Prompt fission γ-ray data from spontaneous fission and the mechanism of fission-fragment de-excitation

NASA Astrophysics Data System (ADS)

Oberstedt, Stephan; Dragic, Aleksandar; Gatera, Angelique; Göök, Alf; Hambsch, Franz-Josef; Oberstedt, Andreas

2017-09-01

The investigation of prompt γ-ray emission in nuclear fission has a great relevance for the assessment of prompt heat generation in a reactor core and for the better understanding of the de-excitation mechanism of fission fragments. Some years ago experimental data was scarce and available only from a few fission reactions, 233,235U(nth, f), 239Pu(nth, f), and 252Cf(sf). Initiated by a high priority data request published by the OECD/NEA a dedicated prompt fission γ-ray measurement program is being conducted at the Joint Research Centre Geel. In recent years we obtained new and accurate prompt fission γ-ray spectrum (PFGS) characteristics (average number of photons per fission, average total energy per fission and mean photon energy) from 252Cf(sf), 235U(nth, f) and 239,241Pu(nth, f) within 2% of uncertainty. In order to understand the dependence of prompt fission γ-ray emission on the compound nuclear mass and excitation energy, we started a first measurement campaign on spontaneously fissioning plutonium and curium isotopes. Results on PFGS characteristics from 240,242Pu(sf) show a dependence on the fragment mass distribution rather than on the average prompt neutron multiplicity, pointing to a more complex competition between prompt fission γ-ray and neutron emission.

76 FR 9706 - Finding of Substantial Inadequacy of Implementation Plan; Call for Iowa State Implementation Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... advance and available for prompt implementation once triggered. Section 110(k)(5) of the CAA provides that... Environmental protection, Air pollution control, Iowa, Particulate matter, State Implementation Plan. Dated...

SU-C-204-01: A Fast Analytical Approach for Prompt Gamma and PET Predictions in a TPS for Proton Range Verification

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

Kroniger, K; Herzog, M; Landry, G

2015-06-15

Purpose: We describe and demonstrate a fast analytical tool for prompt-gamma emission prediction based on filter functions applied on the depth dose profile. We present the implementation in a treatment planning system (TPS) of the same algorithm for positron emitter distributions. Methods: The prediction of the desired observable is based on the convolution of filter functions with the depth dose profile. For both prompt-gammas and positron emitters, the results of Monte Carlo simulations (MC) are compared with those of the analytical tool. For prompt-gamma emission from inelastic proton-induced reactions, homogeneous and inhomogeneous phantoms alongside with patient data are used asmore » irradiation targets of mono-energetic proton pencil beams. The accuracy of the tool is assessed in terms of the shape of the analytically calculated depth profiles and their absolute yields, compared to MC. For the positron emitters, the method is implemented in a research RayStation TPS and compared to MC predictions. Digital phantoms and patient data are used and positron emitter spatial density distributions are analyzed. Results: Calculated prompt-gamma profiles agree with MC within 3 % in terms of absolute yield and reproduce the correct shape. Based on an arbitrary reference material and by means of 6 filter functions (one per chemical element), profiles in any other material composed of those elements can be predicted. The TPS implemented algorithm is accurate enough to enable, via the analytically calculated positron emitters profiles, detection of range differences between the TPS and MC with errors of the order of 1–2 mm. Conclusion: The proposed analytical method predicts prompt-gamma and positron emitter profiles which generally agree with the distributions obtained by a full MC. The implementation of the tool in a TPS shows that reliable profiles can be obtained directly from the dose calculated by the TPS, without the need of full MC simulation.« less

Assessment of progressively delayed prompts on guided skill learning in rats.

PubMed

Reid, Alliston K; Futch, Sara E; Ball, Katherine M; Knight, Aubrey G; Tucker, Martha

2017-03-01

We examined the controlling factors that allow a prompted skill to become autonomous in a discrete-trials implementation of Touchette's (1971) progressively delayed prompting procedure, but our subjects were rats rather than children with disabilities. Our prompted skill was a left-right lever-press sequence guided by two panel lights. We manipulated (a) the effectiveness of the guiding lights prompt and (b) the presence or absence of a progressively delayed prompt in four groups of rats. The less effective prompt yielded greater autonomy than the more effective prompt. The ability of the progressively delayed prompt procedure to produce behavioral autonomy depended upon characteristics of the obtained delay (trial duration) rather than on the pending prompt. Sequence accuracy was reliably higher in unprompted trials than in prompted trials, and this difference was maintained in the 2 groups that received no prompts but yielded equivalent trial durations. Overall sequence accuracy decreased systematically as trial duration increased. Shorter trials and their greater accuracy were correlated with higher overall reinforcement rates for faster responding. Waiting for delayed prompts (even if no actual prompt was provided) was associated with lower overall reinforcement rate by decreasing accuracy and by lengthening trials. These findings extend results from previous studies regarding the controlling factors in delayed prompting procedures applied to children with disabilities.

Increasing the vocal responses of children with autism and developmental disabilities using manual sign mand training and prompt delay.

PubMed

Carbone, Vincent J; Sweeney-Kerwin, Emily J; Attanasio, Vivian; Kasper, Tamara

2010-01-01

The purpose of this study was to determine the effect of manual sign mand training combined with prompt delay and vocal prompting on the production of vocal responses in nonvocal children with developmental disabilities. A multiple baseline design across participants verified the effectiveness of this intervention. All participants showed increases in vocal responses following the implementation of the independent variables.

Project Energise: Using participatory approaches and real time computer prompts to reduce occupational sitting and increase work time physical activity in office workers.

PubMed

Gilson, Nicholas D; Ng, Norman; Pavey, Toby G; Ryde, Gemma C; Straker, Leon; Brown, Wendy J

2016-11-01

This efficacy study assessed the added impact real time computer prompts had on a participatory approach to reduce occupational sedentary exposure and increase physical activity. Quasi-experimental. 57 Australian office workers (mean [SD]; age=47 [11] years; BMI=28 [5]kg/m 2 ; 46 men) generated a menu of 20 occupational 'sit less and move more' strategies through participatory workshops, and were then tasked with implementing strategies for five months (July-November 2014). During implementation, a sub-sample of workers (n=24) used a chair sensor/software package (Sitting Pad) that gave real time prompts to interrupt desk sitting. Baseline and intervention sedentary behaviour and physical activity (GENEActiv accelerometer; mean work time percentages), and minutes spent sitting at desks (Sitting Pad; mean total time and longest bout) were compared between non-prompt and prompt workers using a two-way ANOVA. Workers spent close to three quarters of their work time sedentary, mostly sitting at desks (mean [SD]; total desk sitting time=371 [71]min/day; longest bout spent desk sitting=104 [43]min/day). Intervention effects were four times greater in workers who used real time computer prompts (8% decrease in work time sedentary behaviour and increase in light intensity physical activity; p<0.01). Respective mean differences between baseline and intervention total time spent sitting at desks, and the longest bout spent desk sitting, were 23 and 32min/day lower in prompt than in non-prompt workers (p<0.01). In this sample of office workers, real time computer prompts facilitated the impact of a participatory approach on reductions in occupational sedentary exposure, and increases in physical activity. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Compliance with prompt payment legislation: the initial experiences of New Jersey radiologists.

PubMed

Swayne, Lawrence C; Fask, Alan; Crewson, Philip E; Stelletell, Helen D; Fanburg, John D; Williams, Gary

2002-07-01

Prompt payment has emerged as a dominant issue in managed care reform, with 47 states passing laws or regulations requiring prompt remuneration for medical services. The New Jersey Prompt-Pay Act, effective on December 28, 1999, requires payment within 30 days of electronic submission and within 40 days for nonelectronic submission. This study was undertaken to assess compliance with the New Jersey Prompt-Pay Act for radiology claims submitted 1 and 5 months after implementation (7-11 months after passage of the statute). A retrospective prompt payment analysis was undertaken of all claims submitted in February and June 2000 to six major payers by a common third-party billing company on behalf of 11 radiology practices of various sizes, settings, and locations in New Jersey. A total of 33,537 claims were assigned to one of six time periods on the basis of timeliness of payment: less than or equal to 30 days, 31-40 days, 41-50 days, 51-60 days, 61-90 days, and greater than 90 days or a separate unpaid category after 170 days had elapsed. A detailed analysis of 3156 claims from one practice was performed to estimate a clean claims submission rate. The overall percentage of claims paid within 40 days was 70%. After 170 days, the overall percentage of paid claims was 93%. The annualized interest lost on delayed payments was $23,939 for the practice analyzed. Prompt payment for radiology services remains an elusive goal in New Jersey, despite passage and implementation of prompt payment legislation.

SU-F-J-65: Prediction of Patient Setup Errors and Errors in the Calibration Curve from Prompt Gamma Proton Range Measurements

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

Albert, J; Labarbe, R; Sterpin, E

2016-06-15

Purpose: To understand the extent to which the prompt gamma camera measurements can be used to predict the residual proton range due to setup errors and errors in the calibration curve. Methods: We generated ten variations on a default calibration curve (CC) and ten corresponding range maps (RM). Starting with the default RM, we chose a square array of N beamlets, which were then rotated by a random angle θ and shifted by a random vector s. We added a 5% distal Gaussian noise to each beamlet in order to introduce discrepancies that exist between the ranges predicted from themore » prompt gamma measurements and those simulated with Monte Carlo algorithms. For each RM, s, θ, along with an offset u in the CC, were optimized using a simple Euclidian distance between the default ranges and the ranges produced by the given RM. Results: The application of our method lead to the maximal overrange of 2.0mm and underrange of 0.6mm on average. Compared to the situations where s, θ, and u were ignored, these values were larger: 2.1mm and 4.3mm. In order to quantify the need for setup error corrections, we also performed computations in which u was corrected for, but s and θ were not. This yielded: 3.2mm and 3.2mm. The average computation time for 170 beamlets was 65 seconds. Conclusion: These results emphasize the necessity to correct for setup errors and the errors in the calibration curve. The simplicity and speed of our method makes it a good candidate for being implemented as a tool for in-room adaptive therapy. This work also demonstrates that the Prompt gamma range measurements can indeed be useful in the effort to reduce range errors. Given these results, and barring further refinements, this approach is a promising step towards an adaptive proton radiotherapy.« less

Efficient ECH-assisted plasma start-up using trapped particle configuration in the versatile experiment spherical torus

NASA Astrophysics Data System (ADS)

An, YoungHwa; Lee, Jeongwon; Jo, JongGab; Jung, Bong-Ki; Lee, HyunYeong; Chung, Kyoung-Jae; Na, Yong-Su; Hahm, T. S.; Hwang, Y. S.

2017-01-01

An efficient and robust ECH (electron cyclotron heating)-assisted plasma start-up scheme with a low loop voltage and low volt-second consumption utilizing the trapped particle configuration (TPC) has been developed in the versatile experiment spherical torus (VEST). The TPC is a mirror-like magnetic field configuration providing a vertical magnetic field in the same direction as the equilibrium field. It significantly enhances ECH pre-ionization with enhanced particle confinement due to its mirror effect, and intrinsically provides an equilibrium field with a stable decay index enabling prompt plasma current initiation. Consequently, the formation of TPC before the onset of the loop voltage allows the plasma to start up with a lower loop voltage and lower volt-second consumption as well as a wider operation range in terms of ECH pre-ionization power and H2 filling pressure. The TPC can improve the widely-used field null configuration significantly for more efficient start-up when ECH pre-ionization is used. This can then be utilized in superconducting tokamaks requiring a low loop voltage start-up, such as ITER, or in spherical tori with limited volt-seconds. The TPC can be particularly useful in superconducting tokamaks with a limited current slew-rate of superconducting PF coils, as it can save volt-second consumption before plasma current initiation by providing prompt initiation with an intrinsic stable equilibrium field.

Prompt immune tolerance induction at inhibitor diagnosis regardless of titre may increase overall success in haemophilia A complicated by inhibitors: experience of two U.S. centres.

PubMed

Nakar, C; Manco-Johnson, M J; Lail, A; Donfield, S; Maahs, J; Chong, Y; Blades, T; Shapiro, A

2015-05-01

Current guidelines recommend delaying the start of immune tolerance induction (ITI) until the inhibitor titre is <10 Bethesda units (BU) to improve success. This study was conducted to evaluate ITI outcome relative to time to start ITI from inhibitor detection irrespective of inhibitor titre. Data were retrospectively collected from two U.S. haemophilia treatment centres (HTCs) on subjects with severe/moderate factor VIII (FVIII) deficiency with inhibitors who underwent ITI. Outcomes were defined pragmatically: success--negative inhibitor titre and ability to use FVIII concentrate for treatment/bleed prevention; partial success--inhibitor titre 1 to <5 BU with ability to use FVIII concentrate for treatment of bleeding; failure--ITI ongoing >3 years without achieving success/partial success, or ITI discontinuation. Fifty-eight subjects were included; 32 of 39 (82%) with high-responding inhibitor (HRI) achieved success, 7 failed. HRI subjects were subdivided based on ITI start time: 23/39 subjects started within 1 month of detection and 22/23 (96%) achieved success. Of these 23, 13 started ITI with an inhibitor titre ≥10 BU; all were successes. Eleven of 39 HRI subjects had an interval >6 months until ITI start; 7 (64%) achieved success. Time from inhibitor detection to ITI start may play a critical role in outcome. A titre ≥10 BU at ITI start did not influence outcome in subjects when ITI was initiated within 1 month of detection. Prompt ITI should be considered a viable therapeutic option in newly identified patients with inhibitors regardless of current inhibitor titre. © 2014 John Wiley & Sons Ltd.

Movement Path Tortuosity Predicts Compliance With Therapeutic Behavioral Prompts in Patients With Traumatic Brain Injury.

PubMed

Kearns, William D; Fozard, James L; Ray, Roger D; Scott, Steven; Jasiewicz, Jan M; Craighead, Jeffrey D; Pagano, Craig V

2016-01-01

Rehabilitation of patients with traumatic brain injury typically includes therapeutic prompts for keeping appointments and adhering to medication regimens. Level of cognitive impairment may significantly affect a traumatic brain injury victim's ability to benefit from text-based prompting. We tested the hypothesis that spatial disorientation as measured by movement path tortuosity during ambulation would be associated with poorer compliance with automated prompts by veterans actively being treated for traumatic brain injury. Clinical polytrauma center. Ten (1 female) veteran patients mean age = 35.4 (SD = 12.4) years. Small group correlational study without random assignment. Fractal Dimension, a measure of movement path tortuosity derived from a GPS logging device used to record casual outdoor ambulation at the start of the study. Compliance with smart home machine-generated therapeutic prompts received during rehabilitation at the James A. Haley Veterans Administration Hospital Polytrauma Transitional Rehabilitation Program. A patient was compliant with a prompt if they transited from where the prompt was presented to the prescribed destination (both within the Polytrauma Transitional Rehabilitation Program) within 30 minutes. Noncompliance was failure to appear at the destination within the allotted time. Fractal dimension was significantly inversely related to overall prompt compliance (r = -0.603, n = 10, P = .032; 1-tailed). The findings support the hypothesis that increased spatial disorientation adversely impacts compliance with automated prompts throughout therapy. The results are consistent with previous studies linking elevated path tortuosity to cognitive impairment and increased risk for falls in assisted living facility residents.

Antecedent causes of a measles resurgence in the Democratic Republic of the Congo

PubMed Central

Scobie, Heather Melissa; Ilunga, Benoît Kebela; Mulumba, Audry; Shidi, Calixte; Coulibaly, Tiekoura; Obama, Ricardo; Tamfum, Jean-Jacques Muyembe; Simbu, Elisabeth Pukuta; Smit, Sheilagh Brigitte; Masresha, Balcha; Perry, Robert Tyrrell; Alleman, Mary Margaret; Kretsinger, Katrina; Goodson, James

2015-01-01

Introduction Despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes. Methods We conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC. Results During 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (≤95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (>100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged <10 years (87%) and unvaccinated or with unknown vaccination status (75%). Surveillance detected two genotype B3 and one genotype B2 measles virus strains that were previously identified in the region. Conclusion The resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs. PMID:26401224

Antecedent causes of a measles resurgence in the Democratic Republic of the Congo.

PubMed

Scobie, Heather Melissa; Ilunga, Benoît Kebela; Mulumba, Audry; Shidi, Calixte; Coulibaly, Tiekoura; Obama, Ricardo; Tamfum, Jean-Jacques Muyembe; Simbu, Elisabeth Pukuta; Smit, Sheilagh Brigitte; Masresha, Balcha; Perry, Robert Tyrrell; Alleman, Mary Margaret; Kretsinger, Katrina; Goodson, James

2015-01-01

Despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes. We conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC. During 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (≤95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (>100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged <10 years (87%) and unvaccinated or with unknown vaccination status (75%). Surveillance detected two genotype B3 and one genotype B2 measles virus strains that were previously identified in the region. The resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs.

Building Substantive Engagement through the Use of Connection Prompts

ERIC Educational Resources Information Center

Alamar, Amy

2013-01-01

Conversation is a strategy that helps students build reading skills and improve reading comprehension. This study describes the implementation of connection prompts in a 2nd-grade classroom to support students in making predictions, questioning the text, and initiating further conversation. Research suggests that once conversation is initiated,…

Assisting persons with multiple disabilities to move through simple occupational activities with automatic prompting.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Groeneweg, Jop

2008-01-01

The present study assessed the possibility of assisting four persons with multiple disabilities to move through and perform simple occupational activities arranged within a room with the help of automatic prompting. The study involved two multiple probe designs across participants. The first multiple probe concerned the two participants with blindness or minimal vision and deafness, who received air blowing as a prompt. The second multiple probe concerned the two participants with blindness and typical hearing who received a voice calling as a prompt. Initially, all participants had baseline sessions. Then intervention started with the first participant of each dyad. When their performance was consolidated, new baseline and intervention occurred with the second participant of each dyad. Finally, all four participants were exposed to a second intervention phase, in which the number of activities per session doubled (i.e., from 8 to 16). Data showed that all four participants: (a) learned to move across and perform the activities available with the help of automatic prompting and (b) remained highly successful through the second intervention phase when the sessions were extended. Implications of the findings are discussed.

Technology Infusion Strategy: Beginning with a Pilot Project is the Key.

ERIC Educational Resources Information Center

Ball, John

1996-01-01

Presents an effective way to start a technological revolution in schools by beginning with a single exciting project that incorporates new technologies and then letting interest in the project prompt others to action. (JRH)

Teaching Children with Autism to Engage in Peer-Directed Mands Using a Picture Exchange Communication System

ERIC Educational Resources Information Center

Paden, Amber R.; Kodak, Tiffany; Fisher, Wayne W.; Gawley-Bullington, Elizabeth M.; Bouxsein, Kelly J.

2012-01-01

We evaluated differential reinforcement of alternative behavior (DRA) plus prompting to increase peer-directed mands for preferred items using a picture exchange communication system (PECS). Two nonvocal individuals with autism participated. Independent mands with a peer increased with the implementation of DRA plus prompting for both…

Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

PubMed

Malamed, Stanley F

2015-12-01

Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

Effects of Varied Levels of Treatment Integrity on Appropriate Toy Manipulation in Children with Autism

ERIC Educational Resources Information Center

Groskreutz, Nicole C.; Groskreutz, Mark P.; Higbee, Thomas S.

2011-01-01

We assessed the effects of varying the treatment integrity of a prompting procedure on appropriate toy manipulation in two preschool-aged children with autism. Following an assessment to identify toys with high levels of inappropriate toy manipulation, each of three toys was associated with implementation of the prompting procedure at a different…

How Do Implementation Efforts Relate to Program Adherence? Examining the Role of Organizational, Implementer, and Program Factors

ERIC Educational Resources Information Center

Dariotis, Jacinda K.; Bumbarger, Brian K.; Duncan, Larissa G.; Greenberg, Mark T.

2008-01-01

Widespread replications of evidence-based prevention programs (EBPPs) prompt prevention scientists to examine program implementation adherence in real world settings. Based on Chen's model (1990), we identified five key factors of the implementation system and assessed which characteristics related to program adherence. The sample included 32…

A Fuzzy Logic Prompting Mechanism Based on Pattern Recognition and Accumulated Activity Effective Index Using a Smartphone Embedded Sensor.

PubMed

Liu, Chung-Tse; Chan, Chia-Tai

2016-08-19

Sufficient physical activity can reduce many adverse conditions and contribute to a healthy life. Nevertheless, inactivity is prevalent on an international scale. Improving physical activity is an essential concern for public health. Reminders that help people change their health behaviors are widely applied in health care services. However, timed-based reminders deliver periodic prompts suffer from flexibility and dependency issues which may decrease prompt effectiveness. We propose a fuzzy logic prompting mechanism, Accumulated Activity Effective Index Reminder (AAEIReminder), based on pattern recognition and activity effective analysis to manage physical activity. AAEIReminder recognizes activity levels using a smartphone-embedded sensor for pattern recognition and analyzing the amount of physical activity in activity effective analysis. AAEIReminder can infer activity situations such as the amount of physical activity and days spent exercising through fuzzy logic, and decides whether a prompt should be delivered to a user. This prompting system was implemented in smartphones and was used in a short-term real-world trial by seventeenth participants for validation. The results demonstrated that the AAEIReminder is feasible. The fuzzy logic prompting mechanism can deliver prompts automatically based on pattern recognition and activity effective analysis. AAEIReminder provides flexibility which may increase the prompts' efficiency.

