, Simei; Xiong, Zijun; Zhang, Yesheng; Yan, Liang; Zhong, Chaofang; He, Fengmei; Chen, Junwen; Zeng, Peng; Zhang, Guanghui; Yang, Shengchao; Dong, Yang; Wang, Wen; Cai, Jing

2017-01-01

Orchidaceae is the second largest family of flowering plants, which is highly valued for its ornamental purposes and medicinal uses. Dendrobium officinale is a special orchid species that can grow without seed vernalization. Because the whole-genome sequence of D. officinale is publicly available, this species is poised to become a convenient research model for the evolutionary, developmental, and genetic studies of Orchidaceae. Despite these advantages, the methods of genetic manipulation are poorly developed in D. officinale. In this study, based on the previously developed Agrobacterium-mediated gene transformation system, we identified several highly efficient promoters for exogenous gene expression and successfully applied the CRISPR/Cas9 system for editing endogenous genes in the genome of D. officinale. These two basic techniques contribute to the genetic manipulation toolbox of Orchidaceae. The pCambia-1301-35SN vector containing the CaMV 35S promoter and the β-glucuronidase (GUS) and Superfolder green fluorescence protein (SG) as reporter genes were introduced into the plant tissues by the Agrobacterium-mediated transformation system. Fluorescence emission from the transformed plants confirmed the successful transcription and translation of SG genes into functional proteins. We compared the GUS activity under different promoters including four commonly used promoters (MtHP, CVMV, MMV and PCISV) with CaMV 35S promoter and found that MMV, CVMV, and PCISV were as effective as the 35S promoter. Furthermore, we applied the CRISPR/Cas9-mediated genome editing system successfully in D. officinale. By selecting five target genes (C3H, C4H, 4CL, CCR, and IRX) in the lignocellulose biosynthesis pathway, we showed that, for a given target, this system can generate edits (insertions, deletions, or substitutions) at a rate of 10 to 100%. These results showed that our two genetic manipulation tools can efficiently express exogenous genes and edit endogenous genes in D. officinale. These efficient research tools will not only help create novel D. officinale varieties, but will also facilitate the molecular genetic investigation of orchid biology. PMID:28127299

Building a Genetic Manipulation Tool Box for Orchid Biology: Identification of Constitutive Promoters and Application of CRISPR/Cas9 in the Orchid, Dendrobium officinale.

PubMed

Kui, Ling; Chen, Haitao; Zhang, Weixiong; He, Simei; Xiong, Zijun; Zhang, Yesheng; Yan, Liang; Zhong, Chaofang; He, Fengmei; Chen, Junwen; Zeng, Peng; Zhang, Guanghui; Yang, Shengchao; Dong, Yang; Wang, Wen; Cai, Jing

2016-01-01

Orchidaceae is the second largest family of flowering plants, which is highly valued for its ornamental purposes and medicinal uses. Dendrobium officinale is a special orchid species that can grow without seed vernalization. Because the whole-genome sequence of D. officinale is publicly available, this species is poised to become a convenient research model for the evolutionary, developmental, and genetic studies of Orchidaceae. Despite these advantages, the methods of genetic manipulation are poorly developed in D. officinale . In this study, based on the previously developed Agrobacterium -mediated gene transformation system, we identified several highly efficient promoters for exogenous gene expression and successfully applied the CRISPR/Cas9 system for editing endogenous genes in the genome of D. officinale . These two basic techniques contribute to the genetic manipulation toolbox of Orchidaceae. The pCambia-1301-35SN vector containing the CaMV 35S promoter and the β-glucuronidase ( GUS ) and Superfolder green fluorescence protein (SG) as reporter genes were introduced into the plant tissues by the Agrobacterium -mediated transformation system. Fluorescence emission from the transformed plants confirmed the successful transcription and translation of SG genes into functional proteins. We compared the GUS activity under different promoters including four commonly used promoters (MtHP, CVMV, MMV and PCISV) with CaMV 35S promoter and found that MMV, CVMV, and PCISV were as effective as the 35S promoter. Furthermore, we applied the CRISPR/Cas9-mediated genome editing system successfully in D. officinale . By selecting five target genes ( C3H, C4H, 4CL, CCR, and IRX ) in the lignocellulose biosynthesis pathway, we showed that, for a given target, this system can generate edits (insertions, deletions, or substitutions) at a rate of 10 to 100%. These results showed that our two genetic manipulation tools can efficiently express exogenous genes and edit endogenous genes in D. officinale . These efficient research tools will not only help create novel D. officinale varieties, but will also facilitate the molecular genetic investigation of orchid biology.