Monte Carlo simulation of prompt γ-ray emission in proton therapy using a specific track length estimator

NASA Astrophysics Data System (ADS)

El Kanawati, W.; Létang, J. M.; Dauvergne, D.; Pinto, M.; Sarrut, D.; Testa, É.; Freud, N.

2015-10-01

A Monte Carlo (MC) variance reduction technique is developed for prompt-γ emitters calculations in proton therapy. Prompt-γ emitted through nuclear fragmentation reactions and exiting the patient during proton therapy could play an important role to help monitoring the treatment. However, the estimation of the number and the energy of emitted prompt-γ per primary proton with MC simulations is a slow process. In order to estimate the local distribution of prompt-γ emission in a volume of interest for a given proton beam of the treatment plan, a MC variance reduction technique based on a specific track length estimator (TLE) has been developed. First an elemental database of prompt-γ emission spectra is established in the clinical energy range of incident protons for all elements in the composition of human tissues. This database of the prompt-γ spectra is built offline with high statistics. Regarding the implementation of the prompt-γ TLE MC tally, each proton deposits along its track the expectation of the prompt-γ spectra from the database according to the proton kinetic energy and the local material composition. A detailed statistical study shows that the relative efficiency mainly depends on the geometrical distribution of the track length. Benchmarking of the proposed prompt-γ TLE MC technique with respect to an analogous MC technique is carried out. A large relative efficiency gain is reported, ca. 105.

Effects of No-No Prompting on Teaching Expressive Labeling of Facial Expressions to Children with and without a Pervasive Developmental Disorder

ERIC Educational Resources Information Center

Leaf, Justin B.; Oppenheim-Leaf, Misty L.; Dotson, Wesley H.; Johnson, Valerie A.; Courtemanche, Andrea B.; Sheldon, Jan B.; Sherman, James A.

2011-01-01

Discrete trial teaching is a systematic form of instruction found to be effective for children diagnosed with autism. Three areas of discrete trial teaching warranting more research are the effectiveness and efficiency of various prompting procedures, the effectiveness of implementing teaching in a group instructional format, and the ability of…

The Effects of Prompting and Feedback on Drivers' Stopping at Stop Signs

ERIC Educational Resources Information Center

Austin, John; Hackett, Stacey; Gravina, Nicole; Lebbon, Angela

2006-01-01

Complete stops at a high-traffic intersection on the campus of a public university were increased with a prompting and consequence intervention. Data were collected at two opposing stop signs (Stop A and Stop B); however, the intervention was implemented only at Stop A. During the intervention, a volunteer stood next to Stop A holding a poster…

Use of Video Modeling and Video Prompting Interventions for Teaching Daily Living Skills to Individuals with Autism Spectrum Disorders: A Review

ERIC Educational Resources Information Center

Gardner, Stephanie; Wolfe, Pamela

2013-01-01

Identifying methods to increase the independent functioning of individuals with autism spectrum disorders (ASD) is vital in enhancing their quality of life; teaching students with ASD daily living skills can foster independent functioning. This review examines interventions that implement video modeling and/or prompting to teach individuals with…

Comprehensive overview of the Point-by-Point model of prompt emission in fission

NASA Astrophysics Data System (ADS)

Tudora, A.; Hambsch, F.-J.

2017-08-01

The investigation of prompt emission in fission is very important in understanding the fission process and to improve the quality of evaluated nuclear data required for new applications. In the last decade remarkable efforts were done for both the development of prompt emission models and the experimental investigation of the properties of fission fragments and the prompt neutrons and γ-ray emission. The accurate experimental data concerning the prompt neutron multiplicity as a function of fragment mass and total kinetic energy for 252Cf(SF) and 235 ( n, f) recently measured at JRC-Geel (as well as other various prompt emission data) allow a consistent and very detailed validation of the Point-by-Point (PbP) deterministic model of prompt emission. The PbP model results describe very well a large variety of experimental data starting from the multi-parametric matrices of prompt neutron multiplicity ν (A,TKE) and γ-ray energy E_{γ}(A,TKE) which validate the model itself, passing through different average prompt emission quantities as a function of A ( e.g., ν(A), E_{γ}(A), < ɛ > (A) etc.), as a function of TKE ( e.g., ν (TKE), E_{γ}(TKE)) up to the prompt neutron distribution P (ν) and the total average prompt neutron spectrum. The PbP model does not use free or adjustable parameters. To calculate the multi-parametric matrices it needs only data included in the reference input parameter library RIPL of IAEA. To provide average prompt emission quantities as a function of A, of TKE and total average quantities the multi-parametric matrices are averaged over reliable experimental fragment distributions. The PbP results are also in agreement with the results of the Monte Carlo prompt emission codes FIFRELIN, CGMF and FREYA. The good description of a large variety of experimental data proves the capability of the PbP model to be used in nuclear data evaluations and its reliability to predict prompt emission data for fissioning nuclei and incident energies for which the experimental information is completely missing. The PbP treatment can also provide input parameters of the improved Los Alamos model with non-equal residual temperature distributions recently reported by Madland and Kahler, especially for fissioning nuclei without any experimental information concerning the prompt emission.

40 CFR 89.124 - Record retention, maintenance, and submission.

Code of Federal Regulations, 2013 CFR

2013-07-01

... manufacturer of any nonroad compression-ignition engine must maintain the following adequately organized... emission test data, such as those reporting test cell temperature and relative humidity at start and finish... media, provided that at the Administrator's request, organized, written records in English are promptly...

40 CFR 89.124 - Record retention, maintenance, and submission.

Code of Federal Regulations, 2011 CFR

2011-07-01

... manufacturer of any nonroad compression-ignition engine must maintain the following adequately organized... emission test data, such as those reporting test cell temperature and relative humidity at start and finish... media, provided that at the Administrator's request, organized, written records in English are promptly...

45 CFR 1309.12 - Timely decisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Timely decisions. 1309.12 Section 1309.12 Public... PROGRAM HEAD START FACILITIES PURCHASE, MAJOR RENOVATION AND CONSTRUCTION Application Procedures § 1309.12 Timely decisions. The responsible HHS official shall promptly review and make final decisions regarding...

Sodium intake reduction efforts in Lebanon

PubMed Central

Almedawar, Mohamad M.; Nasreddine, Lara; Olabi, Ammar; Hamade, Haya; Awad, Elie; Toufeili, Imad; Arnaout, Samir

2015-01-01

Sodium intake reduction efforts in Lebanon are quite recent and have just started to take effect on the national level. Starting out from an academic institution, the Lebanese Action on Sodium and Health (LASH) campaign was established to counter the increasing prevalence of hypertension and associated adverse health effects. The campaign’s strategy was based on four pillars: research, health communication, advocacy, and monitoring. The LASH group set out with determining: baseline sodium intake of the population, main sources of sodium intake, and the knowledge, attitudes, and behaviors (KAB) of the population as a situation analysis that prompts for action. This gave LASH tangible evidence of the magnitude of the problem and the need for the government, the food industry, and the consumers, to be mobilized to take part in devising a solution. Currently, Lebanon is at a stage of technically working to reduce the sodium content in the major sources of sodium, namely local bread and bread-like products. The next steps will include implementation of a plan for monitoring industry compliance, while studying other food targets, including dairy products and processed meat. Meanwhile, the health communication plan is ongoing and the Salt Awareness Week is celebrated every year with media appearances of LASH researchers to raise the issue to the public eye. PMID:26090328

The Effects of Varying Levels of Treatment Integrity on Child Compliance during Treatment with a Three-Step Prompting Procedure

ERIC Educational Resources Information Center

Wilder, David A.; Atwell, Julie; Wine, Byron

2006-01-01

The effects of three levels of treatment integrity (100%, 50%, and 0%) on child compliance were evaluated in the context of the implementation of a three-step prompting procedure. Two typically developing preschool children participated in the study. After baseline data on compliance to one of three common demands were collected, a therapist…

Engaging Undergraduate Students in an Online Science Course: The Relationship between Instructor Prompt and Student Engagement in Synchronous Class Sessions

ERIC Educational Resources Information Center

Shoepe, Todd C.

2013-01-01

The number of online courses in higher education is on the rise; however, empirical evidence elucidating best practices for synchronous online instruction is needed to implement these courses. The purpose of this dissertation was to perform a mixed-method investigation into the relationships between instructor prompt and student engagement in 5…

Using the System of Least Prompts to Teach Personal Hygiene Skills to a High School Student with Comorbid Visual Impairment and Autism Spectrum Disorder

ERIC Educational Resources Information Center

Probst, Kristi M.; Walker, Virginia L.

2017-01-01

Introduction: This study evaluated the effectiveness of a workshop and follow-up coaching sessions on the implementation of the system of least prompts procedure by classroom team members and explored whether this intervention resulted in personal hygiene skill acquisition by a male high school student with comorbid visual impairment and autism…

eHealth System for Collecting and Utilizing Patient Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) Among Cancer Patients: Mixed Methods Approach to Evaluate Feasibility and Acceptability.

PubMed

Girgis, Afaf; Durcinoska, Ivana; Levesque, Janelle V; Gerges, Martha; Sandell, Tiffany; Arnold, Anthony; Delaney, Geoff P

2017-10-02

Despite accumulating evidence indicating that collecting patient-reported outcomes (PROs) and transferring results to the treating health professional in real time has the potential to improve patient well-being and cancer outcomes, this practice is not widespread. The aim of this study was to test the feasibility and acceptability of PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care), a newly developed electronic health (eHealth) system that facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. We developed an eHealth system in consultation with content-specific expert advisory groups and tested it with patients receiving treatment or follow-up care in two hospitals in New South Wales, Australia, over a 3-month period. Participants were recruited in clinic and completed self-report Web-based assessments either just before their upcoming clinical consultation or every 4 weeks if in follow-up care. A mixed methods approach was used to evaluate feasibility and acceptability of PROMPT-Care; data collected throughout the study informed the accuracy and completeness of data transfer procedures, and extent of missing data was determined from participants' assessments. Patients participated in cognitive interviews while completing their first assessment and completed evaluation surveys and interviews at study-end to assess system acceptability and usefulness of patient self-management resources, and oncology staff were interviewed at study-end to determine the acceptability and perceived usefulness of real-time PRO reporting. A total of 42 patients consented to the study; 7 patients were withdrawn before starting the intervention primarily because of changes in eligibility. Overall, 35 patients (13 on treatment and 22 in follow-up) completed 67 assessments during the study period. Mean completeness of patient-reported data was 93%, with 100% accuracy of data transfer. Ten patients completed cognitive interviews, 28 completed evaluation surveys, and 14 completed evaluation interviews at study-end. PROMPT-Care patient acceptability was high-100% (28/28) reported the time to complete the Web-based assessments (average 15 min) as about right, most willing to answer more questions (79%, 22/28 yes), 96% (27/28) found the Web-based assessment easier or same as completing a paper copy, and they valued the self-management resources . Oncology staff (n=5) also reported high acceptability and potential feasibility of the system. Patients and oncology staff found the PROMPT-Care system to be highly acceptable, and the results suggest that it would be feasible to implement it into an oncology setting. Suggested modifications to the patient assessment survey, clinician access to the reports, and system requirements will be made as part of the next stage of large-scale testing and future implementation of the system as part of routine care. Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0). ©Afaf Girgis, Ivana Durcinoska, Janelle V Levesque, Martha Gerges, Tiffany Sandell, Anthony Arnold, Geoff P Delaney, The PROMPT-Care Program Group. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.10.2017.

INCREASING FOLLOWING HEADWAY WITH PROMPTS, GOAL SETTING, AND FEEDBACK IN A DRIVING SIMULATOR

PubMed Central

Arnold, Michelle L; Van Houten, Ron

2011-01-01

We evaluated the effects of prompting, goal setting, and feedback on following headway of young drivers in a simulated driving environment and assessed whether changes produced in following headway were associated with reductions in hard braking when drivers were and were not using cell phones. Participants were 4 university students. During baseline, drivers spent half of the time talking on cell phones while driving. At the start of the intervention, drivers were prompted to increase following headway while on the cell phones and were provided a specific target for following headway. Drivers were given feedback on increasing following headway when on cell phones at the end of each session. The intervention package was associated with an increase in following headway and a decrease in hard braking when participants were on and off the cell phones. Cell phone use did not affect any of the measures. PMID:21709782

Using Video Modeling with Voiceover Instruction Plus Feedback to Train Staff to Implement Direct Teaching Procedures.

PubMed

Giannakakos, Antonia R; Vladescu, Jason C; Kisamore, April N; Reeve, Sharon A

2016-06-01

Direct teaching procedures are often an important part of early intensive behavioral intervention for consumers with autism spectrum disorder. In the present study, a video model with voiceover (VMVO) instruction plus feedback was evaluated to train three staff trainees to implement a most-to-least direct (MTL) teaching procedure. Probes for generalization were conducted with untrained direct teaching procedures (i.e., least-to-most, prompt delay) and with an actual consumer. The results indicated that VMVO plus feedback was effective in training the staff trainees to implement the MTL procedure. Although additional feedback was required for the staff trainees to show mastery of the untrained direct teaching procedures (i.e., least-to-most and prompt delay) and with an actual consumer, moderate to high levels of generalization were observed.

An Investigation of the Nontechnical Skills Required to Maximize the Safety and Productivity of U.S. Navy Divers

DTIC Science & Technology

2005-04-01

experience. The critical incident interview uses recollection of a specific incident as its starting point and employs a semistructured interview format...context assessment, expectancies, and judgments. The four sweeps in the critical incident interview include: Sweep 1 - Prompting the interviewee to

Facts on Employee Assistance Programs. Clearinghouse Fact Sheet.

ERIC Educational Resources Information Center

Desmond, Thomas C.

Employee Assistance Programs (EAPs) offer employees confidential, professional assistance for the kinds of personal problems that adversely affect their lives and their jobs. These programs started when acute worker shortages during World War II, coupled with the successes of Alcoholic Anonymous, prompted some companies in the 1940s to develop…

Enhancement of Metacognition Use and Awareness by Means of a Collaborative Intervention

NASA Astrophysics Data System (ADS)

Sandi-Urena, Santiago; Cooper, Melanie M.; Stevens, Ron H.

2011-02-01

Current views on metacognition consider it a fundamental factor in learning and problem-solving which in turn has led to interest in creating learning experiences conducive to developing its use. This paper reports on the effectiveness of a collaborative intervention in promoting college general chemistry students' awareness and use of metacognition. The intervention starts with a cognitive imbalance experience as a trigger for metacognitive reflection, which is then followed by reflective prompting and peer interaction. A quasi-experimental control and treatment design with 537 and 464 participants, respectively, was implemented. Assessment of metacognition was accomplished by using a multi-method instrument that consists of a self-report (Metacognitive Activities Inventory, MCAI) and a concurrent, web-based tool (Interactive Multimedia Exercises, IMMEX). IMMEX has been shown to allow rapid classification of problem solvers according to their regulatory metacognitive skills. Compared to the control group, the treatment group showed a significant increase in metacognition awareness, as evidenced by the MCAI, increased ability in solving non-algorithmic chemistry problems of higher difficulty, and with a higher per cent correctness (IMMEX). These findings are consistent with an overall increase in the use of regulatory metacognitive skills by the treatment group. We propose that the meaningful, purposeful social interaction and the reflective prompting instantiated by the intervention act as promoters of metacognition development. It is of particular relevance that these factors are not exclusive to the intervention employed here and can be embedded by practitioners in their instruction.

Developing a PPO: challenges and benefits.

PubMed

Range, R P

1984-12-01

When deciding upon which kind of alternative delivery system to develop, Saint Vincent Charity Hospital and Health Center, Cleveland, selected the preferred provider organization (PPO) mode because of four basic advantages: (1) the health care consumer's freedom to choose providers; (2) effective cost containment; (3) coordination of services among allied providers; and (4) health promotion programs. More specifically, the Ohio Health Choice Plan (OHCP) benefits hospitals by assisting to maintain or increase market share, facilitating prompt claims payments, and improving financial mix. Physicians benefit not only because they receive prompt payment and are not a risk but also because the fee-for-service system is retained and their market shares can also be preserved or enhanced. Employers' advantages include savings through controlled utilization, positive employee relations, and improved management information. Employees' benefits include lower out-of-pocket costs and freedom of choice. As a full-service PPO, the organization provides benefits plans designed to meet each employer's needs as well as actuary services, claims screening and processing, benefits coordination, utilization control, management reporting, health promotion activities, and networking capabilities. Four major challenges do confront PPOs: 1. Start-up and operating costs can be significant; 2. The administrative skills required are different from those used in traditional health care systems; 3. The commitment in implementing and operating a PPO; and 4. All participating providers must genuinely accept the PPO. A PPO's success also can be measured in three ways: the development of a strong network; size of enrollment; and effectiveness in utilization control.(ABSTRACT TRUNCATED AT 250 WORDS)

An Evaluation of a Parent Implemented in Situ Pedestrian Safety Skills Intervention for Individuals with Autism

ERIC Educational Resources Information Center

Harriage, Bethany; Blair, Kwang-Sun Cho; Miltenberger, Raymond

2016-01-01

This study evaluated an in situ pedestrian safety skills intervention for three individuals with autism, as implemented by their parents. Specifically, this study examined the utility of behavioral skills training (BST) in helping parents implement most-to-least prompting procedures in training their children to use pedestrian safety skills in…

Control of automated behavior: insights from the discrete sequence production task

PubMed Central

Abrahamse, Elger L.; Ruitenberg, Marit F. L.; de Kleine, Elian; Verwey, Willem B.

2013-01-01

Work with the discrete sequence production (DSP) task has provided a substantial literature on discrete sequencing skill over the last decades. The purpose of the current article is to provide a comprehensive overview of this literature and of the theoretical progress that it has prompted. We start with a description of the DSP task and the phenomena that are typically observed with it. Then we propose a cognitive model, the dual processor model (DPM), which explains performance of (skilled) discrete key-press sequences. Key features of this model are the distinction between a cognitive processor and a motor system (i.e., motor buffer and motor processor), the interplay between these two processing systems, and the possibility to execute familiar sequences in two different execution modes. We further discuss how this model relates to several related sequence skill research paradigms and models, and we outline outstanding questions for future research throughout the paper. We conclude by sketching a tentative neural implementation of the DPM. PMID:23515430

Pharmacist-led implementation of a vancomycin guideline across medical and surgical units: impact on clinical behavior and therapeutic drug monitoring outcomes

PubMed Central

Phillips, Cameron J; Gordon, David L

2015-01-01

Background Vancomycin is the antibiotic of choice for the treatment of serious infections such as methicillin-resistant Staphylococcus aureus (MRSA). Inappropriate prescribing of vancomycin can lead to therapeutic failure, antibiotic resistance, and drug toxicity. Objective To examine the effectiveness of pharmacist-led implementation of a clinical practice guideline for vancomycin dosing and monitoring in a teaching hospital. Methods An observational pre–post study design was undertaken to evaluate the implementation of the vancomycin guideline. The implementation strategy principally involved education, clinical vignettes, and provision of pocket guidelines to accompany release of the guideline to the hospital Intranet. The target cohort for clinical behavioral change was junior medical officers, as they perform the majority of prescribing and monitoring of vancomycin in hospitals. Assessment measures were recorded for vancomycin prescribing, therapeutic drug monitoring, and patient outcomes. Results Ninety-nine patients, 53 pre- and 46 post-implementation, were included in the study. Prescribing of a loading dose increased from 9% to 28% (P=0.02), and guideline adherence to starting maintenance dosing increased from 53% to 63% (P=0.32). Dose adjustment by doctors when blood concentrations were outside target increased from 53% to 71% (P=0.12), and correct timing of initial concentration measurement increased from 43% to 57% (P=0.23). Appropriately timed trough concentrations improved from 73% to 81% (P=0.08). Pre-dose (trough) concentrations in target range rose from 33% to 44% (P=0.10), while potentially toxic concentrations decreased from 32% to 21% (P=0.05) post-implementation. Infection cure rates for patients increased from 85% to 96% (P=0.11) after the guideline was implemented. Conclusion The implementation strategy employed in this study demonstrated potential effectiveness, and should prompt additional larger studies to optimize strategies that will translate into improved clinical practice using vancomycin. PMID:29354529

In College Gyms, a Time for Women Only

ERIC Educational Resources Information Center

Supiano, Beckie

2008-01-01

Harvard University quietly started offering women-only gym hours early this semester. But since the news broke several weeks ago, it has prompted an onslaught of media attention. Harvard's move, however, is not unique. In recent years, women at several colleges across the country have requested women-only workout times. Some of those women have…

Making Digital Game-Based Learning Work: Domain Knowledge Transparency

ERIC Educational Resources Information Center

Wang, Feihong; Burton, John K.

2010-01-01

During the past two decades, the popularity of computer and video games has prompted games to be a source of study for educational applications (Dickey, 2007). The most distinguishing characteristic of games is their capability to engage and motivate their players (Kiili, 2005). Educators started to explore game-based learning by testing…

Getting Started: Curriculum Exploration Process Introduction

ERIC Educational Resources Information Center

Powell, Gwynn M.

2013-01-01

This mini-article describes a faculty meeting process used for curriculum planning. The proffered outline helped us document and assess our program, to focus our conversation, to envision where we wanted students to be, and to share across the curriculum what was happening in our solitary courses. The results prompted us to share with each other…

Implementation of the Short-Term Assessment of Risk and Treatability over two phases.

PubMed

Kroppan, Erik; Nonstad, Kåre; Iversen, Runar Busch; Søndenaa, Erik

2017-01-01

Over the last decade, the Short-Term Assessment of Risk and Treatability (START) has provided a strong evidence base to predict a range of problem behaviors. The implementation of START and adaptation of the services to the use of START have so far been sparsely described in the literature. The purpose of this study was to describe the continuation and the interdisciplinarity of risk assessments through the two phases. Over a period of 10 years, the forensic mental health services at Brøset has implemented START in two phases: initially with implementing the instrument (2005-2009) and secondarily by customizing the instrument to everyday treatment and planning (since 2009). This implementation was based on data from 887 START assessments for 181 patients over a decade (2005-2015). The results showed that the number of START assessments has been stable throughout the past 10 years and the interval between the ratings has decreased significantly ( p <0.05). The involvement by diversity of professionals has increased significantly over the two implementation phases. This study also addressed the continuity and organization of the implementation process and presented an overview of how START has been widespread in the service through treatment. The results showed an increased multidisciplinary participation and a continuing rate of assessments as the implementation progressed from assessment to a combined assessment-treatment phase.

Implementation of the Short-Term Assessment of Risk and Treatability over two phases

PubMed Central

Kroppan, Erik; Nonstad, Kåre; Iversen, Runar Busch; Søndenaa, Erik

2017-01-01

Background Over the last decade, the Short-Term Assessment of Risk and Treatability (START) has provided a strong evidence base to predict a range of problem behaviors. The implementation of START and adaptation of the services to the use of START have so far been sparsely described in the literature. The purpose of this study was to describe the continuation and the interdisciplinarity of risk assessments through the two phases. Methods Over a period of 10 years, the forensic mental health services at Brøset has implemented START in two phases: initially with implementing the instrument (2005–2009) and secondarily by customizing the instrument to everyday treatment and planning (since 2009). This implementation was based on data from 887 START assessments for 181 patients over a decade (2005–2015). Results The results showed that the number of START assessments has been stable throughout the past 10 years and the interval between the ratings has decreased significantly (p<0.05). The involvement by diversity of professionals has increased significantly over the two implementation phases. Conclusion This study also addressed the continuity and organization of the implementation process and presented an overview of how START has been widespread in the service through treatment. The results showed an increased multidisciplinary participation and a continuing rate of assessments as the implementation progressed from assessment to a combined assessment–treatment phase. PMID:28860799

42 CFR 460.106 - Plan of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Services § 460.106 Plan of care. (a) Basic requirement. The interdisciplinary team must promptly develop a... outcomes to be achieved. (c) Implementation of the plan of care. (1) The team must implement, coordinate...) The team must continuously monitor the participant's health and psychosocial status, as well as the...

42 CFR 460.106 - Plan of care.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Services § 460.106 Plan of care. (a) Basic requirement. The interdisciplinary team must promptly develop a... outcomes to be achieved. (c) Implementation of the plan of care. (1) The team must implement, coordinate...) The team must continuously monitor the participant's health and psychosocial status, as well as the...

Prompting methods affect the accuracy of children's school lunch recalls.

PubMed

Baxter, S D; Thompson, W O; Davis, H C

2000-08-01

To evaluate the feasibility of implementing 3 specific prompting methods among students in the first and fourth grades (mean age = 7.2 and 10.1 years, respectively), to validate recall accuracy of first- and fourth-grade students against observation, to develop a single measure of inaccuracy that cumulated errors in reporting food items and amounts without allowing underreporting and overreporting to cancel each other, and to establish information regarding the measure of inaccuracy for use in future studies. Children were interviewed the morning after they were observed eating lunch provided by the school. Interviews included free recall, nonsuggestive prompted recall, and specific prompted recall (either preference, food category, or visual). Ninety-six children (48 students per grade) were studied--32 per the specific prompting method--stratified by grade, sex, and ethnicity (African-American or white). Specific prompting method was randomly assigned to children within strata. Food items were categorized and weighted as: combination entree = 2, condiments = 1/3, and other = 1. To calculate inaccuracy of recall, absolute differences between amounts reported and observed eaten were calculated for each item and then multiplied by each item's weight; these values were then summed across all items for each child. Inaccuracy of recall was determined before specific prompting and after specific prompting and for the difference (inaccuracy after specific prompting minus inaccuracy before specific prompting). Before specific prompting, median inaccuracy was 2.7 servings for the 48 first-grade students and 1.7 servings for the 48 fourth-grade students. The median difference in inaccuracy from before to after specific prompting was 0 for both grades. Specific prompting increased recall accuracy for 9 first-graders and 12 fourth-graders, but decreased recall accuracy for 21 first-graders and 7 fourth-graders, and did not change recall accuracy for 18 first-graders and 29 fourth-graders. Among children whose recall accuracy increased after specific prompting, 5 first-graders and 8 fourth-graders received prompting for food category. Among first-grade students, specific prompting (either preference, food category, or visual) may hurt more than help recall accuracy. Among fourth-grade students, prompting for food category yields small gains in recall accuracy with minimal losses. Validation studies are needed with larger sample sizes to determine prompting methods that produce more accurate dietary recalls from children of various socioeconomic status groups, other racial/ethnic groups, and at other meals.

Implementing and testing theoretical fission fragment yields in a Hauser-Feshbach statistical decay framework

NASA Astrophysics Data System (ADS)

Jaffke, Patrick; Möller, Peter; Stetcu, Ionel; Talou, Patrick; Schmitt, Christelle

2018-03-01

We implement fission fragment yields, calculated using Brownian shape-motion on a macroscopic-microscopic potential energy surface in six dimensions, into the Hauser-Feshbach statistical decay code CGMF. This combination allows us to test the impact of utilizing theoretically-calculated fission fragment yields on the subsequent prompt neutron and γ-ray emission. We draw connections between the fragment yields and the total kinetic energy TKE of the fission fragments and demonstrate that the use of calculated yields can introduce a difference in the 〈TKE〉 and, thus, the prompt neutron multiplicity v, as compared with experimental fragment yields. We deduce the uncertainty on the 〈TKE〉 and v from this procedure and identify possible applications.

Experience with decision support system and comfort with topic predict clinicians' responses to alerts and reminders.

PubMed

Bauer, Nerissa S; Carroll, Aaron E; Saha, Chandan; Downs, Stephen M

2016-04-01

Clinicians at our institution typically respond to about half of the prompts they are given by the clinic's computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use. We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as "easy" or "not easy" to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user's experience with CHICA contribute to user response rates. We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as "easy" to discuss. The position of the prompt on the page, clinician gender, and the patient's age, race/ethnicity, and preferred language were also predictive of prompt response rate. This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician's length of exposure to the CDSS, the prompt's position on the page, and the clinician's comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Helenistic Encomium: A Reflection on Comics and Rhetoric

ERIC Educational Resources Information Center

Helms, Jason

2009-01-01

This video reflection starts in a presentation on comics at the Thomas R. Watson Conference last October, which prompted the author to explore the etymology of cosmos and comos through an alternate reading of Gorgias' "Encomium of Helen". The author then works with comos, as revelry, to offer thoughts on comics as a form of multimodal composition…

"FruitZotic": A Sensory Approach to Introducing Preschoolers to Fresh Exotic Fruits at Head Start Locations in Western Massachusetts

ERIC Educational Resources Information Center

Kannan, Srimathi; Smith, Rebecca; Foley, Christine; Del Sole, Sarah; White, Alissa; Sheldon, Lisa A.; Mietlcki-Floyd, Shirley; Severin, Suzanne

2011-01-01

FruitZotic incorporated fruit stories (exotic-fruits-literacy), a "See, Smell, Hear, Touch and Taste" (sensory) segment and a question-prompted discussion. Three take-home components incorporating the exotic fruits were: Coloring Activity, Recipes, and Fact Sheets. Sensory based nutrition education can increase familiarity with exotic…

PuTTY | High-Performance Computing | NREL

Science.gov Websites

PuTTY PuTTY Learn how to use PuTTY to connect to NREL's high-performance computing (HPC) systems . Connecting When you start the PuTTY app, the program will display PuTTY's Configuration menu. When this comes . When prompted, type your password again followed by . Note: to increase

77 FR 38468 - Airworthiness Directives; Bombardier, Inc. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-28

... was prompted by a report of a ground fire which was fed by oxygen escaping from a damaged third crew person oxygen line and had started in the vicinity of an electrical panel. This AD requires replacing and changing the routing of the flexible oxygen hose of the third crew person oxygen line and modifying the...

Attempting to Balance Wiki-Feminism: A Case Study

ERIC Educational Resources Information Center

Bruno, Walter

2013-01-01

There has been a long culture war over the validity of "Wikipedia" for research. Many university departments banned it as a primary source starting around 2007, but many others still allow it as a heuristic prompt. Certainly, one knows that students are still going to "Wikipedia" and dabbling in it. This reflects a recent gain in "Wikipedia"…

Mid South Middle Start: Studies of Three Middle Start Schools in the Mid South Delta

ERIC Educational Resources Information Center

Rose, Lea Williams; Cheney, Nancy

2005-01-01

These three case studies highlight the implementation and impact of Mid South Middle Start by: (1) contributing toward an in-depth understanding of what it means to be a school implementing Middle Start; (2) describing a holistic portrait of the schools' participation in Mid South Middle Start; and (3) assisting the Academy for Educational…

Tuberculosis screening in patients with HIV: An audit against UK national guidelines to assess current practice and the effectiveness of an electronic tuberculosis-screening prompt.

PubMed

Fox-Lewis, A; Brima, N; Muniina, P; Grant, A D; Edwards, S G; Miller, R F; Pett, S L

2016-09-01

A retrospective clinical audit was performed to assess if the British HIV Association 2011 guidelines on routine screening for tuberculosis in HIV are being implemented in a large UK urban clinic, and if a tuberculosis-screening prompt on the electronic patient record for new attendees was effective. Of 4658 patients attending during the inclusion period, 385 were newly diagnosed first-time attendees and routine tuberculosis screening was recommended in 165. Of these, only 6.1% of patients had a completed tuberculosis screening prompt, and 12.1% underwent routine tuberculosis screening. This audit represents the first published UK data on routine screening rates for tuberculosis in HIV and demonstrates low rates of tuberculosis screening despite an electronic screening prompt designed to simplify adherence to the national guideline. Reasons why tuberculosis screening rates were low, and the prompt ineffective, are unclear. A national audit is ongoing, and we await the results to see if our data reflect a lack of routine tuberculosis screening in HIV-infected patients at a national level. © The Author(s) 2016.

Alternative Student Growth Measures for Teacher Evaluation: Implementation Experiences of Early-Adopting Districts. REL 2015-093

ERIC Educational Resources Information Center

McCullough, Moira; English, Brittany; Angus, Megan Hague; Gill, Brian

2015-01-01

Alternative student growth measures for teacher evaluation: Implementation experiences of early-adopting districts: State requirements to include student achievement growth in teacher evaluations are prompting the development of alternative ways to measure growth in grades and subjects not covered by state assessments. These alternative growth…

PIRPOSAL Model of Integrative STEM Education: Conceptual and Pedagogical Framework for Classroom Implementation

ERIC Educational Resources Information Center

Wells, John G.

2016-01-01

The PIRPOSAL model is both a conceptual and pedagogical framework intended for use as a pragmatic guide to classroom implementation of Integrative STEM Education. Designerly questioning prompted by a "need to know" serves as the basis for transitioning student designers within and among multiple phases while they progress toward an…

The cost of local, multi-professional obstetric emergencies training.

PubMed

Yau, Christopher W H; Pizzo, Elena; Morris, Steve; Odd, David E; Winter, Cathy; Draycott, Timothy J

2016-10-01

We aim to outline the annual cost of setting up and running a standard, local, multi-professional obstetric emergencies training course, PROMPT (PRactical Obstetric Multi-Professional Training), at Southmead Hospital, Bristol, UK - a unit caring for approximately 6500 births per year. A retrospective, micro-costing analysis was performed. Start-up costs included purchasing training mannequins and teaching props, printing of training materials and assembly of emergency boxes (real and training). The variable costs included administration time, room hire, additional printing and the cost of releasing all maternity staff in the unit, either as attendees or trainers. Potential, extra start-up costs for maternity units without established training were also included. The start-up costs were €5574 and the variable costs for 1 year were €143 232. The total cost of establishing and running training at Southmead for 1 year was €148 806. Releasing staff as attendees or trainers accounted for 89% of the total first year costs, and 92% of the variable costs. The cost of running training in a maternity unit with around 6500 births per year was approximately €23 000 per 1000 births for the first year and around €22 000 per 1000 births in subsequent years. The cost of local, multi-professional obstetric emergencies training is not cheap, with staff costs potentially representing over 90% of the total expenditure. It is therefore vital that organizations consider the clinical effectiveness of local training packages before implementing them, to ensure the optimal allocation of finite healthcare budgets. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Investigation report: H Reactor mischarging incident

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

Vinther, A.P.

1964-05-01

All cold reactor start-up procedures require the vertical safety rods (VSR) to be withdrawn in pairs with specific waiting periods between each pair withdrawal. This rod withdrawal procedure will assure an early and safe detection of reactor criticality should reactor reactivity conditions be different than predicted so that proper corrective actions can be taken. During the paired VSR removal of H reactor on April 17, 1964, while preparing for reactor start-up, an extremely low level rising period was detected with six VSR's still in the reactor. The withdrawn VSR's were promptly re-inserted. During the next several days other process difficultiesmore » were encountered. H Processing personnel began investigating the possibility that a number of process tubes might have been mischarged; one shift's charging effort appeared to be suspect as longitudinal peaking appeared nearly twice as severe as normal in the distorted region. Following verification of a charging error in the suspect group of 171 tubes, that group of tubes was discharged and recharged with the proper charge make-up. On April 24, during VSR removal for start-up, low level criticality was detected with three VSR's still in the unit. The VSR's were re-inserted and Operational Physics analysis requested. Following installation of additional poisoning, the Operational Physics analysis uncovered a reactivity prediction error related to the prior operation with the skewed flux distribution. However, in this case, as on April 17, the procedural paired VSR withdrawal provided safe detection of the criticality condition in adequate time to take prompt corrective action. A successful reactor start-up was then achieved later on April 24, and reactor operation has been normal since that time. 4 figs.« less

Repetitive Daily Point of Choice Prompts and Occupational Sit-Stand Transfers, Concentration and Neuromuscular Performance in Office Workers: An RCT

PubMed Central

Donath, Lars; Faude, Oliver; Schefer, Yannick; Roth, Ralf; Zahner, Lukas

2015-01-01

Objective: Prolonged office sitting time adversely affects neuromuscular and cardiovascular health parameters. As a consequence, the present study investigated the effects of prompting the use of height-adjustable working desk (HAWD) on occupational sitting and standing time, neuromuscular outcomes and concentration in office workers. Methods: A single-blinded randomized controlled trial (RCT) with parallel group design was conducted. Thirty-eight office workers were supplied with HAWDs and randomly assigned (Strata: physical activity (PA), BMI, gender, workload) to a prompt (INT) or non-prompt (CON) group. INT received three daily screen-based prompts within 12 weeks. CON was only instructed once concerning the benefits of using HAWDs prior to the start of the study. Sitting and standing times were objectively assessed as primary outcomes for one entire working week using the ActiGraph wGT3X-BT at baseline (pre), after 6 (mid) and 12 weeks (post). Concentration (d2-test), postural sway during upright stance (under single, dual and triple task) and lower limb strength endurance (heel-rise) were collected as secondary outcomes. Results: With large but not statistically significant within group effects from pre to post, INT increased weekly standing time at work by 9% (p = 0.22, d = 0.8) representing an increase from 7.2 h (4.8) to 9.7 (6.6) h (p = 0.07). Concentration and neuromuscular performance did not change from pre to post testing (0.23 < p < 0.95; 0.001 < ηp² < 0.05). Conclusion: Low-frequent and low cost screen-based point of choice prompts (3 per day within 12 weeks) already result in notable increases of occupational standing time of approx. daily 30 min. These stimuli, however, did not relevantly affect neuromuscular outcomes.   PMID:25903058

Understanding Implementation and Effectiveness of "Strong Start K-2" on Social-Emotional Behavior

ERIC Educational Resources Information Center

Whitcomb, Sara A.; Merrell, Kenneth W.

2012-01-01

"Strong Start K-2" is a social-emotional learning curriculum, designed for use with children in kindergarten through grade 2. The objectives of this study were twofold. First, authors aimed to evaluate the feasibility and quality of "Strong Start" implementation. Additionally authors examined the effect of "Strong Start" on first grade students'…

Campaign for Right to Carry Concealed Guns on Campuses Gains Traction

ERIC Educational Resources Information Center

Wiseman, Rachel

2012-01-01

Five years after the Virginia Tech massacre prompted a student in Texas to start a Facebook page in favor of the right to carry concealed weapons on college campuses, the resulting group, Students for Concealed Carry, has advanced its cause. In more than a dozen states, legislation has been introduced to allow the carrying of concealed firearms on…

Teachers' Silences about Racist Attitudes and Students' Desires to Address These Attitudes

ERIC Educational Resources Information Center

Rosvall, Per-Åke; Öhrn, Elisabet

2014-01-01

In this article, we use ethnographic data to explore school-based perceptions of racism. We draw on the findings of a one-year study conducted in two upper secondary classes in a Swedish school. The starting point of the analysis was student discussions of racism in the school and the surrounding neighbourhood, which prompted an examination of…

Psychology in its Place: Personal Reflections on the State We're In

ERIC Educational Resources Information Center

Hollin, Gregory J. S.; Hollin, Clive R.

2009-01-01

John Radford's original article (Radford, 2008a) asked some hard questions about the content and purpose of a degree in psychology. The original article prompted a number of replies and a rejoinder from Radford (2008b). In the spirit of carrying on the discussion started by Radford and others, this article offers two personal perspectives on our…

Stickybear's Early Learning Activities: School Version with Lesson Plans (Ages 2-6). [CD-ROM].

ERIC Educational Resources Information Center

Highsmith, Joni Bitman

Aimed at children ages 2 to 6, this software product is designed to give preschoolers an essential skills head start with sight and sounds that will capture their interest. The courseware provides two modes of play, allowing children to learn through prompted direction or through discovery. The program is bilingual, offering skill development in…

45 CFR 286.165 - How is a Tribal Family Assistance Plan amended?

Code of Federal Regulations, 2014 CFR

2014-10-01

... Assistance Plan amended? (a) An amendment to a TFAP is necessary if the Tribe makes any substantial changes... Tribe must submit a plan amendment(s) to the Secretary no later than 30 days prior to the proposed implementation date. Proposed implementation dates shall be the first day of any month. (c) We will promptly...

78 FR 73769 - Approval and Promulgation of Air Quality Implementation Plans; West Virginia; Approval of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-09

..., contingency measures, and other planning SIPs related to the attainment of either the 1997 annual or 2006 24... contingency measures, with a schedule for implementation, as EPA deems necessary to assure prompt correction... continued attainment; and (5) a contingency plan to prevent or correct future violations of the NAAQS. III...

40 CFR 92.706 - Approval of plan: Implementation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) CONTROL OF AIR POLLUTION FROM LOCOMOTIVES AND LOCOMOTIVE ENGINES Recall Regulations § 92.706... days after the completion of such hearing, order the manufacturer or remanufacturer to provide prompt...

TH-A-19A-08: Intel Xeon Phi Implementation of a Fast Multi-Purpose Monte Carlo Simulation for Proton Therapy

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

Souris, K; Lee, J; Sterpin, E

2014-06-15

Purpose: Recent studies have demonstrated the capability of graphics processing units (GPUs) to compute dose distributions using Monte Carlo (MC) methods within clinical time constraints. However, GPUs have a rigid vectorial architecture that favors the implementation of simplified particle transport algorithms, adapted to specific tasks. Our new, fast, and multipurpose MC code, named MCsquare, runs on Intel Xeon Phi coprocessors. This technology offers 60 independent cores, and therefore more flexibility to implement fast and yet generic MC functionalities, such as prompt gamma simulations. Methods: MCsquare implements several models and hence allows users to make their own tradeoff between speed andmore » accuracy. A 200 MeV proton beam is simulated in a heterogeneous phantom using Geant4 and two configurations of MCsquare. The first one is the most conservative and accurate. The method of fictitious interactions handles the interfaces and secondary charged particles emitted in nuclear interactions are fully simulated. The second, faster configuration simplifies interface crossings and simulates only secondary protons after nuclear interaction events. Integral depth-dose and transversal profiles are compared to those of Geant4. Moreover, the production profile of prompt gammas is compared to PENH results. Results: Integral depth dose and transversal profiles computed by MCsquare and Geant4 are within 3%. The production of secondaries from nuclear interactions is slightly inaccurate at interfaces for the fastest configuration of MCsquare but this is unlikely to have any clinical impact. The computation time varies between 90 seconds for the most conservative settings to merely 59 seconds in the fastest configuration. Finally prompt gamma profiles are also in very good agreement with PENH results. Conclusion: Our new, fast, and multi-purpose Monte Carlo code simulates prompt gammas and calculates dose distributions in less than a minute, which complies with clinical time constraints. It has been successfully validated with Geant4. This work has been financialy supported by InVivoIGT, a public/private partnership between UCL and IBA.« less

Prevention of Glucocorticoid-Induced Osteoporosis: Clinical audit to evaluate the implementation of National Osteoporosis Guideline Group 2017 guidelines in a primary care setting.