Improved production of transgenic Dioscorea zingiberensis (Dioscoreaceae) by Agrobacterium tumefaciens-mediated transformation.

PubMed

Shi, L; Fan, J Q; Hu, C G; Luo, J; Yao, J L

2012-02-03

The establishment of high-efficiency Agrobacterium-mediated transformation techniques could improve the production of Dioscorea zingiberensis, a medicinal species with a high diosgenin content. We co-cultivated embryogenic calli induced from mature seeds with A. tumefaciens strain EHA105. A binary vector, pCAMBIA1381, which contains the gfp and hpt genes under the control of the ubiquitin promoter and the CaMV 35S promoter, respectively, was used for transformation. Pre-culture, basic medium, acetosyringone, and bacterial density were evaluated to establish the most efficient protocol. The optimal conditions consisted of MS medium without CaCl(2) for pre- and co-cultivation, three days for pre-culture, addition of 200 μM AS, and an OD(600) of 0.5. The transgenic plants grown under selection were confirmed by PCR analysis and Southern blot analysis. This protocol produced transgenic D. zingiberensis plants in seven months, with a transformation efficiency of 6%.

Energy Factors in Commercial Mortgages: Gaps and Opportunities

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

Mathew, Paul; Coleman, Philip; Wallace, Nancy

2016-09-01

The commercial real estate mortgage market is enormous, with almost half a trillion dollars in deals originated in 2015. Relative to other energy efficiency financing mechanisms, very little attention has been paid to the potential of commercial mortgages as a channel for promoting energy efficiency investments. The valuation and underwriting elements of the business are largely driven by the “net operating income” (NOI) metric – essentially, rents minus expenses. While NOI ostensibly includes all expenses, energy factors are in several ways given short shrift in the underwriting process. This is particularly interesting when juxtaposed upon a not insignificant body ofmore » research revealing that there are in fact tangible benefits (such as higher valuations and lower vacancy and default rates) for energy-efficient and “green” commercial buildings. This scoping report characterizes the current status and potential interventions to promote greater inclusion of energy factors in the commercial mortgage process.« less

Application of acoustic agglomeration to enhance air filtration efficiency in air-conditioning and mechanical ventilation (ACMV) systems.

PubMed

Ng, Bing Feng; Xiong, Jin Wen; Wan, Man Pun

2017-01-01

The recent episodes of haze in Southeast Asia have caused some of the worst regional atmospheric pollution ever recorded in history. In order to control the levels of airborne fine particulate matters (PM) indoors, filtration systems providing high PM capturing efficiency are often sought, which inadvertently also results in high airflow resistance (or pressure drop) that increases the energy consumption for air distribution. A pre-conditioning mechanism promoting the formation of particle clusters to enhance PM capturing efficiency without adding flow resistance in the air distribution ductwork could provide an energy-efficient solution. This pre-conditioning mechanism can be fulfilled by acoustic agglomeration, which is a phenomenon that promotes the coagulation of suspended particles by acoustic waves propagating in the fluid medium. This paper discusses the basic mechanisms of acoustic agglomeration along with influencing factors that could affect the agglomeration efficiency. The feasibility to apply acoustic agglomeration to improve filtration in air-conditioning and mechanical ventilation (ACMV) systems is investigated experimentally in a small-scale wind tunnel. Experimental results indicate that this novel application of acoustic pre-conditioning improves the PM2.5 filtration efficiency of the test filters by up to 10% without introducing additional pressure drop. The fan energy savings from not having to switch to a high capturing efficiency filter largely outstrip the additional energy consumed by the acoustics system. This, as a whole, demonstrates potential energy savings from the combined acoustic-enhanced filtration system without compromising on PM capturing efficiency.