PubMed

Carter, Matthew

2018-04-12

Treatment with glucocorticoids is the leading cause of drug-induced osteoporosis. National Osteoporosis Guideline Group (NOGG) 2017 guidelines advise a case-finding strategy for patients at risk. The aims of the audit were to evaluate the implementation of the NOGG 2017 guidelines for patients receiving long-term glucocorticoid therapy in a suburban general practice, to instigate changes to ensure 90% of patients are investigated and treated appropriately, and to evaluate impact at a 6-mo re-audit. Reporting Analysis and Intelligence Delivering Results (RAIDR) is a health-care intelligence tool accessing primary care clinical data. Using RAIDR, data on relevant osteoporotic risk factors were combined to produce FRAX scores for patients who had been prescribed glucocorticoids 3 or more times in the past 12 months. FRAX data were displayed in a NOGG guidance graph for major osteoporotic fracture probability. Patients were assessed as high, intermediate, or low risk. High- and intermediate-risk patients above the NOGG threshold were recommended to start bisphosphonates; these patients were sent a prescription for alendronate and a letter of explanation. There were no intermediate patients below the NOGG threshold. Low-risk patients were recommended to have lifestyle advice; a leaflet was produced and sent to these patients. Initial results showed that only 25% of patients recommended to be on bisphosphonates were taking them. Steps were taken to educate the general practitioners in the FRAX tool and NOGG guidelines; the chronic obstructive pulmonary disease annual template was amended to aid adherence by alerting the nurse to the number of glucocorticoid courses prescribed, with additional boxes for prescribing alendronate and printing the lifestyle leaflet; and 2-monthly RAIDR searches by the practice pharmacist were started. A re-audit 6 mo later showed improvement to 92%. This audit showed that education, reminders, and simple computer prompts can greatly improve the implementation of NOGG guidelines for glucocorticoid-induced osteoporosis. Copyright © 2018 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Explicit awareness supports conditional visual search in the retrieval guidance paradigm.

PubMed

Buttaccio, Daniel R; Lange, Nicholas D; Hahn, Sowon; Thomas, Rick P

2014-01-01

In four experiments we explored whether participants would be able to use probabilistic prompts to simplify perceptually demanding visual search in a task we call the retrieval guidance paradigm. On each trial a memory prompt appeared prior to (and during) the search task and the diagnosticity of the prompt(s) was manipulated to provide complete, partial, or non-diagnostic information regarding the target's color on each trial (Experiments 1-3). In Experiment 1 we found that the more diagnostic prompts was associated with faster visual search performance. However, similar visual search behavior was observed in Experiment 2 when the diagnosticity of the prompts was eliminated, suggesting that participants in Experiment 1 were merely relying on base rate information to guide search and were not utilizing the prompts. In Experiment 3 participants were informed of the relationship between the prompts and the color of the target and this was associated with faster search performance relative to Experiment 1, suggesting that the participants were using the prompts to guide search. Additionally, in Experiment 3 a knowledge test was implemented and performance in this task was associated with qualitative differences in search behavior such that participants that were able to name the color(s) most associated with the prompts were faster to find the target than participants who were unable to do so. However, in Experiments 1-3 diagnosticity of the memory prompt was manipulated via base rate information, making it possible that participants were merely relying on base rate information to inform search in Experiment 3. In Experiment 4 we manipulated diagnosticity of the prompts without manipulating base rate information and found a similar pattern of results as Experiment 3. Together, the results emphasize the importance of base rate and diagnosticity information in visual search behavior. In the General discussion section we explore how a recent computational model of hypothesis generation (HyGene; Thomas, Dougherty, Sprenger, & Harbison, 2008), linking attention with long-term and working memory, accounts for the present results and provides a useful framework of cued recall visual search. Copyright © 2013 Elsevier B.V. All rights reserved.

Choosing Wellness: Comprehensive Health Education Planning and Implementation Handbook. A Handbook for Head Start Programs [and] Resource Guide: A Guide for Head Start Programs.

ERIC Educational Resources Information Center

Enright, Margaret; Davidson, Tasha

These materials consist of: (1) a planning and implementation handbook designed to help Head Start managers better understand, plan, and implement a more comprehensive aproach to health education and health promotion--one that addresses local needs and tailors programs to the needs of the children, parents, and staff; and (2) a resource guide that…

[Neurodevelopmental assessment of patients with congenital hypothyroidism].

PubMed

Núñez, Alicia; Bedregal, Paula; Becerra, Carlos; Grob L, Francisca

2017-12-01

Congenital hypothyroidism (CH) is the most common cause of preventable cognitive disability worldwide. Generally, it is produced by an alteration in the embryogenesis of the thyroid gland or by an alteration in the synthesis of thyroid hormones, which determine that affected patients have low or absent thyroid hormone concentrations. The importance of this fact is that brain development during the first three years of life is highly dependent on thyroid hormones. Prior to the implementation of national neonatal screening programs around the world, 8 to 27% of children with CH had an IQ lower than 70. Nowadays, this percentage is close to 0 in countries that have implemented the program. In Chile, CH neonatal screening program achieved national coverage in 1996. Currently, the incidence of the disease in our country is 1: 3163. The degree of disability produced by CH not only depends on the time of detection of the disease and the prompt start of therapy, but also on an adequate monitoring. Despite screening programs, neurocognitive impairment in schoolchildren and teenagers with CH is still observed, reflected in lower scores in cognitive, language and gross motor assessments, receptive communication, expressive communication, fine motor and gross motor skills compared to healthy children. Also, lesser achievements in learning and language disorders are observed. The objective of this review is to update the information available on neurodevelopment of patients with CH.

Teaching foster grandparents to train severely handicapped persons.

PubMed Central

Fabry, P L; Reid, D H

1978-01-01

Five foster grandparents were taught training skills for use in their daily interactions with severely handicapped persons in an institution. Following baseline, specific teaching procedures consisting of teacher instructions, prompts, modelling, and praise were implemented. The grandparents' frequency of training three skill areas increased as the specific teaching was implemented in multiple-baseline format. The total amount of training continued as teacher instructions, prompts, and modelling were terminated and praise continued, although the grandparents spent their training time emphasizing only two of the three skill areas. Teacher presence was gradually reduced over an 11-week period, with no decrease in grandparents' frequency of training. Four of the foster grandchildren, all profoundly retarded and multiply handicapped, demonstrated progress throughout the study. Results were discussed in light of the available contributions of foster grandparents in institutional settings and maintenance of staff training. PMID:148446

Comment on 'Imaging of prompt gamma rays emitted during delivery of clinical proton beams with a Compton camera: feasibility studies for range verification'.

PubMed

Sitek, Arkadiusz

2016-12-21

The origin ensemble (OE) algorithm is a new method used for image reconstruction from nuclear tomographic data. The main advantage of this algorithm is the ease of implementation for complex tomographic models and the sound statistical theory. In this comment, the author provides the basics of the statistical interpretation of OE and gives suggestions for the improvement of the algorithm in the application to prompt gamma imaging as described in Polf et al (2015 Phys. Med. Biol. 60 7085).

Comment on ‘Imaging of prompt gamma rays emitted during delivery of clinical proton beams with a Compton camera: feasibility studies for range verification’

NASA Astrophysics Data System (ADS)

Sitek, Arkadiusz

2016-12-01

The origin ensemble (OE) algorithm is a new method used for image reconstruction from nuclear tomographic data. The main advantage of this algorithm is the ease of implementation for complex tomographic models and the sound statistical theory. In this comment, the author provides the basics of the statistical interpretation of OE and gives suggestions for the improvement of the algorithm in the application to prompt gamma imaging as described in Polf et al (2015 Phys. Med. Biol. 60 7085).

Intervention for Food Selectivity in a Specialized School Setting: Teacher Implemented Prompting, Reinforcement, and Demand Fading for an Adolescent Student with Autism

ERIC Educational Resources Information Center

Knox, Maria; Rue, Hanna C.; Wildenger, Leah; Lamb, Kara; Luiselli, James K.

2012-01-01

Food selectivity is a common problem among children and youth who have intellectual and developmental disabilities or autism spectrum disorders. Whereas most intervention research has been conducted under simulated conditions in clinic and hospital settings, this study evaluated teacher implemented procedures at a specialized school. The…

Reduced γ-γ time walk to below 50 ps using the multiplexed-start and multiplexed-stop fast-timing technique with LaBr3(Ce) detectors

NASA Astrophysics Data System (ADS)

Régis, J.-M.; Saed-Samii, N.; Rudigier, M.; Ansari, S.; Dannhoff, M.; Esmaylzadeh, A.; Fransen, C.; Gerst, R.-B.; Jolie, J.; Karayonchev, V.; Müller-Gatermann, C.; Stegemann, S.

2016-07-01

The electronic γ-γ fast-timing technique using arrays consisting of many LaBr3(Ce) detectors is a powerful method to determine lifetimes of nuclear excited states with a lower limit of about 5 ps. This method requires the determination of the energy-dependent time walk of the zero time which is represented by the centroid of a prompt γ-γ time distribution. The full-energy peak versus full-energy peak prompt response difference which represents the linearly combined mean γ-γ time walk of a fast-timing array consisting of 8 LaBr3(Ce) detectors was measured using a standard 152Eu γ-ray source for the energy region of 40-1408 keV. The data were acquired using a "multiplexed-start and multiplexed-stop" analogue electronics circuitry and analysed by employing the generalized centroid difference method. Concerning the cylindrical 1.5 in.×1.5 in. LaBr3(Ce) crystals which are coupled to the Hamamatsu R9779 photomultiplier tubes, the best fast-timing array time resolution of 202(3) ps is obtained for the two prompt γ lines of 60Co by using the leading-edge timing principle. When using the zero-crossover timing principle the time resolution is degraded by up to 30%, dependent on the energy and the shaping delay time of the constant fraction discriminator model Ortec 935. The smallest γ-γ time walk to below 50 ps is obtained by using a shaping delay time of about 17 ns and an optimum "time-walk adjustment" needed for detector output pulses with amplitudes smaller than 400 mV.

Implementation of the World Starts with Me, a Comprehensive Rights-Based Sex Education Programme in Uganda

ERIC Educational Resources Information Center

Rijsdijk, Liesbeth E.; Bos, Arjan E. R.; Lie, Rico; Leerlooijer, Joanne N.; Eiling, Ellen; Atema, Vera; Gebhardt, Winifred A.; Ruiter, Robert A. C.

2014-01-01

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation…

Evaluation of infrared treatments for managing roadside vegetation : appendices

DOT National Transportation Integrated Search

2000-12-01

Environmental concerns have prompted many agencies to seek alternatives to herbicides in controlling vegetation on roadway shoulders. This study was implemented to evaluate the potential for infrared technology to address this need. Infrared technolo...

Evaluation of infrared treatments for managing roadside vegetation

DOT National Transportation Integrated Search

2000-12-01

Environmental concerns have prompted many agencies to seek alternatives to herbicides in controlling vegetation on roadway shoulders. This study was implemented to evaluate the potential for infrared technology to address this need. Infrared technolo...

Improving on-time surgical starts: the impact of implementing pre-OR timeouts and performance pay.

PubMed

Martin, Luke; Langell, John

2017-11-01

Operating room (OR) time is expensive. Underutilized OR time negatively impacts efficiency and is an unnecessary cost for hospitals. The purpose of this study was to evaluate the impact of a pre-OR timeout and performance pay incentive on the frequency of on-time, first surgical starts. At a single Veterans Affairs Medical Center, we implemented a pre-OR timeout in the form of a safety-briefing checklist and a modest performance pay incentive for on-time starts (>90% compliance) for attending surgeons. Data were collected on all first-start cases beginning before implementation in 2008 and continued through 2015. Each year, an average of 960 first starts occurred across nine surgical divisions. Before implementation of either the timeout or pay incentive, only 15% of cases started on time, and by 2015, greater than 72% were on time (P < 0.001). Over the study period, there were significant improvements in on-time starts (P = 0.01), of delays <15 min (P = 0.01), and of delays 16 to 30 min (P = 0.04). The trends for delays of 31 to 60 min or >60 min were not significant (P = 0.31; P = 0.81). Assuming a loss of 7 min per case for delays <15 min and 20 min per case for delays of 16 to 30 min, the total OR time saved from implementing these measures was 37,556 min. At an estimated cost of $20/min, gross savings from this project were $751,120. Implementation of a pre-OR timeout and performance pay for on-time starts significantly improves OR utilization and reduces unnecessary costs. Published by Elsevier Inc.

Approaches to Mixed Methods Dissemination and Implementation Research: Methods, Strengths, Caveats, and Opportunities.

PubMed

Green, Carla A; Duan, Naihua; Gibbons, Robert D; Hoagwood, Kimberly E; Palinkas, Lawrence A; Wisdom, Jennifer P

2015-09-01

Limited translation of research into practice has prompted study of diffusion and implementation, and development of effective methods of encouraging adoption, dissemination and implementation. Mixed methods techniques offer approaches for assessing and addressing processes affecting implementation of evidence-based interventions. We describe common mixed methods approaches used in dissemination and implementation research, discuss strengths and limitations of mixed methods approaches to data collection, and suggest promising methods not yet widely used in implementation research. We review qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies, and describe methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings.

Approaches to Mixed Methods Dissemination and Implementation Research: Methods, Strengths, Caveats, and Opportunities

PubMed Central

Green, Carla A.; Duan, Naihua; Gibbons, Robert D.; Hoagwood, Kimberly E.; Palinkas, Lawrence A.; Wisdom, Jennifer P.

2015-01-01

Limited translation of research into practice has prompted study of diffusion and implementation, and development of effective methods of encouraging adoption, dissemination and implementation. Mixed methods techniques offer approaches for assessing and addressing processes affecting implementation of evidence-based interventions. We describe common mixed methods approaches used in dissemination and implementation research, discuss strengths and limitations of mixed methods approaches to data collection, and suggest promising methods not yet widely used in implementation research. We review qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies, and describe methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings. PMID:24722814

An Examination of Teacher Understanding of Project Based Science as a Result of Participating in an Extended Professional Development Program: Implications for Implementation

ERIC Educational Resources Information Center

Mentzer, Gale A.; Czerniak, Charlene M.; Brooks, Lisa

2017-01-01

Project-based science (PBS) aligns with national standards that assert children should learn science by actively engaging in the practices of science. Understanding and implementing PBS requires a shift in teaching practices away from one that covers primarily content to one that prompts children to conduct investigations. A common challenge to…

Teaching physical activities to students with significant disabilities using video modeling.

PubMed

Cannella-Malone, Helen I; Mizrachi, Sharona V; Sabielny, Linsey M; Jimenez, Eliseo D

2013-06-01

The objective of this study was to examine the effectiveness of video modeling on teaching physical activities to three adolescents with significant disabilities. The study implemented a multiple baseline across six physical activities (three per student): jumping rope, scooter board with cones, ladder drill (i.e., feet going in and out), ladder design (i.e., multiple steps), shuttle run, and disc ride. Additional prompt procedures (i.e., verbal, gestural, visual cues, and modeling) were implemented within the study. After the students mastered the physical activities, we tested to see if they would link the skills together (i.e., complete an obstacle course). All three students made progress learning the physical activities, but only one learned them with video modeling alone (i.e., without error correction). Video modeling can be an effective tool for teaching students with significant disabilities various physical activities, though additional prompting procedures may be needed.

Indications for laboratory tests in primary care: assessment of the most frequent indications and requests with blank clinical information

PubMed Central

Salinas, Maria; López-Garrigós, Maite; Flores, Emilio; Leiva-Salinas, Maria; Esteban, Patricia; Ahumada, Miguel; Leiva-Salinas, Carlos

2016-01-01

Introduction The aim of this work is twofold. Firstly, to study the temporal evolution in the number of laboratory requests from primary care without clinical indication, and to analyse the number of such requests before and after the implementation of an automated requesting procedure. Secondly, to investigate what are the most frequent clinical indications that prompted laboratory testing. Materials and methods This is a retrospective observational study conducted from January 2009 to December 2015. We counted the requests without clinical question, calculated the number of such requests per total number of requests and listed the most frequent indications. Results The number of tests requests with a blank clinical indication was significantly higher in 2009 when compared to 2015 (80% vs. 20%; P < 0.001). For every year in this 7-year period, dyslipidemia, essential hypertension and diabetes were the most prevalent diagnoses that prompted a laboratory test in primary care, accounting for more than 20% of all indications. Conclusions The number of primary care requests without patient clinical question has decreased after the implementation of an automated requesting procedure. Disorders of lipid metabolism, essential hypertension and diabetes mellitus were the most prevalent diagnoses that prompted a laboratory test in primary care. PMID:27812310

A young woman with seizures and psychosis

PubMed Central

Naha, Sowjanya; Naha, Kushal; Hande, H Manjunath; Vivek, Ganapathiraman

2014-01-01

We present a case of a 24-year-old woman with abnormal behaviour of recent onset. She had been diagnosed previously with epilepsy and had been started on antiepileptic medication. Clinical examination confirmed features of psychosis including paranoid delusions and auditory hallucination. Neurological examination showed nystagmus and dysmetria. Further evaluation revealed the underlying cause for her symptoms. She responded promptly to appropriate therapy with complete resolution of psychosis. PMID:25008334

Working Group 11F Opening Comments NASA Planning for NASA's Future Ground Systems

NASA Technical Reports Server (NTRS)

Smith, Danford S.

2016-01-01

These are simple charts for the introductory comments to be made at the start of a panel session at the Ground System Architecture Workshop (GSAW2016). It is not meant as a formal paper, but rather contains information to prompt further discussion of the panel members and audience. The panel topic is: Embracing Change via the Use of Service-Based Frameworks and Products in an Enterprise.

CRAFFT: An Activity Prediction Model based on Bayesian Networks

PubMed Central

Nazerfard, Ehsan; Cook, Diane J.

2014-01-01

Recent advances in the areas of pervasive computing, data mining, and machine learning offer unique opportunities to provide health monitoring and assistance for individuals facing difficulties to live independently in their homes. Several components have to work together to provide health monitoring for smart home residents including, but not limited to, activity recognition, activity discovery, activity prediction, and prompting system. Compared to the significant research done to discover and recognize activities, less attention has been given to predict the future activities that the resident is likely to perform. Activity prediction components can play a major role in design of a smart home. For instance, by taking advantage of an activity prediction module, a smart home can learn context-aware rules to prompt individuals to initiate important activities. In this paper, we propose an activity prediction model using Bayesian networks together with a novel two-step inference process to predict both the next activity features and the next activity label. We also propose an approach to predict the start time of the next activity which is based on modeling the relative start time of the predicted activity using the continuous normal distribution and outlier detection. To validate our proposed models, we used real data collected from physical smart environments. PMID:25937847

Neutron Detector Signal Processing to Calculate the Effective Neutron Multiplication Factor of Subcritical Assemblies

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

Talamo, Alberto; Gohar, Yousry

2016-06-01

This report describes different methodologies to calculate the effective neutron multiplication factor of subcritical assemblies by processing the neutron detector signals using MATLAB scripts. The subcritical assembly can be driven either by a spontaneous fission neutron source (e.g. californium) or by a neutron source generated from the interactions of accelerated particles with target materials. In the latter case, when the particle accelerator operates in a pulsed mode, the signals are typically stored into two files. One file contains the time when neutron reactions occur and the other contains the times when the neutron pulses start. In both files, the timemore » is given by an integer representing the number of time bins since the start of the counting. These signal files are used to construct the neutron count distribution from a single neutron pulse. The built-in functions of MATLAB are used to calculate the effective neutron multiplication factor through the application of the prompt decay fitting or the area method to the neutron count distribution. If the subcritical assembly is driven by a spontaneous fission neutron source, then the effective multiplication factor can be evaluated either using the prompt neutron decay constant obtained from Rossi or Feynman distributions or the Modified Source Multiplication (MSM) method.« less

CRAFFT: An Activity Prediction Model based on Bayesian Networks.

PubMed

Nazerfard, Ehsan; Cook, Diane J

2015-04-01

Recent advances in the areas of pervasive computing, data mining, and machine learning offer unique opportunities to provide health monitoring and assistance for individuals facing difficulties to live independently in their homes. Several components have to work together to provide health monitoring for smart home residents including, but not limited to, activity recognition, activity discovery, activity prediction, and prompting system. Compared to the significant research done to discover and recognize activities, less attention has been given to predict the future activities that the resident is likely to perform. Activity prediction components can play a major role in design of a smart home. For instance, by taking advantage of an activity prediction module, a smart home can learn context-aware rules to prompt individuals to initiate important activities. In this paper, we propose an activity prediction model using Bayesian networks together with a novel two-step inference process to predict both the next activity features and the next activity label. We also propose an approach to predict the start time of the next activity which is based on modeling the relative start time of the predicted activity using the continuous normal distribution and outlier detection. To validate our proposed models, we used real data collected from physical smart environments.

Exploiting the Spur of the Moment to Enhance Healthy Consumption: Verbal Prompting to Increase Fruit Choices in a Self-Service Restaurant.

PubMed

van Kleef, Ellen; van den Broek, Oriana; van Trijp, Hans C M

2015-07-01

People often have good intentions to eat healthily, but these intentions may get overruled by temporary moments of temptation. The current study examined the effectiveness of "verbal prompting" as a nudge to increase fruit salad sales in a natural setting. A field experiment was conducted in a self-service restaurant during breakfast time. After an initial baseline period, the intervention involved four different prompts suggesting ordering a side dish (i.e. orange juice, fruit salad, pancakes) given by cashiers to visitors. The intervention phase lasted 13 weeks. Cash register and observational data were obtained. In addition, a sample of visitors (N = 393) responded to a survey. A significant increase in sales of orange juice was observed during the orange juice verbal prompts intervention periods (35-42% of all breakfasts sold) compared to baseline (20% of all breakfasts sold). Similarly, sales of fruit salad (9%) and pancakes (3%) rose to a small but significant extent compared to baseline sales (3% and 1%, respectively). Survey results showed that customers did not feel pressurised into purchasing a side dish. Together, findings suggest that verbal prompts involving healthy side dishes are a potential useful nudge to implement in other food service settings. © 2015 The International Association of Applied Psychology.

Teaching children with autism to engage in peer-directed mands using a picture exchange communication system.

PubMed

Paden, Amber R; Kodak, Tiffany; Fisher, Wayne W; Gawley-Bullington, Elizabeth M; Bouxsein, Kelly J

2012-01-01

We evaluated differential reinforcement of alternative behavior (DRA) plus prompting to increase peer-directed mands for preferred items using a picture exchange communication system (PECS). Two nonvocal individuals with autism participated. Independent mands with a peer increased with the implementation of DRA plus prompting for both participants. In addition, peers engaged in brief social interactions following the majority of mands for leisure items. These results suggest that teaching children to use PECS with peers may be one way to increase manding and social interactions in individuals with limited or no vocal repertoire.

TEACHING CHILDREN WITH AUTISM TO ENGAGE IN PEER-DIRECTED MANDS USING A PICTURE EXCHANGE COMMUNICATION SYSTEM

PubMed Central

Paden, Amber R; Kodak, Tiffany; Fisher, Wayne W; Gawley-Bullington, Elizabeth M; Bouxsein, Kelly J

2012-01-01

We evaluated differential reinforcement of alternative behavior (DRA) plus prompting to increase peer-directed mands for preferred items using a picture exchange communication system (PECS). Two nonvocal individuals with autism participated. Independent mands with a peer increased with the implementation of DRA plus prompting for both participants. In addition, peers engaged in brief social interactions following the majority of mands for leisure items. These results suggest that teaching children to use PECS with peers may be one way to increase manding and social interactions in individuals with limited or no vocal repertoire. PMID:22844150

The Influence of Self-Efficacy Beliefs and Metacognitive Prompting on Genetics Problem Solving Ability among High School Students in Kenya

NASA Astrophysics Data System (ADS)

Aurah, Catherine Muhonja

Within the framework of social cognitive theory, the influence of self-efficacy beliefs and metacognitive prompting on genetics problem solving ability among high school students in Kenya was examined through a mixed methods research design. A quasi-experimental study, supplemented by focus group interviews, was conducted to investigate both the outcomes and the processes of students' genetics problem-solving ability. Focus group interviews substantiated and supported findings from the quantitative instruments. The study was conducted in 17 high schools in Western Province, Kenya. A total of 2,138 high school students were purposively sampled. A sub-sample of 48 students participated in focus group interviews to understand their perspectives and experiences during the study so as to corroborate the quantitative data. Quantitative data were analyzed through descriptive statistics, zero-order correlations, 2 x 2 factorial ANOVA,, and sequential hierarchical multiple regressions. Qualitative data were transcribed, coded, and reported thematically. Results revealed metacognitive prompts had significant positive effects on student problem-solving ability independent of gender. Self-efficacy and metacognitive prompting significantly predicted genetics problem-solving ability. Gender differences were revealed, with girls outperforming boys on the genetics problem-solving test. Furthermore, self-efficacy moderated the relationship between metacognitive prompting and genetics problem-solving ability. This study established a foundation for instructional methods for biology teachers and recommendations are made for implementing metacognitive prompting in a problem-based learning environment in high schools and science teacher education programs in Kenya.

Evaluation of learning from Practical Obstetric Multi-Professional Training and its impact on patient outcomes in Australia using Kirkpatrick's framework: a mixed methods study.

PubMed

Kumar, Arunaz; Sturrock, Sam; Wallace, Euan M; Nestel, Debra; Lucey, Donna; Stoyles, Sally; Morgan, Jenny; Neil, Peter; Schlipalius, Michelle; Dekoninck, Philip

2018-02-17

The aim of this study was to evaluate the implementation of the Practical Obstetric Multi-Professional Training (PROMPT) simulation using the Kirkpatrick's framework. We explored participants' acquisition of knowledge and skills, its impact on clinical outcomes and organisational change to integrate the PROMPT programme as a credentialing tool. We also aimed to assess participants' perception of usefulness of PROMPT in their clinical practice. Mixed methods approach with a pre-test/post-test design. Healthcare network providing obstetric care in Victoria, Australia. Medical and midwifery staff attending PROMPT between 2013 and 2015 (n=508); clinical outcomes were evaluated in two cohorts: 2011-2012 (n=15 361 births) and 2014-2015 (n=12 388 births). Attendance of the PROMPT programme, a simulation programme taught in multidisciplinary teams to facilitate teaching emergency obstetric skills. Clinical outcomes compared before and after embedding PROMPT in educational practice. Assessment of knowledge gained by participants through a qualitative analysis and description of process of embedding PROMPT in educational practice. There was a change in the management of postpartum haemorrhage by early recognition and intervention. The key learning themes described by participants were being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment. Participants reported a positive learning experience and increase in confidence in managing emergency obstetric situations through the PROMPT programme, which was perceived as a realistic demonstration of the emergencies. Participants reported an improvement of both clinical and non-technical skills highlighting principles of teamwork, communication, leadership and prioritisation in an emergency situation. An improvement was observed in management of postpartum haemorrhage, but no significant change was noted in clinical outcomes over a 2-year period after PROMPT. However, the skills acquired by medical and midwifery staff justify embedding PROMPT in educational programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

14 CFR 120.225 - How to implement an alcohol testing program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... principal place of business prior to starting operations, (ii) Implement an FAA alcohol testing program no... District Office nearest to your principal place of business. (3) An air traffic control facility not... Specification,(ii) Implement an FAA alcohol testing program no later than the date you start operations, and...

A structured management approach to implementation of health promotion interventions in Head Start.

PubMed

Herman, Ariella; Nelson, Bergen B; Teutsch, Carol; Chung, Paul J

2013-09-12

Improving the health and health literacy of low-income families is a national public health priority in the United States. The federal Head Start program provides a national infrastructure for implementation of health promotion interventions for young children and their families. The Health Care Institute (HCI) at the Anderson School of Management at the University of California, Los Angeles, developed a structured approach to health promotion training for Head Start grantees using business management principles. This article describes the HCI approach and provides examples of implemented programs and selected outcomes, including knowledge and behavior changes among Head Start staff and families. This prevention-focused training platform has reached 60,000 Head Start families in the United States since its inception in 2001. HCI has demonstrated consistent outcomes in diverse settings and cultures, suggesting both scalability and sustainability.

Florida First Start Program: Program Planning and Implementation Guide.

ERIC Educational Resources Information Center

Florida State Dept. of Education, Tallahassee. Office of Early Intervention and School Readiness.

This guide is designed to facilitate the implementation of the Florida First Start (FFS) program, created to help at-risk children from birth to 3 years of age have the best possible start in life and to support parents in their roles as their children's first teachers. Emphasis is on providing early, high-quality education and support services.…

Acute isolated appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia.

PubMed

Decembrino, Nunzia; Zecca, Marco; Tortorano, Anna Maria; Mangione, Francesca; Lallitto, Fabiola; Introzzi, Francesca; Bergami, Elena; Marone, Piero; Tamarozzi, Francesca; Cavanna, Caterina

2016-01-01

We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomannan was low positive. A. carneus, a rare species of Aspergillus formerly placed in section Flavipedes and recently considered a member of section Terrei, was identified in the specimen. Treatment with voriconazole was promptly started with success. No other site of Aspergillus localization was detected. Appendicitis is rarely caused by fungal organisms and isolated intestinal aspergillosis without pulmonary infection is unusual. To our knowledge, this is the first report of infection due to A. carneus in a child and in a primary gastrointestinal infection.

Reminiscence through the Lens of Social Media

PubMed Central

Thomas, Lisa; Briggs, Pam

2016-01-01

Reminiscence is used to support and create new social bonds and give meaning to life. Originally perceived as a preoccupation of the aged, we now recognize that reminiscence has value throughout the lifespan. Increasingly, social media can be used to both support and prompt reminiscence, with Facebook’s Lookback or Year in Review as recent examples. This work takes prompted reminiscence further, asking what forms and functions of reminiscence are supported by social media. Utilizing the online service MySocialBook, we invited participants to curate content from their personal Facebook account to then be transformed into a printed book. We used that book as a prompt for discussion of the reminiscence function of the curated material, using Westerhof and Bohlmeijer’s (2014) reminiscence framework as a starting point. We conclude that this framework is valuable in understanding the role of social media in reminiscence, but note that earlier models, such as Webster’s Reminiscence Functions Scale, are also relevant. We contribute to the reminiscence debate by adding a technological lens to the process of life review, whilst concurring with other researchers in this field that a robust conceptual framework is lacking, particularly when considering the forms of reminiscence that are most salient for younger people. PMID:27378971

Alternative Education: Evaluation and Implementation of EBCE.

ERIC Educational Resources Information Center

Shively, Joe E.; Sanders, Jack

Increasing student disenchantment with traditional schooling prompted the development of an alternative educational program: Experience-Based Career Education (EBCE). During three years of development, evaluation provided student, parent, and employer data on program impact and effectiveness. Stakeholders' involvement in program development and…

Implementation of an Automated Road Maintenance Machine (ARMM)

DOT National Transportation Integrated Search

1999-08-01

Crack sealing is a hazardous, costly, and labor-intensive operation. In North America, approximately $200 million is spent each year on crack sealing. Prompted by concerns of safety and cost, the University of Texas at Austin, in cooperation with the...

One system's journey in creating a disclosure and apology program.

PubMed

Peto, Randolph R; Tenerowicz, Lynn M; Benjamin, Evan M; Morsi, Deborah S; Burger, Pamela K

2009-10-01

Patients experience adverse events more frequently than the public appreciates. A number of health systems have led the movement toward open, prompt, and compassionate disclosure of adverse events. In 2006 Baystate Health (BH) formed a disclosure advisory committee to design and implement an enhanced program to support prompt and skillful disclosure of adverse events. The proposed model for a disclosure and apology program resembled a consultation service, similar to a hospital ethics consultation service. BH hired an outside trainer to teach coaches/facilitators. Emotional support services were formalized and expanded not only for patients and families but also clinicians. THE EXPERIENCE SO FAR: Implementation of a formal disclosure and apology program has placed internal pressure on the organization to more promptly determine causality of adverse events and to respond to patient/family requests for information and/or assistance. Root causes and degree of system culpability are often not clear early after an event and sometimes are debated among the clinical team and the trained coaches/facilitators and risk managers. After a medical error, patients and families expect the organization to make changes to the system to prevent other patients from being harmed by the same mistake. To minimize the chance that patients and families feel that their suffering has been "in vain," health care systems will need to put systems in place to deliver on the promise to reduce the risk of future harm. Some of the challenges in sustaining such a program include the ability to promptly investigate, to accurately determine liability, to communicate empathetically even if unable to meet all patient/family expectations, and to ensure establishment of a just culture.

JPRS Report West Europe

DTIC Science & Technology

1988-10-28

analysis effort can start. This analysis work will be done in the spring of 1989, and the Defense Commission is to be ready with its report at the end...production processes, electronic equipment and weapons promptly. JPRS-WER-88-061 28 October 1988 21 MILITARY The project JF 90 will eclipse all of the...by the numerical superiority of a potential enemy, his attack-oriented military doc- trine and equipment , and his continually improving all-weather

Patients push for price data. Lawsuits, regulations could cause consumers nationwide to start seeking more transparency from hospitals on outpatient fees.

PubMed

Becker, Cinda

2006-11-20

Lawsuits over hospital outpatient fees, including a case at Virginia Mason Medical Center, could prompt consumers nationwide to seek more information about their bills. The issue highlights the turf battle between physician- or corporate-owned clinics and competing hospital facilities, and how they're marketed. "We absolutely agree that patients need full information", says Virginia Mason's Sarah Patterson, left.

The Inner Cold War: State Party Control and East German Society

DTIC Science & Technology

2014-06-01

explain: “The means of exerting pressure— existentially , psychologically, and morally—were so comprehensive that they had to seriously affect most...with a very different ideology and in principle far more humanistic set of goals, yet with a comparable disregard for individual human rights and...the universities were far too focused upon humanistic research for the Party’s taste,”185 and prompted reforms in these areas starting in 1951. The

Developing a mobile electronic D2B checklist for treatment of ST elevation myocardial infarction patients who need a primary coronary intervention.

PubMed

Lin, Hung-Jung; Hsu, Min-Huei; Huang, Chien-Cheng; Liu, Chung-Feng; Tan, Che-Kim; Chou, Shu-Lien; Huang, Shou-Yung; Chen, Chia-Jung

2015-04-01

ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, "Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention," a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented.

Developing a Mobile Electronic D2B Checklist for Treatment of ST Elevation Myocardial Infarction Patients Who Need a Primary Coronary Intervention

PubMed Central

Lin, Hung-Jung; Hsu, Min-Huei; Huang, Chien-Cheng; Tan, Che-Kim; Chou, Shu-Lien; Huang, Shou-Yung; Chen, Chia-Jung

2015-01-01

Abstract ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, “Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention,” a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented. PMID:25615278

A Structured Management Approach to Implementation of Health Promotion Interventions in Head Start

PubMed Central

Herman, Ariella; Teutsch, Carol; Chung, Paul J.

2013-01-01

Improving the health and health literacy of low-income families is a national public health priority in the United States. The federal Head Start program provides a national infrastructure for implementation of health promotion interventions for young children and their families. The Health Care Institute (HCI) at the Anderson School of Management at the University of California, Los Angeles, developed a structured approach to health promotion training for Head Start grantees using business management principles. This article describes the HCI approach and provides examples of implemented programs and selected outcomes, including knowledge and behavior changes among Head Start staff and families. This prevention-focused training platform has reached 60,000 Head Start families in the United States since its inception in 2001. HCI has demonstrated consistent outcomes in diverse settings and cultures, suggesting both scalability and sustainability. PMID:24028835

Clouded Economy Prompts Colleges to Weigh Changes.

ERIC Educational Resources Information Center

Grassmuck, Karen

1990-01-01

Public and private colleges and universities are bracing for an unfavorable economic climate in the 1990s, spurred by concerns about federal funding. Institutions are cutting costs, becoming more enterprising, and implementing new pricing policies, using techniques previously used in government and business. (MSE)

North Dakota implementation of mechanistic-empirical pavement design guide (MEPDG).

DOT National Transportation Integrated Search

2014-12-01

North Dakota currently designs roads based on the AASHTO Design Guide procedure, which is based on : the empirical findings of the AASHTO Road Test of the late 1950s. However, limitations of the current : empirical approach have prompted AASHTO to mo...

Rolling and tumbling: status of the SuperAGILE experiment

NASA Astrophysics Data System (ADS)

Del Monte, E.; Costa, E.; di Persio, G.; Donnarumma, I.; Evangelista, Y.; Feroci, M.; Lapshov, I.; Lazzarotto, F.; Mastropietro, M.; Morelli, E.; Pacciani, L.; Rapisarda, M.; Rubini, A.; Soffitta, P.; Tavani, M.; Argan, A.; Trois, A.

2010-07-01

The SuperAGILE experiment is the hard X-ray monitor of the AGILE mission. It is a 2 x one-dimensional imager, with 6-arcmin angular resolution in the energy range 18 - 60 keV and a field of view in excess of 1 steradian. SuperAGILE is successfully operating in orbit since Summer 2007, providing long-term monitoring of bright sources and prompt detection and localization of gamma-ray bursts. Starting on October 2009 the AGILE mission lost its reaction wheel and the satellite attitude is no longer stabilized. The current mode of operation of the AGILE satellite is a Spinning Mode, around the Sun-pointing direction, with an angular velocity of about 0.8 degree/s (corresponding to 8 times the SuperAGILE point spread function every second). In these new conditions, SuperAGILE continuously scans a much larger fraction of the sky, with much smaller exposure to each region. In this paper we review some of the results of the first 2.5 years of "standard" operation of SuperAGILE, and show how new implementations in the data analysis software allows to continue the hard X-ray sky monitoring by SuperAGILE also in the new attitude conditions.

VALUE: A trans-disciplinary research project - and some challenges in its implementation

NASA Astrophysics Data System (ADS)

Huebener, Heike

2013-04-01

The EU-COST-action VALUE ("Validating and Integrating Downscaling Methods for Climate Change Research") is composed as a trans-disciplinary network activity, meaning that stakeholders and end-users not only from different scientific disciplines (i.e. inter-disciplinary research) but also from outside science are included in the design, planning and progress of the project. This gives the optimal chance to produce really workable project results for the intended end-users. However, some considerable challenges lie this way. These challenges start with identifying and motivating the target-stakeholders, they cover communication in different user-specific languages and reach as far as the question of the freedom of research when under the prompting of politics or economy. We will cover only some of the mentioned challenges; focusing on the identification of the target-stakeholders or end-users, their motivation to participate in the project and on some typical problems arising in this constellation. First experiences from the project will be presented. The aim of the presentation is to instigate discussion on developing workable project structures for trans-disciplinary research, as this will become more and more relevant in future research funding.

Management options for cholestatic liver disease in children.

PubMed

Catzola, Andrea; Vajro, Pietro

2017-11-01

Due to a peculiar age-dependent increased susceptibility, neonatal cholestasis affects the liver of approximately 1 in every 2500 term infants. A high index of suspicion is the key to an early diagnosis, and to implement timely, often life-saving treatments. Even when specific treatment is not available or curative, prompt medical management and optimization of nutrition are of paramount importance to survival and avoidance of complications. Areas covered: The present article will prominently focus on a series of newer diagnostic and therapeutic options of cholestasis in neonates and infants blended with consolidated established paradigms. The overview of strategies for the management reported here is based on a systematic literature search published in English using accessible databases (PubMed, MEDLINE) with the keywords biliary atresia, choleretics and neonatal cholestasis. References lists from retrieved articles were also reviewed. Expert commentary: A large number of uncommon and rare hepatobiliary disorders may present with cholestasis during the neonatal and infantile period. Potentially life-saving disease-specific pharmacological and surgical therapeutic approaches are currently available. Advances in hepatobiliary transport mechanisms have started clarifying fundamental aspects of inherited and acquired cholestasis, laying the foundation for the development of possibly more effective specific therapies.

[ISRAEL NEONATOLOGY: PRESENT AND FUTURE].

PubMed

Dollberg, Shaul

2016-01-01

The practice of neonatology in Israel debuted in the 1970s as local enterprises by individual hospitals that needed to provide sick and preterm newly born infants with up-to-date and effective care. Descriptions of research and advances in humane and gentle treatment during neonatal care for preterm infants and their families, as well as prevention of neonatal infections, follow-up of preterm infants and care of full-term infants are presented in this issue. The Israel National Very Low Birth Weight (VLBW) Infant database provides an excellent source of knowledge, which has led to multiple scientific publications. Recent international comparisons of the outcome of preterm VLBW infants, made possible by this unique database in Israel, has provided the neonatal community and the Ministry of Health with insights as to the differences in prognosis between Israel and other countries, especially among extremely low birth weight infants. At the border of viability, mortality in Israelis significantly higher than that reported in other countries and proactive steps undertaken to examine these differences and prompt correctional action should be pursued. The Israel Ministry of Health started positive initiatives and should ensure that their steps are implemented at the preterm infant's bedside.

Actively caring to prevent bullying in an elementary school: Prompting and rewarding prosocial behavior.

PubMed

McCarty, Shane; Teie, Sophia; McCutchen, Jenna; Geller, E Scott

2016-01-01

This field study evaluated the impact of an intervention designed to prevent bullying among elementary-school students by prompting and rewarding prosocial behavior. More specifically, teachers of 404 second-, third-, fourth-, fifth-, and sixth-grade students from an elementary school in northeast Virginia asked their students to look out for other students' prosocial behaviors (termed "actively caring") and to submit their stories about actively caring. At the start of every class day, the teachers read three of these stories and recognized one story and the two associated students (i.e., the observer and the performer) by providing each with a wristband engraved with "Actively Caring for People." For six consecutive Fridays, students reported their observations of bullying and completed a single item estimate of self-esteem. Weekly surveys revealed reductions in "being bullied" and "bullying others," as well as an increase in self-esteem.

Chemical Burns of the Eye: The Role of Retinal Injury and New Therapeutic Possibilities.