Application of acoustic agglomeration to enhance air filtration efficiency in air-conditioning and mechanical ventilation (ACMV) systems

PubMed Central

Xiong, Jin Wen; Wan, Man Pun

2017-01-01

The recent episodes of haze in Southeast Asia have caused some of the worst regional atmospheric pollution ever recorded in history. In order to control the levels of airborne fine particulate matters (PM) indoors, filtration systems providing high PM capturing efficiency are often sought, which inadvertently also results in high airflow resistance (or pressure drop) that increases the energy consumption for air distribution. A pre-conditioning mechanism promoting the formation of particle clusters to enhance PM capturing efficiency without adding flow resistance in the air distribution ductwork could provide an energy-efficient solution. This pre-conditioning mechanism can be fulfilled by acoustic agglomeration, which is a phenomenon that promotes the coagulation of suspended particles by acoustic waves propagating in the fluid medium. This paper discusses the basic mechanisms of acoustic agglomeration along with influencing factors that could affect the agglomeration efficiency. The feasibility to apply acoustic agglomeration to improve filtration in air-conditioning and mechanical ventilation (ACMV) systems is investigated experimentally in a small-scale wind tunnel. Experimental results indicate that this novel application of acoustic pre-conditioning improves the PM2.5 filtration efficiency of the test filters by up to 10% without introducing additional pressure drop. The fan energy savings from not having to switch to a high capturing efficiency filter largely outstrip the additional energy consumed by the acoustics system. This, as a whole, demonstrates potential energy savings from the combined acoustic-enhanced filtration system without compromising on PM capturing efficiency. PMID:28594862

Tanzanian midwives' perception of their professional role and implications for continuing professional development education.

PubMed

Jones, Brooke; Michael, Rene; Butt, Janice; Hauck, Yvonne

2016-03-01

This study explored Tanzanian midwives' perceptions of their professional role within their local context. Findings were to inform recommendations for continuing professional development education programs by Western midwifery educators. Using focus group interviews with sixteen Tanzanian midwives, the findings revealed that the midwives' overwhelming focus was on saving lives of women and newborns. The fundamental elements of saving lives involved prioritising care through receiving handover and undertaking physical assessment. Midwives were challenged by the poor working conditions, perceived lack of knowledge and associated low status within the local community. Based upon these findings, recommendations for continuing professional development education for Tanzanian midwives must ensure that saving lives is a major focus and that strategies taught must be relevant to the low-resource context of this developing country. In recognition of the high-risk women being cared for, there needs to be a focus on the prevention and management of maternity emergencies, in collaboration with medical practitioners. Copyright © 2015 Elsevier Ltd. All rights reserved.

Spacecraft rendezvous operational considerations affecting vehicle systems design and configuration

NASA Astrophysics Data System (ADS)

Prust, Ellen E.

One lesson learned from Orbiting Maneuvering Vehicle (OMV) program experience is that Design Reference Missions must include an appropriate balance of operations and performance inputs to effectively drive vehicle systems design and configuration. Rendezvous trajectory design is based on vehicle characteristics (e.g., mass, propellant tank size, and mission duration capability) and operational requirements, which have evolved through the Gemini, Apollo, and STS programs. Operational constraints affecting the rendezvous final approach are summarized. The two major objectives of operational rendezvous design are vehicle/crew safety and mission success. Operational requirements on the final approach which support these objectives include: tracking/targeting/communications; trajectory dispersion and navigation uncertainty handling; contingency protection; favorable sunlight conditions; acceptable relative state for proximity operations handover; and compliance with target vehicle constraints. A discussion of the ways each of these requirements may constrain the rendezvous trajectory follows. Although the constraints discussed apply to all rendezvous, the trajectory presented in 'Cargo Transfer Vehicle Preliminary Reference Definition' (MSFC, May 1991) was used as the basis for the comments below.