PubMed

Dohlman, Claes H; Cade, Fabiano; Regatieri, Caio V; Zhou, Chengxin; Lei, Fengyang; Crnej, Alja; Harissi-Dagher, Mona; Robert, Marie-Claude; Papaliodis, George N; Chen, Dongfeng; Aquavella, James V; Akpek, Esen K; Aldave, Anthony J; Sippel, Kimberly C; DʼAmico, Donald J; Dohlman, Jan G; Fagerholm, Per; Wang, Liqiang; Shen, Lucy Q; González-Andrades, Miguel; Chodosh, James; Kenyon, Kenneth R; Foster, C Stephen; Pineda, Roberto; Melki, Samir; Colby, Kathryn A; Ciolino, Joseph B; Vavvas, Demetrios G; Kinoshita, Shigeru; Dana, Reza; Paschalis, Eleftherios I

2018-02-01

To propose a new treatment paradigm for chemical burns to the eye - in the acute and chronic phases. Recent laboratory and clinical data on the biology and treatment of chemical burns are analyzed. Corneal blindness from chemical burns can now be successfully treated with a keratoprosthesis, on immediate and intermediate bases. Long term outcomes, however, are hampered by early retinal damage causing glaucoma. New data suggest that rapid diffusion of inflammatory cytokines posteriorly (TNF-α, etc) can severely damage the ganglion cells. Prompt anti-TNF-α treatment is markedly neuroprotective. Long term profound reduction of the intraocular pressure is also vital. A new regimen, in addition to standard treatment, for severe chemical burns is proposed. This involves tumor necrosis factor alpha (TNF-α) inhibition promptly after the accident (primarily for retinal neuroprotection), prophylactic maximal lowering of the intraocular pressure (starting immediately), and keratoprosthesis implantation in a later quiet state.

Self-treatment of acute exacerbations of chronic obstructive pulmonary disease requires more than symptom recognition - a qualitative study of COPD patients' perspectives on self-treatment.

PubMed

Laue, Johanna; Melbye, Hasse; Risør, Mette Bech

2017-01-25

Self-treatment of acute exacerbations of COPD with antibiotics and/or oral corticosteroids has emerged as a promising strategy to reduce hospitalization rates, mortality and health costs. However, for reasons little understood, the effect of self-treatment, particularly when not part of comprehensive self-management programs, remains unclear. Therefore, this study aims to get insight into the patients' perspective on self-treatment of acute exacerbations of COPD, focusing specifically on how patients decide for the right moment to start treatment with antibiotics and/or oral corticosteroids, what they consider important when making this decision and aspects which might interfere with successful implementation. We interviewed 19 patients with chronic obstructive pulmonary disease using qualitative semi-structured interviews, and applied thematic analysis for data analysis. Patients were well equipped with experiential knowledge to recognize and promptly respond to worsening COPD symptoms. Worries regarding potential adverse effects of antibiotics and oral corticosteroids played an important role in the decision to start treatment and could result in hesitation to start treatment. Although self-treatment represented a practical and appreciated option for some patients with predictable symptom patterns and treatment effect, all patients favoured assistance from a medical professional when their perceived competence reached its limits. However, a feeling of obligation to succeed with self-treatment or distrust in their doctors or the health care system could keep patients from timely help seeking. COPD patients regard self-treatment of exacerbations with antibiotics and/or oral corticosteroids as a valuable alternative. How they engage in self-treatment depends on their concerns regarding the medications' adverse effects as well as on their understanding of and preferences for self-treatment as a means of health care. Caregivers should address these perspectives in a collaborative approach when offering COPD patients the opportunity for self-treatment of exacerbations.

Tests of a Compton imaging prototype in a monoenergetic 4.44 MeV photon field—a benchmark setup for prompt gamma-ray imaging devices

NASA Astrophysics Data System (ADS)

Golnik, C.; Bemmerer, D.; Enghardt, W.; Fiedler, F.; Hueso-González, F.; Pausch, G.; Römer, K.; Rohling, H.; Schöne, S.; Wagner, L.; Kormoll, T.

2016-06-01

The finite range of a proton beam in tissue opens new vistas for the delivery of a highly conformal dose distribution in radiotherapy. However, the actual particle range, and therefore the accurate dose deposition, is sensitive to the tissue composition in the proton path. Range uncertainties, resulting from limited knowledge of this tissue composition or positioning errors, are accounted for in the form of safety margins. Thus, the unverified particle range constrains the principle benefit of proton therapy. Detecting prompt γ-rays, a side product of proton-tissue interaction, aims at an on-line and non-invasive monitoring of the particle range, and therefore towards exploiting the potential of proton therapy. Compton imaging of the spatial prompt γ-ray emission is a promising measurement approach. Prompt γ-rays exhibit emission energies of several MeV. Hence, common radioactive sources cannot provide the energy range a prompt γ-ray imaging device must be designed for. In this work a benchmark measurement-setup for the production of a localized, monoenergetic 4.44 MeV γ-ray source is introduced. At the Tandetron accelerator at the HZDR, the proton-capture resonance reaction 15N(p,α γ4.439)12C is utilized. This reaction provides the same nuclear de-excitation (and γ-ray emission) occurrent as an intense prompt γ-ray line in proton therapy. The emission yield is quantitatively described. A two-stage Compton imaging device, dedicated for prompt γ-ray imaging, is tested at the setup exemplarily. Besides successful imaging tests, the detection efficiency of the prototype at 4.44 MeV is derived from the measured data. Combining this efficiency with the emission yield for prompt γ-rays, the number of valid Compton events, induced by γ-rays in the energy region around 4.44 MeV, is estimated for the prototype being implemented in a therapeutic treatment scenario. As a consequence, the detection efficiency turns out to be a key parameter for prompt γ-rays Compton imaging limiting the applicability of the prototype in its current realization.

A problem unstuck? Evaluating the effectiveness of sticker prompts for encouraging household food waste recycling behaviour.

PubMed

Shearer, Linzi; Gatersleben, Birgitta; Morse, Stephen; Smyth, Matthew; Hunt, Sally

2017-02-01

This Randomised Control Trial (RCT) investigated the effectiveness of using stickers as a visual prompt to encourage the separate collection of household food waste for recycling in two local authorities in South East England. During a baseline period of up to 15weeks, separately collected food waste was weighed (in tonnes) and averaged across households in both treatment (N=33,716 households within 29 defined areas) and control groups (N=30,568 households within 26 areas). A sticker prompt was then affixed to the lids of refuse bins in the treatment group area only. Weights for both groups were subsequently measured across a 16-week experimental period. Results showed that, in the control group, there was no change in the average weight of food waste captured for recycling between the baseline and experimental period. However, there was a significant increase (20.74%) in the treatment group, and this change in behaviour persisted in the longer term. Sticker prompts therefore appear to have a significant and sustained impact on food waste recycling rates, while being simple, practically feasible and inexpensive (£0.35 per household) for local authorities to implement at scale. Copyright © 2016 Elsevier Ltd. All rights reserved.

Understanding nurses' views on a pressure ulcer prevention care bundle: a first step towards successful implementation.

PubMed

Chaboyer, Wendy; Gillespie, Brigid M

2014-12-01

To explore nurses' views of the barriers and facilitators to the use of a newly devised patient-centred pressure ulcer prevention care bundle. Given pressure ulcer prevention strategies are not implemented consistently, the use of a pressure ulcer care bundle may improve implementation given bundles generally assist in standardising care. A quality improvement project was undertaken after a pressure ulcer prevention care bundle was developed and pilot-tested. Short, conversational interviews with nurse explored their views of a patient-centred pressure ulcer care bundle. Interviews were audio-taped and transcribed. Inductive content analysis was used to analyse the transcripts. A total of 20 nurses were interviewed. Five categories with corresponding subcategories emerged from the analysis. They were increasing awareness of pressure ulcer prevention, prompting pressure ulcer prevention activities, promoting active patient participation, barriers to using a pressure ulcer prevention care bundle and enabling integration of the pressure ulcer prevention care bundle into routine practice. Benefits of using a patient-centred pressure ulcer prevention care bundle may include prompting patients and staff to implement prevention strategies and promote active patient participation in care. The success of the care bundle relied on both patients' willingness to participate and nurses' willingness to incorporate it into their routine work. A patient-centred pressure ulcer prevention care bundle may facilitate more consistent implementation of pressure ulcer prevention strategies and active patient participation in care. © 2014 John Wiley & Sons Ltd.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Improving first case start times using Lean in an academic medical center.

PubMed

Deldar, Romina; Soleimani, Tahereh; Harmon, Carol; Stevens, Larry H; Sood, Rajiv; Tholpady, Sunil S; Chu, Michael W

2017-06-01

Lean is a process improvement strategy that can improve efficiency of the perioperative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases 7 months before and after implementation were analyzed. A total of 4,492 first-start cases were included; 2,181 were pre-Lean and 2,311 were post-Lean. The post-Lean group had significantly higher on-time starts than the pre-Lean group (69.0% vs 57.0%, P < .01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to preoperative assessment (14.9% vs 9.9%, P < .01) and more likely due to patient-related (16.5% vs 22.3%, P < .01) or chaplain (1.8% vs 4.0%, P < .01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (P < .01). Modifying preoperative tasks using Lean methods can improve operating room efficiency and increase on-time starts. Copyright © 2016 Elsevier Inc. All rights reserved.

Correlated prompt fission data in transport simulations

DOE PAGES

Talou, P.; Vogt, R.; Randrup, J.; ...

2018-01-24

Detailed information on the fission process can be inferred from the observation, modeling and theoretical understanding of prompt fission neutron and γ-ray observables. Beyond simple average quantities, the study of distributions and correlations in prompt data, e.g., multiplicity-dependent neutron and γ-ray spectra, angular distributions of the emitted particles, n -n, n - γ, and γ - γ correlations, can place stringent constraints on fission models and parameters that would otherwise be free to be tuned separately to represent individual fission observables. The FREYA and CGMF codes have been developed to follow the sequential emissions of prompt neutrons and γ raysmore » from the initial excited fission fragments produced right after scission. Both codes implement Monte Carlo techniques to sample initial fission fragment configurations in mass, charge and kinetic energy and sample probabilities of neutron and γ emission at each stage of the decay. This approach naturally leads to using simple but powerful statistical techniques to infer distributions and correlations among many observables and model parameters. The comparison of model calculations with experimental data provides a rich arena for testing various nuclear physics models such as those related to the nuclear structure and level densities of neutron-rich nuclei, the γ-ray strength functions of dipole and quadrupole transitions, the mechanism for dividing the excitation energy between the two nascent fragments near scission, and the mechanisms behind the production of angular momentum in the fragments, etc. Beyond the obvious interest from a fundamental physics point of view, such studies are also important for addressing data needs in various nuclear applications. The inclusion of the FREYA and CGMF codes into the MCNP6.2 and MCNPX - PoliMi transport codes, for instance, provides a new and powerful tool to simulate correlated fission events in neutron transport calculations important in nonproliferation, safeguards, nuclear energy, and defense programs. Here, this review provides an overview of the topic, starting from theoretical considerations of the fission process, with a focus on correlated signatures. It then explores the status of experimental correlated fission data and current efforts to address some of the known shortcomings. Numerical simulations employing the FREYA and CGMF codes are compared to experimental data for a wide range of correlated fission quantities. The inclusion of those codes into the MCNP6.2 and MCNPX - PoliMi transport codes is described and discussed in the context of relevant applications. The accuracy of the model predictions and their sensitivity to model assumptions and input parameters are discussed. Lastly, a series of important experimental and theoretical questions that remain unanswered are presented, suggesting a renewed effort to address these shortcomings.« less

Correlated prompt fission data in transport simulations

NASA Astrophysics Data System (ADS)

Talou, P.; Vogt, R.; Randrup, J.; Rising, M. E.; Pozzi, S. A.; Verbeke, J.; Andrews, M. T.; Clarke, S. D.; Jaffke, P.; Jandel, M.; Kawano, T.; Marcath, M. J.; Meierbachtol, K.; Nakae, L.; Rusev, G.; Sood, A.; Stetcu, I.; Walker, C.

2018-01-01

Detailed information on the fission process can be inferred from the observation, modeling and theoretical understanding of prompt fission neutron and γ-ray observables. Beyond simple average quantities, the study of distributions and correlations in prompt data, e.g., multiplicity-dependent neutron and γ-ray spectra, angular distributions of the emitted particles, n - n, n - γ, and γ - γ correlations, can place stringent constraints on fission models and parameters that would otherwise be free to be tuned separately to represent individual fission observables. The FREYA and CGMF codes have been developed to follow the sequential emissions of prompt neutrons and γ rays from the initial excited fission fragments produced right after scission. Both codes implement Monte Carlo techniques to sample initial fission fragment configurations in mass, charge and kinetic energy and sample probabilities of neutron and γ emission at each stage of the decay. This approach naturally leads to using simple but powerful statistical techniques to infer distributions and correlations among many observables and model parameters. The comparison of model calculations with experimental data provides a rich arena for testing various nuclear physics models such as those related to the nuclear structure and level densities of neutron-rich nuclei, the γ-ray strength functions of dipole and quadrupole transitions, the mechanism for dividing the excitation energy between the two nascent fragments near scission, and the mechanisms behind the production of angular momentum in the fragments, etc. Beyond the obvious interest from a fundamental physics point of view, such studies are also important for addressing data needs in various nuclear applications. The inclusion of the FREYA and CGMF codes into the MCNP6.2 and MCNPX - PoliMi transport codes, for instance, provides a new and powerful tool to simulate correlated fission events in neutron transport calculations important in nonproliferation, safeguards, nuclear energy, and defense programs. This review provides an overview of the topic, starting from theoretical considerations of the fission process, with a focus on correlated signatures. It then explores the status of experimental correlated fission data and current efforts to address some of the known shortcomings. Numerical simulations employing the FREYA and CGMF codes are compared to experimental data for a wide range of correlated fission quantities. The inclusion of those codes into the MCNP6.2 and MCNPX - PoliMi transport codes is described and discussed in the context of relevant applications. The accuracy of the model predictions and their sensitivity to model assumptions and input parameters are discussed. Finally, a series of important experimental and theoretical questions that remain unanswered are presented, suggesting a renewed effort to address these shortcomings.

Correlated prompt fission data in transport simulations

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

Talou, P.; Vogt, R.; Randrup, J.

Detailed information on the fission process can be inferred from the observation, modeling and theoretical understanding of prompt fission neutron and γ-ray observables. Beyond simple average quantities, the study of distributions and correlations in prompt data, e.g., multiplicity-dependent neutron and γ-ray spectra, angular distributions of the emitted particles, n -n, n - γ, and γ - γ correlations, can place stringent constraints on fission models and parameters that would otherwise be free to be tuned separately to represent individual fission observables. The FREYA and CGMF codes have been developed to follow the sequential emissions of prompt neutrons and γ raysmore » from the initial excited fission fragments produced right after scission. Both codes implement Monte Carlo techniques to sample initial fission fragment configurations in mass, charge and kinetic energy and sample probabilities of neutron and γ emission at each stage of the decay. This approach naturally leads to using simple but powerful statistical techniques to infer distributions and correlations among many observables and model parameters. The comparison of model calculations with experimental data provides a rich arena for testing various nuclear physics models such as those related to the nuclear structure and level densities of neutron-rich nuclei, the γ-ray strength functions of dipole and quadrupole transitions, the mechanism for dividing the excitation energy between the two nascent fragments near scission, and the mechanisms behind the production of angular momentum in the fragments, etc. Beyond the obvious interest from a fundamental physics point of view, such studies are also important for addressing data needs in various nuclear applications. The inclusion of the FREYA and CGMF codes into the MCNP6.2 and MCNPX - PoliMi transport codes, for instance, provides a new and powerful tool to simulate correlated fission events in neutron transport calculations important in nonproliferation, safeguards, nuclear energy, and defense programs. Here, this review provides an overview of the topic, starting from theoretical considerations of the fission process, with a focus on correlated signatures. It then explores the status of experimental correlated fission data and current efforts to address some of the known shortcomings. Numerical simulations employing the FREYA and CGMF codes are compared to experimental data for a wide range of correlated fission quantities. The inclusion of those codes into the MCNP6.2 and MCNPX - PoliMi transport codes is described and discussed in the context of relevant applications. The accuracy of the model predictions and their sensitivity to model assumptions and input parameters are discussed. Lastly, a series of important experimental and theoretical questions that remain unanswered are presented, suggesting a renewed effort to address these shortcomings.« less

Challenging Teacher Bias: Implementing a Community Learning Fair

ERIC Educational Resources Information Center

Lafferty, Karen Elizabeth; Pang, Valerie Ooka

2014-01-01

Required courses in teacher education programs can sometimes prompt less-than-positive responses from pre-service teachers. Multicultural teacher educators, in particular, may face resistance from prospective teachers who, believing that they do not harbor prejudices, question the need to examine their attitudes toward culturally and…

Motivating Factors Influencing Paraprofessionals to Become Teachers

ERIC Educational Resources Information Center

Bennett, Shelia Lorraine

2016-01-01

Critical predictions of future teacher shortages across the nation prompt school districts and teacher preparation programs to produce avenues, to identify recruitment plans, and to implement creative opportunities to address the teacher supply and demand. High teacher attrition rates from teachers leaving the profession, early retirements of…

Leadership & Technology: What School Board Members Need To Know.

ERIC Educational Resources Information Center

Bailey, Gerald D.; And Others

Board members' role in technology implementation ranges from prompting development of technology plans to gathering community support for funding technology initiatives; they need substantial knowledge to enable them to ask the right questions, absorb new information, make good decisions, set appropriate policies, and lead confidently as…

75 FR 17874 - Digital Audio Broadcasting Systems and Their Impact on the Terrestrial Radio Broadcast Service

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-08

... power (ERP), and implements interference mitigation and remediation procedures to resolve promptly..., and the interference mitigation and remediation procedures will make certain that permissible... ERP to more than 4% of authorized analog ERP. 4. Establishes interference remediation procedures that...

Project Developmental Continuity Evaluation: Implementation Rating Instrument.

ERIC Educational Resources Information Center

High/Scope Educational Research Foundation, Ypsilanti, MI.

This instrument is part of a series of documents on the evaluation of Project Developmental Continuity (PDC), a Head Start demonstration program aimed at providing educational and developmental continuity between children's Head Start and primary school experiences. The Implementation Rating Instrument (IRI) was developed to provide a quantitative…

Antisynthetase syndrome (ASS) presenting as acute respiratory distress syndrome (ARDS) in a patient without myositis features.

PubMed

Kanchustambham, Venkat Kiran; Saladi, Swetha; Mahmoudassaf, Sarah; Patolia, Setu

2016-12-09

A woman aged 61 years presented to the emergency room with a 1-week history of dyspnoea on exertion and dry cough. X-ray of the chest showed diffuse interstitial opacities and was started on antibiotics and furosemide, and despite these measures, patient's respiratory status worsened, prompting endotracheal intubation. CT of the chest showed diffuse bilateral ground glass opacities and underwent bronchoscope with trans-bronchial biopsy that showed chronic bronchitis. Pt was empirically started on intravenous steroids due to concerns for interstitial lung disease (ILD). Autoimmune work up was sent and underwent video-assisted thoracoscopic surgery-guided biopsy of the lung that showed non-specific interstitial pattern with fibrosis. The patient was diagnosed as having antisynthetase syndrome with pulmonary involvement (ILD) as the cause of her acute respiratory failure. Azathioprine was started as steroid-sparing agent and was weaned off the ventilator to a tracheostomy collar and discharged to long-term rehabilitation centre. 2016 BMJ Publishing Group Ltd.

Enhancing students' critical thinking in science: A two-year design based exploration in a large undergraduate science course

NASA Astrophysics Data System (ADS)

Yoo, Suhyun

The purpose of this study was to explore how to enhance students' critical thinking in an introductory undergraduate science course. As a design experiment, this study aimed to design, develop, implement, and refine learning activities, and investigate how the learning activities worked in fostering students' critical thinking in a large size classroom context. In this study, critical thinking in science was framed with six categories, 1) identifying decisions, 2) evaluating decisions, 3) providing own decision, 4) argument and justification for own decision, 5) presenting supporting data/evidence, and 6) integrating other perspectives, as the result of literature review. To enhance critical thinking, three design principles, 1) authentic task, 2) question prompts, and 3) peer interaction, were associated with the learning activities for two consecutive years. The research context was within a large general science course and the learning activities for a module were designed, implemented and refined for two years. Specially, changes in design strategies were made in the two design principles, question prompts and peer interaction, after the 1st implementation. With regard to the use of question prompts, the students of the 2nd year were provided with procedural and elaborative question prompts, while those of the 1st year only received procedural question prompts embedded in the Group and Community Discussion Charts. Second, instead of being engaged six times in two types of discussions, group and community discussions, the students of the 2nd year were required to take part in a community discussion twice and to prepare for the discussion by learning about and understanding important aspects of dealing with the hurricane situation. For individual preparation, elaborative question prompts were embedded in the Individual Worksheet. Quantitative and qualitative research methods were taken to investigate how the two different designs of the 1st and 2nd years worked for enhancing critical thinking in a large-size classroom. Data came from the students' written documents during and after the learning activities. The result from the descriptive and comparative analysis on the written documents for two years indicated that there were changes in patterns of reasoning between the two years. It was evident that the groups engaged in decision-making for communities of the 2nd year showed more concrete and shaped reasoning than those of the 1st year. The result of the t-test indicated that there was a significant difference in critical thinking demonstrated in individual reports between the students of the 1st and the 2nd years. The students of the 2nd year demonstrated better levels of critical thinking than those of the 1st year. Specially, among the six categories of critical thinking, the students of the 2nd year demonstrated better levels in three categories, 1) providing one's own decision, 2) argumentation and justification for one's own decision, and 3) integrating other perspectives, than those of the 1st year. By the multiple-case study method, four themes were found to explain what made students demonstrated higher levels of critical thinking: 1) understanding of one's assigned role, 2) linking roles to make decisions, 3) answers to the question prompts, and 4) use of data and source, were raised in explaining the different pattern between the students with higher and lower levels of critical thinking. Also, a trend was visible across artifacts for higher performing students in both years.

Reiter's Syndrome.

PubMed

Savant, S S; Fernandez, J C; Dhurandhar, M W; Fernandez, R J

1979-01-01

A case of Reiter's syndrome occurring in a young mate aged 20 years having extensive skin lesions of keratoderina blenoffhagica is presented along with a review of literature. Although urethritis was absent, other clinical and histopathological features of the cutaneous lesions led us to the diagnosis. The-possible relationship of postural psoriasis to Reiter's syndrome is discussed. Failure of the patient to respond satisfactorily to steroids, antibiotics etc, prompted the use of rnethotrexate in the case. The result was dramatic, as the patient completely recovered within ten days of starting treatment.

Ocular trauma.

PubMed

Cassen, J H

1997-10-01

A review of the literature was conducted to investigate recent articles about ocular trauma. Eye injuries may be divided into blunt and penetrating types. Males are more affected than females. Evaluation of eye injuries should start with visual acuity and continue with prompt referral to an ophthalmologist as indicated. Medlines search/American Academy of Ophthalmology. Ocular trauma is a frequent reason for emergency room visits. Most injuries stem from sports, recreation, military, occupational, or automotive. Patient education is highly recommended, as well as prevention by use of protective polycarbonate eyewear.

[Exanthematic typhus epidemic in Chile (1932-1939)].

PubMed

Laval, Enrique

2013-06-01

After the great epidemic of the exanthematic typhus of 1918-1919 in Chile, there was a gradual decrease in the number of cases , until it became endemic around 1926. Starting in 1932 and until 1939 a new epidemic outbreak occured that prompted researchers to its study supported by the new clinical and technological advances of this period. Subsequently, two important events occured: the erradication of the vector ( human louse) by means of effective insecticides and the discovery of an effective antibiotic treatment.

40 CFR 49.126 - Rule for limiting fugitive particulate matter emissions.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., and other surfaces that can create airborne dust. (iii) Full or partial enclosure of materials... particulate matter from becoming airborne. (iv) Implementation of good housekeeping practices to avoid or minimize the accumulation of dusty materials that have the potential to become airborne, and the prompt...

Program Evaluation of Math Factual Operations for Understanding

ERIC Educational Resources Information Center

Rouse, Julie A.

2013-01-01

Deficiencies in mathematics standardized test scores prompted school district policymakers to consider implementing a program designed to increase students' basic multiplication fact skills. This study was an evaluation of the Math Factual Operations for Understanding program. The program, marketed with a martial arts theme, was intended to…

Mental Health Profiles and Quality of Life among Korean Adolescents

ERIC Educational Resources Information Center

Kim, Eui Kyung; Dowdy, Erin; Furlong, Michael J.; You, Sukkyung

2017-01-01

In an attempt to identify and intervene with students in need of services, the South Korean government has implemented national mental health screening. However, concerns raised about the unintended stigmatization of the screening assessment that focuses on student deficits prompts the need for additional research. This study evaluated the…

Effects of Learning Support in Simulation-Based Physics Learning

ERIC Educational Resources Information Center

Chang, Kuo-En; Chen, Yu-Lung; Lin, He-Yan; Sung, Yao-Ting

2008-01-01

This paper describes the effects of learning support on simulation-based learning in three learning models: experiment prompting, a hypothesis menu, and step guidance. A simulation learning system was implemented based on these three models, and the differences between simulation-based learning and traditional laboratory learning were explored in…

Teaching Teachers to Use Prompts, Opportunities to Respond, and Specific Praise

ERIC Educational Resources Information Center

Simonsen, Brandi; Myers, Diane; DeLuca, Carla

2010-01-01

Classroom management skills are critical for teachers. Yet teachers receive little training in classroom management, and empirical research on teacher training in classroom management is lacking. This study was conducted to investigate the effects of explicit training and performance feedback on teachers' implementation of three classroom…

A Comprehensive Multi-Media Program to Prevent Smoking among Black Students.

ERIC Educational Resources Information Center

Kaufman, Joy S.; And Others

1994-01-01

Implemented program to decrease incidence of new smokers among black adolescents. Program combined school-based curriculum with comprehensive media intervention. There were two experimental conditions: one group participated in school-based intervention and was prompted to participate in multimedia intervention; other group had access to…

Tuberculosis Screening and Targeted Testing of College and University Students

ERIC Educational Resources Information Center

Journal of American College Health, 2011

2011-01-01

Screening and targeted testing for tuberculosis (TB) is a key strategy for controlling and preventing infection on college and university campuses. Early detection provides an opportunity to promote the health of affected individuals through prompt diagnosis and treatment while preventing potential spread to others. Implementation of a screening…

Continuing multiplication of Salmonella Enteritidis strains in egg yolk during refrigeration at 7.2° C

USDA-ARS?s Scientific Manuscript database

The continuing attribution of human illness caused by Salmonella Enteritidis (SE) to the consumption of contaminated eggs has led to widespread implementation of risk reduction programs for commercial egg production. Prompt refrigeration of eggs to prevent bacterial multiplication to dangerously hig...

Achieving Alignment in the Preparation of CSPAP Leaders in PETE Programs

ERIC Educational Resources Information Center

Bulger, Sean; Illg, Kiel; Jones, Emily

2017-01-01

The emergence of a research focus on comprehensive school physical activity programs (CSPAP) has prompted faculty within physical education teacher education (PETE) at West Virginia University to reconceptualize undergraduate, graduate and doctoral plans of study. In response to their experiences during the implementation of several multicomponent…

Supporting Students' Knowledge Transfer in Modeling Activities

ERIC Educational Resources Information Center

Piksööt, Jaanika; Sarapuu, Tago

2014-01-01

This study investigates ways to enhance secondary school students' knowledge transfer in complex science domains by implementing question prompts. Two samples of students applied two web-based models to study molecular genetics--the model of genetic code (n = 258) and translation (n = 245). For each model, the samples were randomly divided into…

Survival Skills. Pre-Apprenticeship Phase 2 Training. Instructors Guide

ERIC Educational Resources Information Center

Lane Community Coll., Eugene, OR.

This instructor's guide contains the 43 Survival Skills modules developed for Pre-Apprenticeship Phase 2 Training. Introductory materials include a description of components of the pre-apprenticeship project, recommendations for module implementation, and synopses of the modules that were developed to prompt social skills development. Each module…

Assessing the Culture of Fresh Produce Safety within a Leafy Green Producing Community

ERIC Educational Resources Information Center

Nolte, Kurt D.; Sanchez, Charles A.; Fonseca, Jorge M.

2011-01-01

The 2006 "Escherichia coli" outbreak in spinach prompted the implementation of unprecedented production strategies (Arizona Leafy Green Products Shipper Marketing Agreement) to minimize microbial risk in leafy greens. As the new procedures require assessments of physical intrusion and excrement in fields, outreach was initiated to…

3 CFR 13607 - Executive Order 13607 of April 27, 2012. Establishing Principles of Excellence for Educational...

Code of Federal Regulations, 2013 CFR

2013-01-01

... President their progress on implementation, including promptly revising regulations, Department of Defense... continued provision of educational benefits in the Department of Defense's Tuition Assistance Program (10 U... Principles of Excellence. (a) The Departments of Defense and Veterans Affairs shall reflect the Principles...

Design and implementation of the ESL compact range underhung bridge crane

NASA Technical Reports Server (NTRS)

Shamansky, H. T.; Dominek, A. K.; Burnside, W. D.

1987-01-01

As the indoor compact range technology has continued to increase, the need to handle larger and heavier targets has also increased. This need for target lifting and handling prompted the feasibility study of the use of an underhung bridge crane to be installed in the ESL (ElectroScience Laboratory, Ohio State University) compact range. This report documents both the design of the underhung bridge crane that was installed and the implementation of the design in the actual installation of the crane.

Implementation of a patient-held urinary catheter passport to improve catheter management, by prompting for early removal and enhancing patient compliance.

PubMed

Codd, Jane

2014-05-01

Over the past few years a number of strategic initiatives to improve catheter management and reduce associated infections have been introduced. This paper details the introduction of a patient-held catheter passport and an improved documentation record using the PDSA (Plan, Do, Study, Act) cycle of change implementation in one large acute National Health Service (NHS) trust and local health economy (NHS Institute for Innovation and Improvement, 2008).

Implementation of a patient-held urinary catheter passport to improve catheter management, by prompting for early removal and enhancing patient compliance

PubMed Central

2013-01-01

Over the past few years a number of strategic initiatives to improve catheter management and reduce associated infections have been introduced. This paper details the introduction of a patient-held catheter passport and an improved documentation record using the PDSA (Plan, Do, Study, Act) cycle of change implementation in one large acute National Health Service (NHS) trust and local health economy (NHS Institute for Innovation and Improvement, 2008) PMID:28989364

Evaluation of the Effectiveness of Two Morphine Protocols to Treat Neonatal Abstinence Syndrome in a Level II Nursery in a Community Hospital.

PubMed

DeAtley, Heather N; Burton, Amanda; Fraley, Michelle DeLuca; Haltom, Joan

2017-07-01

The authors sought to evaluate the impact on length of hospital stay and treatment duration of morphine after implementation of a change in the institutional protocol for managing neonatal abstinence syndrome (NAS) in an effort to improve patient outcomes. A single-center, retrospective chart review was conducted at a Level II nursery in a community hospital in Kentucky. Fifty-nine neonates born between January 1, 2014, and December 31, 2015, who were diagnosed with NAS and received morphine for treatment were included. The protocol 1 group consisted of 33 neonates who received an initial dose of morphine 0.04 mg/kg/dose administered orally every 4 hours (January 1-December 31, 2014), and the protocol 2 group consisted of 26 neonates who received an initial dose of morphine 0.06 mg/kg/dose administered orally every 3 hours (January 1-November 30, 2015), after a change in the protocol for managing NAS was implemented on January 1, 2015. Data were reviewed and compared between the two protocol groups to determine the impact that the dosage change had on length of hospital stay and morphine treatment duration. The average length of stay decreased by 7 days in the protocol 2 group compared with the protocol 1 group (21 vs 28.65 days). The average duration of treatment decreased by 7 days in the protocol 2 group compared with the protocol 1 group (18.3 vs 25.4 days). These differences between groups were not statistically significant, however, because the population size was not large enough to achieve adequate power. These results indicate that protocol 2 displayed the potential to decrease length of stay and duration of treatment compared with protocol 1 at this facility; however, balancing higher starting doses with the risk of oversedation will continue to challenge the health care team. Concern for oversedation when using the higher starting dose in protocol 2 has prompted further research (e.g., protocol 3, initial morphine 0.05 mg/kg/dose every 3 hrs). Continued research is also necessary with larger patient populations to enable generalizability to other institutions. © 2017 Pharmacotherapy Publications, Inc.

The Milestones Passport: A Learner-Centered Application of the Milestone Framework to Prompt Real-Time Feedback in the Emergency Department.

PubMed

Yarris, Lalena M; Jones, David; Kornegay, Joshua G; Hansen, Matthew

2014-09-01

In July 2013, emergency medicine residency programs implemented the Milestone assessment as part of the Next Accreditation System. We hypothesized that applying the Milestone framework to real-time feedback in the emergency department (ED) could affect current feedback processes and culture. We describe the development and implementation of a Milestone-based, learner-centered intervention designed to prompt real-time feedback in the ED. We developed and implemented the Milestones Passport, a feedback intervention incorporating subcompetencies, in our residency program in July 2013. Our primary outcomes were feasibility, including faculty and staff time and costs, number of documented feedback encounters in the first 2 months of implementation, and user-reported time required to complete the intervention. We also assessed learner and faculty acceptability. Development and implementation of the Milestones Passport required 10 hours of program coordinator time, 120 hours of software developer time, and 20 hours of faculty time. Twenty-eight residents and 34 faculty members generated 257 Milestones Passport feedback encounters. Most residents and faculty reported that the encounters required fewer than 5 minutes to complete, and 48% (12 of 25) of the residents and 68% (19 of 28) of faculty reported satisfaction with the Milestones Passport intervention. Faculty satisfaction with overall feedback in the ED improved after the intervention (93% versus 54%, P  =  .003), whereas resident satisfaction with feedback did not change significantly. The Milestones Passport feedback intervention was feasible and acceptable to users; however, learner satisfaction with the Milestone assessment in the ED was modest.

Clinical and economic outcomes from a community hospital's antimicrobial stewardship program.

PubMed

Malani, Anurag N; Richards, Patrick G; Kapila, Shikha; Otto, Michael H; Czerwinski, Jennifer; Singal, Bonita

2013-02-01

Data from community antimicrobial stewardship programs (ASPs) are limited. We describe clinical and economic outcomes from the first year of our hospital's ASP. The ASP team comprised 2 infectious disease physicians and 3 intensive care unit pharmacists. The team prospectively audited the new starts and weekly use of 8 target antimicrobials: aztreonam, caspofungin, daptomycin, ertapenem, linezolid, meropenem, tigecycline, and voriconazole. Using administrative data, outcomes from the first year of the program, including death within 30 days of hospitalization, readmission within 30 days of discharge, and development of Clostridium difficile infection (CDI), were compared with outcomes from a similar period before institution of the program. A total of 510 antimicrobial orders were reviewed, of which 323 (63%) were appropriate, 94 (18%) prompted deescalation, 61 (12%) were denied, and 27 (5%) led to formal consultation with an infectious disease physician. On multivariate analysis, implementation of the ASP was associated with an approximate 50% reduction in the odds of developing CDI (odds ratio, 0.46; 95% confidence interval, 0.25-0.82). The ASP was not associated with decreased mortality at 30 days after discharge or readmission rate. The antimicrobial cost per patient-day decreased by 13.3%, from $10.16 to $8.81. The antimicrobial budget decreased by 15.2%, resulting in a total savings of $228,911. There was a 25.4% decrease in defined daily doses of the target antimicrobials. Implementation of the ASP was associated with significant reductions in CDI rate, antimicrobial use, and pharmacy costs. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

An evaluation of the relative efficacy of and children's preferences for teaching strategies that differ in amount of teacher directedness.

PubMed

Heal, Nicole A; Hanley, Gregory P; Layer, Stacy A

2009-01-01

The manner in which teachers mediate children's learning varies across early childhood classrooms. In this study, we used a multielement design to evaluate the efficacy of three commonly implemented strategies that varied in teacher directedness for teaching color- and object-name relations. Strategy 1 consisted of brief exposure to the target relations followed by an exclusively child-led play period in which correct responses were praised. Strategy 2 was similar except that teachers prompted the children to vocalize relations and corrected errors via model prompts. Strategy 3 incorporated the same procedures as Strategy 2 except that a brief period of teacher-initiated trials was arranged; these trials involved the use of prompt delay between questions and prompts, and correct responses resulted in tokens and back-up activity reinforcers. Children's preferences for the different teaching strategies were also directly assessed. Strategy 3 was most effective in promoting the acquisition and generalization of the color- and object-name relations and was also most preferred by the majority of children, Strategy 1 was the least effective, and Strategy 2 was typically the least preferred. Implications for the design of early educational environments based on evidence-based values are discussed.

Management of simulated maternal cardiac arrest by residents: didactic teaching versus electronic learning.

PubMed

Hards, Andrea; Davies, Sharon; Salman, Aliya; Erik-Soussi, Magda; Balki, Mrinalini

2012-09-01

Successful resuscitation of a pregnant woman undergoing cardiac arrest and survival of the fetus require prompt, high-quality cardiopulmonary resuscitation. The objective of this observational study was to assess management of maternal cardiac arrest by anesthesia residents using high-fidelity simulation and compare subsequent performance following either didactic teaching or electronic learning (e-learning). Twenty anesthesia residents were randomized to receive either didactic teaching (Didactic group, n = 10) or e-learning (Electronic group, n = 10) on maternal cardiac arrest. Baseline management skills were tested using high-fidelity simulation, with repeat simulation testing one month after their teaching intervention. The time from cardiac arrest to start of perimortem Cesarean delivery (PMCD) was measured, and the technical and nontechnical skills scores between the two teaching groups were compared. The median [interquartile range] time to PMCD decreased after teaching, from 4.5 min [3.4 to 5.1 min] to 3.5 min [2.5 to 4.0 min] (P = 0.03), although the change within each group was not statistically significant (Didactic group 4.9 to 3.8 min, P = 0.2; Electronic group 3.9 to 2.5 min, P = 0.07; Didactic group vs Electronic group, P = 1.0). Even after teaching, only 65% of participants started PMCD within four minutes. Technical and nontechnical skills scores improved after teaching in both groups, and there were no differences between the groups. There are gaps in the knowledge and implementation of resuscitation protocols and the recommended modifications for pregnancy among residents. Teaching can improve performance during management of maternal cardiac arrest. Electronic learning and didactic teaching offer similar benefits.

Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service.

PubMed

Devescovi, Raffaella; Monasta, Lorenzo; Mancini, Alice; Bin, Maura; Vellante, Valerio; Carrozzi, Marco; Colombi, Costanza

2016-01-01

Early diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System. Twenty-one toddlers at risk for autism spectrum disorders, aged 20-36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents' and teachers' active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months). Children made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment. Our results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.

Head Start Program Regulations and Program Guidance for Parts 1304 and 1308. Revised.

ERIC Educational Resources Information Center

Administration for Children, Youth, and Families (DHHS), Washington, DC. Head Start Bureau.

Head Start and Early Head Start are comprehensive child development programs providing services to children from birth to age 5, pregnant women, and their families. The Head Start Program Performance Standards, mandatory regulations that grantees and delegate agencies must implement in order to operate a Head Start program, are designed to ensure…

Optimization of fiber grating couplers on SOI using advanced search algorithms.

PubMed

Wohlfeil, Benjamin; Zimmermann, Lars; Petermann, Klaus

2014-06-01

A one-dimensional fiber grating coupler is derived from a waveguide with random etches using implementations of particle swarm and genetic algorithms. The resulting gratings yield a theoretical coupling efficiency of up to 1.1 dB and prompt clear design rules for the layout of highly efficient fiber grating couplers.

Learning Curves: Expanding the Constituency for Comprehensive Sexuality Education, Fall 2005

ERIC Educational Resources Information Center

Sen, Rinku; Fellner, Kim

2005-01-01

Support in the United States for comprehensive sexuality education is overwhelming. Yet a small, vocal opposition and increasingly hostile public policy have deterred its implementation in many communities across the country. The chasm between community needs and public policy prompted the Ms. Foundation for Women and the David and Lucille Packard…

The Impact of Facebook in Teaching Practicum: Teacher Trainees' Perspectives

ERIC Educational Resources Information Center

Goktalay, Sehnaz Baltaci

2015-01-01

Prompt feedback is one of the critical components of teacher education programs. To reap the greatest benefit from the teaching practicum process, the quality of feedback as well as its implementation by stakeholders, supervisors, cooperating teachers, and teacher trainees, takes on great importance. The purpose of this study is to examine how Web…

Students' Perceptions of the Impact of Nutrition Policies on Dietary Behaviors

ERIC Educational Resources Information Center

Vecchiarelli, Stephanie; Takayanagi, Sumiko; Neumann, Charlotte

2006-01-01

Poor dietary habits, rising rates of overweight students, and lack of oversight of vending contracts prompted the Los Angeles Unified School District (LAUSD) to develop and implement 2 of the most comprehensive nutrition policies in the country. The Healthy Beverage Resolution and Obesity Prevention Motion limit the types of and access to…

Improving the Grammatical Accuracy of the Spoken English of Indonesian International Kindergarten Students

ERIC Educational Resources Information Center

Gozali, Imelda; Harjanto, Ignatius

2014-01-01

The need to improve the spoken English of kindergarten students in an international preschool in Surabaya prompted this Classroom Action Research (CAR). It involved the implementation of Form-Focused Instruction (FFI) strategy coupled with Corrective Feedback (CF) in Grammar lessons. Four grammar topics were selected, namely Regular Plural form,…

Maryland English Journal, Volume 30, Numbers 1-2.

ERIC Educational Resources Information Center

Pula, Judith J., Ed.