Ad Hoc Access Gateway Selection Algorithm

NASA Astrophysics Data System (ADS)

Jie, Liu

With the continuous development of mobile communication technology, Ad Hoc access network has become a hot research, Ad Hoc access network nodes can be used to expand capacity of multi-hop communication range of mobile communication system, even business adjacent to the community, improve edge data rates. For mobile nodes in Ad Hoc network to internet, internet communications in the peer nodes must be achieved through the gateway. Therefore, the key Ad Hoc Access Networks will focus on the discovery gateway, as well as gateway selection in the case of multi-gateway and handover problems between different gateways. This paper considers the mobile node and the gateway, based on the average number of hops from an average access time and the stability of routes, improved gateway selection algorithm were proposed. An improved gateway selection algorithm, which mainly considers the algorithm can improve the access time of Ad Hoc nodes and the continuity of communication between the gateways, were proposed. This can improve the quality of communication across the network.

Nurse practitioner-based sign-out system to facilitate patient communication on a neurosurgical service: a pilot study with recommendations.

PubMed

Rabinovitch, Deborah L; Hamill, Melinda; Zanchetta, Clauda; Bernstein, Mark

2009-12-01

Failure to communicate important patient information between physicians causes medical errors and adverse patient events. On-call neurosurgery physicians at the Toronto Western Hospital do not know the medical details of all the patients that they are covering at night because they do not care for the entire service of patients during the day. Because there is no formal handover system to transfer patient information to the on-call physician, a nurse practitioner-based sign-out system was recently introduced. Its effectiveness for communication was evaluated with preintervention-postintervention questionnaires and by recording daily logins. There was a statistically significant decrease in number of logins after 8 weeks of use (p = .05, Fisher's exact test), and the tool was abandoned after 16 weeks. Modifications identified to improve the system include the ability to sort by attending physician and to automatically populate the list with new patients. Effective communication is important for reducing medical errors, and perhaps these modifications will facilitate this important endeavor.

Communication in Hong Kong Accident and Emergency Departments

PubMed Central

Chandler, Eloise; Pun, Jack; Lock, Graham; Matthiessen, Christian M. I. M.; Espindola, Elaine; Ng, Carman

2015-01-01

In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs). In light of the Hong Kong Hospital Authority’s policy emphasis on patient-centered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and time-burdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice. PMID:28462303

Direct-Y: Fast Acquisition of the GPS PPS Signal

NASA Technical Reports Server (NTRS)

Namoos, Omar M.; DiEsposti, Raymond S.

1996-01-01

The NAVSTAR Global Positioning System (GPS) provides positioning and time information to military users via the Precise Positioning Service (PPS) which typically allows users a significant margin of precision over the commercially available Standard Positioning Service (SPS), Military sets that rely on first acquiring the SPS Coarse Acquisition (C/A) code, read from the data message the handover word (HOW) that provides the time-of-signal transmission needed to acquire and lock onto the PPS Y-code. Under extreme battlefield conditions, the use of GPS would be denied to the warfighter who cannot pick up the un-encrypted C/A code. Studies are underway at the GPS Joint Program Office (JPO) at the Space and Missile Center, Los Angeles Air Force Base that are aimed at developing the capability to directly acquire Y-code without first acquiring C/A code. This paper briefly outlines efforts to develop 'direct-Y' acquisition, and various approaches to solving this problem. The potential ramifications of direct-Y to military users are also discussed.

Improved Fast Centralized Retransmission Scheme for High-Layer Functional Split in 5G Network

NASA Astrophysics Data System (ADS)

Xu, Sen; Hou, Meng; Fu, Yu; Bian, Honglian; Gao, Cheng

2018-01-01

In order to satisfy the varied 5G critical requirements and the virtualization of the RAN hardware, a two-level architecture for 5G RAN has been studied in 3GPP 5G SI stage. The performance of the PDCP-RLC split option and intra-RLC split option, two mainly concerned options for high layer functional split, exist an ongoing debate. This paper firstly gives an overview of CU-DU split study work in 3GPP. By the comparison of implementation complexity, the standardization impact and system performance, our evaluation result shows the PDCP-RLC split Option outperforms the intra-RLC split option. Aiming to how to reduce the retransmission delay during the intra-CU inter-DU handover, the mainly drawback of PDCP-RLC split option, this paper proposes an improved fast centralized retransmission solution with a low implementation complexity. Finally, system level simulations show that the PDCP-RLC split option with the proposed scheme can significantly improve the UE’s experience.

A shared electronic health record: lessons from the coalface.

PubMed

Silvester, Brett V; Carr, Simon J

2009-06-01

A shared electronic health record system has been successfully implemented in Australia by a Division of General Practice in northern Brisbane. The system grew out of coordinated care trials that showed the critical need to share summary patient information, particularly for patients with complex conditions who require the services of a wide range of multisector, multidisciplinary health care professionals. As at 30 April 2008, connected users of the system included 239 GPs from 66 general practices, two major public hospitals, three large private hospitals, 11 allied health and community-based provider organisations and 1108 registered patients. Access data showed a patient's shared record was accessed an average of 15 times over a 12-month period. The success of the Brisbane implementation relied on seven key factors: connectivity, interoperability, change management, clinical leadership, targeted patient involvement, information at the point of care, and governance. The Australian Commission on Safety and Quality in Health Care is currently evaluating the system for its potential to reduce errors relating to inadequate information transfer during clinical handover.

Nursing shortage: the facts and strategies in Macao society.

PubMed

Liu, Ming; Lam, Bernice; Fong, Pedro; Yuan, Hao Bin

2012-11-19

Historically, Macao, a Special Administrative Region (SAR) in the People's Republic of China, has been troubled by a shortage of nurses. This shortage became especially severe during the period immediately after the handover of Macao from Portugal to the People's Republic of China in 1999. A fast-growing population, an aging population, the risk of epidemics, and competition for personnel with other industries have all contributed to this shortage. In recent years, Macao has implemented the following successful strategies to address the shortage: increased school enrollments, benefits, and professional development, along with the development of a clinical specialist program, a transition program for new graduates, and training for more certified nursing assistants. Strong government support and collaboration among all stakeholders have also served to enhance the nursing work force. In this article, the authors describe the nursing shortage in Macao SAR, discuss factors contributing to the shortage, and present strategies used to manage the shortage. They conclude by emphasizing the importance of increasing salary and professional status and providing transition programs for new graduates.

Achieving compliance with the European Working Time Directive in a large teaching hospital: a strategic approach.

PubMed

Jones, Gareth J; Vanderpump, Mark P J; Easton, Mark; Baker, Daryll M; Ball, Carol; Leenane, Michael; O'Brien, Heather; Turner, Nigel; Else, Martin; Reid, Wendy M N; Johnson, Margaret

2004-01-01

This paper describes the strategy which achieved European Working Time Directive (EWTD) compliance at the Royal Free Hampstead NHS Trust in medicine and surgery. Compliance with EWTD regulations was assessed by diary card exercise, clinical care assessed through critical incident reports, electronic handover documents and nursing reports, training opportunities assessed by unit training directors, cost controls assessed by finance department analysis, and workload assessed by staff attendance on wards, in casualty and in theatres. There was a change in focus of care to a consultant-led, specialist registrar- (SpR-)driven service extending into evenings and on weekends, coupled with a move to a multi-skilled team for night cover, and to a move from traditional on-call shifts to a full shift system across both medicine and surgery. Compliance with the EWTD was achieved whilst maintaining good standards of clinical care, ensuring training opportunities for doctors in training, controlling payroll costs, removing the need for locums, and reducing workload for both junior doctors and consultants.