1996-01-01

The two issues of this journal contain articles about aspects of English teaching and samples of student work. The Fall 1995 issue contains: "'I Want More Books Like It': Implementing a Reading Workshop in an Urban Classroom with At-Risk Students" (Rebecca Joseph); "Service Learning Prompt for the Maryland Writing Test" (Kathy A. Megyeri); "My…

U.S. Teachers' Perceptions of School Violence Prevention Programs

ERIC Educational Resources Information Center

Chestnut, Natakie

2016-01-01

In response to high profile violent incidents and crimes, many schools have developed plans that address school discipline to create a school climate and culture wherein everyone is valued and treated with respect. The problem that prompted this study is teachers are struggling with effectively implementation prevention program. The purpose of…

Career Development among Undergraduate Students of Madda Walabu University, South East Ethiopia

ERIC Educational Resources Information Center

Getachew, Abera; Daniel, Gobena

2016-01-01

Career guidance and counselling is a vaguely implemented concept in most educational institutions, governmental and non-governmental organisations. The severity of the problem and scarcity of relevant information among university students have prompted the undertaking of this study the aim of which was to assess career development among…

Implementing Work Systems across the School Day: Increasing Engagement in Students with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Hume, Kara; Reynolds, Beth

2010-01-01

Work systems provide visual information and organization for students with autism spectrum disorders (ASD) and assist in increasing on-task behavior and productivity while simultaneously decreasing adult prompting. Work systems are a core component of the Treatment and Education of Autistic and Related Communication-Handicapped Children…

Establishing a Chargeback Policy: What the Department of Defense Can Learn from One Company’s Approach

DTIC Science & Technology

1993-12-10

is using the MOC ( Managing Organizational Change ) change technology, a philosophy of intervention purchased from an external consulting organization...conveyed in ODR’s two-day course entitled " Managing Organizational Change Implementation Planning Application." In the first phase, an organization, prompted

Revisiting the Virginia Tech Shootings: An Ecological Systems Analysis

ERIC Educational Resources Information Center

Hong, Jun Sung; Cho, Hyunkag; Lee, Alvin Shiulain

2010-01-01

School shooting cases since the late 1990s have prompted school officials and legislators to develop and implement programs and measures that would prevent violence in school. Despite the number of explanations by the media, politicians, organizations, and researchers about the etiology of school shootings, we are not united in our understanding…

Indirect nitrous oxide emissions from streams within the US Corn Belt scale with stream order

USDA-ARS?s Scientific Manuscript database

Nitrous oxide (N2O) is an important greenhouse gas and the primary stratospheric ozone depleting substance. Its deleterious effects on the environment have prompted appeals to regulate emissions from agriculture, which represents the primary source in the global N2O budget. Successful implementation...

Pre-Service Teachers and Self-Efficacy: A Study in Contrast

ERIC Educational Resources Information Center

Colson, Tori; Sparks, Kelly; Berridge, Gina; Frimming, Renee; Willis, Clarissa

2017-01-01

With increased emphasis on student achievement in schools, teacher education programs are challenged to meet the demand for highly effective teachers. Ensuring that pre-service teachers feel confident in their ability to teach, prompted one Midwestern University to implement an extended student teaching placement. The idea behind this endeavor was…

Exploring Ohio Police Preparedness for Active Shooter Incidents in Public Schools

ERIC Educational Resources Information Center

Pignatelli, Daniel A.

2010-01-01

School shootings, such as Columbine, have prompted police executives to explore response tactics and preparedness efforts for combating active shooters. This qualitative exploratory case study focused on specific preparation initiatives that have been implemented for the purpose of dealing with active shooters. Being prepared is one of the only…

Processes Utilized by High School Students Reading Scientific Text

ERIC Educational Resources Information Center

Clinger, Alicia Farr

2014-01-01

In response to an increased emphasis on disciplinary literacy in the secondary science classroom, an investigation of the literacy processes utilized by high school students while reading scientific text was undertaken. A think-aloud protocol was implemented to collect data on the processes students used when not prompted while reading a magazine…

Prompting Teacher Geometric Reasoning through Coaching in a Dynamic Geometry Software Context

ERIC Educational Resources Information Center

Knapp, Andrea K.; Barrett, Jeffrey E.; Moore, Cynthia J.

2016-01-01

This study investigated the ways in which four middle grades teachers developed mathematical knowledge for teaching (MKT) geometry as they implemented dynamic geometry software in their classrooms with the assistance of a coach. Teachers developed various components of MKT by observing coaches teach, by dynamic discourse with students, which is…

A Placement Test for Computer Science: Design, Implementation, and Analysis

ERIC Educational Resources Information Center

Nugent, Gwen; Soh, Leen-Kiat; Samal, Ashok; Lang, Jeff

2006-01-01

An introductory CS1 course presents problems for educators and students due to students' diverse background in programming knowledge and exposure. Students who enroll in CS1 also have different expectations and motivations. Prompted by the curricular guidelines for undergraduate programmes in computer science released in 2001 by the ACM/IEEE, and…

22 CFR 507.8 - Recording keeping of closed meetings.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of a meeting, closed to the public. (b) The Board, after review by the Chairman, shall make promptly... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Recording keeping of closed meetings. 507.8 Section 507.8 Foreign Relations BROADCASTING BOARD OF GOVERNORS RULES FOR IMPLEMENTING OPEN MEETINGS UNDER...

Post-tsunami outbreaks of influenza in evacuation centers in Miyagi Prefecture, Japan.

PubMed

Hatta, Masumitsu; Endo, Shiro; Tokuda, Koichi; Kunishima, Hiroyuki; Arai, Kazuaki; Yano, Hisakazu; Ishibashi, Noriomi; Aoyagi, Tetsuji; Yamada, Mitsuhiro; Inomata, Shinya; Kanamori, Hajime; Gu, Yoshiaki; Kitagawa, Miho; Hirakata, Yoichi; Kaku, Mitsuo

2012-01-01

We describe 2 post-tsunami outbreaks of influenza A in evacuation centers in Miyagi Prefecture, Japan, in 2011. Although containment of the outbreak was challenging in the evacuation settings, prompt implementation of a systemic approach with a bundle of control measures was important to control the influenza outbreaks.

A Process Evaluation of Project Developmental Continuity. Interim Report IV, Volume 2: Development of the Implementation and Cost Studies.

ERIC Educational Resources Information Center

Smith, Allen G.; And Others

This interim report describes the development of program implementation and cost studies for Year II of the process evaluation of Project Developmental Continuity (PDC), a Head Start demonstration program aimed at providing educational and developmental continuity between children's Head Start and primary school experiences. Specific areas focused…

Intensive Evaluation of Head Start Implementation in the Tucson Early Education Model.

ERIC Educational Resources Information Center

Rentfrow, Robert K.

As part of the national Head Start Planned Variation Study, this study used a relatively small sample in an intensive evaluation of program implementation in one field community using the Tucson Early Education Model (TEEM). A modified Solomon four-group research design formed the organization framework. Evaluation of six TEEM classrooms and two…

Implementation of Head Start Planned Variation: 1970-1971. Part II.

ERIC Educational Resources Information Center

Lukas, Carol Van Deusen; Wohlleb, Cynthia

This volume of appendices is Part II of a study of program implementation in 12 models of Head Start Planned Variation. It presents details of the data analysis, copies of data collection instruments, and additional analyses and statistics. The appendices are: (A) Analysis of Variance Designs, (B) Copies of Instruments, (C) Additional Analyses,…

Identifying Head Start Children for Higher Tiers of Language and Literacy Instruction

ERIC Educational Resources Information Center

Albritton, Kizzy; Stuckey, Adrienne; Patton Terry, Nicole

2017-01-01

The application of Response to Intervention (RtI) to early childhood settings presents many opportunities and challenges; however, it remains unclear how best to implement this framework in settings in which children at risk of academic difficulty are overrepresented, like Head Start. One of the first steps in implementing any RtI process is the…

Screening of lysosomal storage disorders: application of the online trapping-and-cleanup liquid chromatography/mass spectrometry method for mucopolysaccharidosis I.

PubMed

Ombrone, Daniela; Malvagia, Sabrina; Funghini, Silvia; Giocaliere, Elisa; Della Bona, Maria Luisa; Forni, Giulia; De Luca, Alessio; Villanelli, Fabio; Casetta, Bruno; Guerrini, Renzo; la Marca, Giancarlo

2013-01-01

In recent years, new treatments have become available to treat some lysosomal storage disorders (LSDs) and many studies suggest that there is a benefit with starting therapy early. Newborn screening should detect diseases early enough for prompt treatment. Some countries include additional conditions, such as some LSDs, into their newborn screening panels. Mucopolysaccharidosis Type I (MPS I) is an autosomal recessive disorder caused by the deficiency of α-L-iduronidase (IDUA) activity. Currently, enzyme replacement therapy (ERT) or bone marrow transplantation is available and this has raised a growing interest for the development of a newborn screening test. In 2009, we reported a new fast and simplified tandem mass spectrometry-based method for quantifying five enzyme activities on dried blood spots. Here, we describe the inclusion of IDUA activity determination for the simultaneous detection of six lysosomal storage diseases. We have defined reference normal ranges by testing 680 healthy newborns and 240 adults. The assay was checked through three confirmed MPS I patients whose IDUA activity was below the normal range. Reproducibility of the assays has been established by assessing the intra-day and inter-day assay imprecisions. This quick assay has been devised to be implemented in newborn screening by liquid chromatography tandem mass spectrometry.

Full parabolic trough qualification from prototype to demonstration loop

NASA Astrophysics Data System (ADS)

Janotte, Nicole; Lüpfert, Eckhard; Pottler, Klaus; Schmitz, Mark

2017-06-01

On the example of the HelioTrough® collector development the full accompanying and supporting qualification program for large-scale parabolic trough collectors for solar thermal power plants is described from prototype to demonstration loop scale. In the evaluation process the actual state and the optimization potential are assessed. This includes the optical and geometrical performance determined by concentrator shape, deformation, assembly quality and local intercept factor values. Furthermore, its mechanical performance in terms of tracking accuracy and torsional stiffness and its thermal system performance on the basis of the overall thermal output and heat loss are evaluated. Demonstration loop tests deliver results of collector modules statistical slope deviation of 1.9 to 2.6 mrad, intercept factor above 98%, peak optical performance of 81.6% and heat loss coefficients from field tests. The benefit of such a closely monitored development lies in prompt feedback on strengths, weaknesses and potential improvements on the new product at any development stage from first module tests until demonstration loop evaluation. The product developer takes advantage of the achieved technical maturity, already before the implementation in a commercial power plant. The well-understood performance characteristics allow the reduction of safety margins making the new HelioTrough collector competitive from the start.

Using a behaviour change techniques taxonomy to identify active ingredients within trials of implementation interventions for diabetes care.

PubMed

Presseau, Justin; Ivers, Noah M; Newham, James J; Knittle, Keegan; Danko, Kristin J; Grimshaw, Jeremy M

2015-04-23

Methodological guidelines for intervention reporting emphasise describing intervention content in detail. Despite this, systematic reviews of quality improvement (QI) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated. We aimed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 (BCTTv1) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients. Three psychologists independently coded a random sample of 23 trials of healthcare system, provider- and/or patient-focused implementation interventions from a systematic review that included 142 such studies. Intervention content was coded using the BCTTv1, which describes 93 behaviour change techniques (BCTs) grouped within 16 categories. We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature. Less than a quarter of possible BCTs within the BCTTv1 were identified. For implementation interventions targeting providers, the most commonly identified BCTs included the following: adding objects to the environment, prompts/cues, instruction on how to perform the behaviour, credible source, goal setting (outcome), feedback on outcome of behaviour, and social support (practical). For implementation interventions also targeting patients, the most commonly identified BCTs included the following: prompts/cues, instruction on how to perform the behaviour, information about health consequences, restructuring the social environment, adding objects to the environment, social support (practical), and goal setting (behaviour). The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour. The BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels. Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions, which may help to better inform replication efforts. In addition, prospective use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions.

Starting Strong: Feasibility of an Indicated Prevention Programme during the Transition to Kindergarten

ERIC Educational Resources Information Center

Eisenhower, Abbey; Baker, Bruce L.; Taylor, Heather

2016-01-01

School-based mental health services are a promising context for evidence-based interventions to promote early socio-emotional development, yet implementation presents significant challenges. This paper describes the rationale, content and format of a school-based intervention, Starting Strong in Kindergarten (Starting Strong). Starting Strong is a…

Effects of multidisciplinary teams and an integrated follow-up electronic system on clinical pharmacist interventions in a cancer hospital.

PubMed

Aziz, Muhammad Tahir; Rehman, Tofeeq Ur; Qureshi, Sadia; Andleeb, Sidrah

2017-12-01

Background The aim of drug therapy is to attain distinct therapeutic effects that not only improve patient's quality of life but also reduce the inherent risks associated with the therapeutic use of drugs. Pharmacists play a key role in reducing these risks by developing appropriate interventions. Whether to accept or reject the intervention made by the pharmacist is a relevant consultant's decision. Objective To evaluate the impact of electronic prompts and follow-up of rejected pharmacy interventions by clinical pharmacists in an in-patient setting. Setting Shaukat Khanum Cancer Hospital & Research Center, Lahore, Pakistan. Method The study was conducted in two phases. Data for 3 months were collected for each phase of the study. Systematic and quantifiable consensus validity was developed for rejected interventions in phase 1, based on patient outcome analyses. Severity rating was assigned to assess the significance of interventions. Electronic prompts for follow-on interventions in phase 2 were then developed and implemented, including daily review via a multidisciplinary team (MDT) approach. Main outcome measure Validity of rejected interventions, acceptance of follow-on interventions before and after re-engineering the pharmacy processes, rejection rate and severity rating of follow-on interventions. Result Of a total of 2649 and 3064 interventions that were implemented during phase 1 and phase 2, 238 (9%) and 307 (10%) were rejected, respectively. Additionally, 133 (56%) were inappropriate rejections during phase 1. The estimated reliability between pharmacists regarding rejected interventions was 0.74 (95% CI of 0.69, 0.79, p 0.000). Prospective data were analysed after implementing electronic alerts and an MDT approach. The acceptance rate of follow-on interventions in phase 2 was 60% (184). Conclusion Electronic prompts for follow-on interventions together with an MDT approach enhance the optimization of pharmacotherapy, increase drug rationality and improve patient care.

Head Start Program Performance Standards and Other Regulations (45 CFR Parts 1301, 1302, 1303, 1304 and Guidance, 1305, 1306, and 1308 and Guidance).

ERIC Educational Resources Information Center

Administration for Children, Youth, and Families (DHHS), Washington, DC. Head Start Bureau.

Head Start and Early Head Start are comprehensive child development programs providing services to children from birth to age 5, pregnant women, and their families. The Head Start Program Performance Standards, mandatory regulations that grantees and delegate agencies must implement in order to operate a Head Start program, are designed to ensure…

Field Plan and Implementation Package for the Ethnographic Component of the Child and Family Mental Health Project Evaluation.

ERIC Educational Resources Information Center

Macias, Jose; And Others

This report contains the field plan and implementation procedures which were utilized for the observational/focused ethnographic component of Head Start's Child and Family Mental Health (CFMH) Evaluation Project. The introductory section of the document provides the reader with an overview of the Head Start program, its mental health goals, the…

Constructed-response matching to sample and spelling instruction.

PubMed Central

Dube, W V; McDonald, S J; McIlvane, W J; Mackay, H A

1991-01-01

The development of interactive programmed instruction using a microcomputer as a teaching machine is described. The program applied a constructed-response matching-to-sample procedure to computer-assisted spelling instruction and review. On each trial, subjects were presented with a sample stimulus and a choice pool consisting of 10 individual letters. In initial training, sample stimuli were arrays of letters, and subjects were taught to construct identical arrays by touching the matching letters in the choice pool. After generalized constructed-response identity matching was established, pictures (line drawings) of common objects were presented as samples. At first, correct spelling was prompted by also presenting the printed name to be "copied" via identity matching; then the prompts were faded out. The program was implemented with 2 mentally retarded individuals. Assessment trials determined appropriate words for training. Correct spelling was established via the prompt-fading procedure; training trials were interspersed among baseline trials that reviewed and maintained spelling of previously learned words. As new words were learned, they were added to a cumulative baseline to generate an individualized review and practice battery for each subject. PMID:1890049

The Milestones Passport: A Learner-Centered Application of the Milestone Framework to Prompt Real-Time Feedback in the Emergency Department

PubMed Central

Yarris, Lalena M.; Jones, David; Kornegay, Joshua G.; Hansen, Matthew

2014-01-01

Background In July 2013, emergency medicine residency programs implemented the Milestone assessment as part of the Next Accreditation System. Objective We hypothesized that applying the Milestone framework to real-time feedback in the emergency department (ED) could affect current feedback processes and culture. We describe the development and implementation of a Milestone-based, learner-centered intervention designed to prompt real-time feedback in the ED. Methods We developed and implemented the Milestones Passport, a feedback intervention incorporating subcompetencies, in our residency program in July 2013. Our primary outcomes were feasibility, including faculty and staff time and costs, number of documented feedback encounters in the first 2 months of implementation, and user-reported time required to complete the intervention. We also assessed learner and faculty acceptability. Results Development and implementation of the Milestones Passport required 10 hours of program coordinator time, 120 hours of software developer time, and 20 hours of faculty time. Twenty-eight residents and 34 faculty members generated 257 Milestones Passport feedback encounters. Most residents and faculty reported that the encounters required fewer than 5 minutes to complete, and 48% (12 of 25) of the residents and 68% (19 of 28) of faculty reported satisfaction with the Milestones Passport intervention. Faculty satisfaction with overall feedback in the ED improved after the intervention (93% versus 54%, P  =  .003), whereas resident satisfaction with feedback did not change significantly. Conclusions The Milestones Passport feedback intervention was feasible and acceptable to users; however, learner satisfaction with the Milestone assessment in the ED was modest. PMID:26279784

ANEMIA OF CENTRAL ORIGIN

PubMed Central

Ishii, Kazusa; Young, Neal S.

2015-01-01

Hypoproliferative anemia results from the inability of bone marrow to produce adequate numbers of red blood cells. The list of conditions that cause hypoproliferative anemia is long, starting from common etiologies as iron deficiency to rarer diagnoses of constitutional bone marrow failure syndromes. There is no perfect diagnostic algorithm, and clinical data may not always clearly distinguish “normal” from “abnormal”, yet it is important for practicing clinicians to recognize each condition so that treatment can be initiated promptly. This review describes diagnostic approaches to hypoproliferative anemia, with particular emphasis on bone marrow failure syndromes. PMID:26404444

[Neonatal hyperthyroidism: A sometimes challenging diagnosis].

PubMed

Couturier, C; Cneude, F; Spiteri, A; Nugues, F; Debillon, T

2017-07-01

Graves disease complicates two pregnancies out of 1000 and when it is known before pregnancy, it warrants careful monitoring of the fetus and the newborn. We report on a case of neonatal hyperthyroidism, which revealed a previously unknown maternal thyroid disease. In this situation, neonatal signs can be misinterpreted, delaying the diagnosis. Neonatal hyperthyroidism is, however, a therapeutic emergency because of the risk of cardiac and neurological complications. The neonatologist must identify thyroid disease in the absence of a maternal history in order to promptly start therapy. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Synthesis of Trifluoromethylated Isoxazolidines: 1,3-Dipolar Cycloaddition of Nitrosoarenes, (Trifluoromethyl)diazomethane, and Alkenes

PubMed Central

Molander, Gary A.; Cavalcanti, Livia N.

2013-01-01

Isoxazolidines have proven to be important substrates in synthetic organic chemistry. Limited examples in the literature that provide trifluoromethylated versions of these compounds have prompted us to investigate a 1,3-dipolar cycloaddition route providing access to N-functionalized isoxazolidines containing a trifluoromethyl group. Thus, a 1,3-dipolar cycloaddition of nitrosoarenes, (trifluoromethyl)diazomethane, and alkenes was developed. The starting materials can be synthesized from easy to handle and accessible reagents. The reaction proved to be tolerant of a variety of electron-deficient alkenes and nitrosoarenes. PMID:24490778

The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample.

PubMed

Rogal, Shari S; Yakovchenko, Vera; Waltz, Thomas J; Powell, Byron J; Kirchner, JoAnn E; Proctor, Enola K; Gonzalez, Rachel; Park, Angela; Ross, David; Morgan, Timothy R; Chartier, Maggie; Chinman, Matthew J

2017-05-11

Hepatitis C virus (HCV) is a common and highly morbid illness. New medications that have much higher cure rates have become the new evidence-based practice in the field. Understanding the implementation of these new medications nationally provides an opportunity to advance the understanding of the role of implementation strategies in clinical outcomes on a large scale. The Expert Recommendations for Implementing Change (ERIC) study defined discrete implementation strategies and clustered these strategies into groups. The present evaluation assessed the use of these strategies and clusters in the context of HCV treatment across the US Department of Veterans Affairs (VA), Veterans Health Administration, the largest provider of HCV care nationally. A 73-item survey was developed and sent to all VA sites treating HCV via electronic survey, to assess whether or not a site used each ERIC-defined implementation strategy related to employing the new HCV medication in 2014. VA national data regarding the number of Veterans starting on the new HCV medications at each site were collected. The associations between treatment starts and number and type of implementation strategies were assessed. A total of 80 (62%) sites responded. Respondents endorsed an average of 25 ± 14 strategies. The number of treatment starts was positively correlated with the total number of strategies endorsed (r = 0.43, p < 0.001). Quartile of treatment starts was significantly associated with the number of strategies endorsed (p < 0.01), with the top quartile endorsing a median of 33 strategies, compared to 15 strategies in the lowest quartile. There were significant differences in the types of strategies endorsed by sites in the highest and lowest quartiles of treatment starts. Four of the 10 top strategies for sites in the top quartile had significant correlations with treatment starts compared to only 1 of the 10 top strategies in the bottom quartile sites. Overall, only 3 of the top 15 most frequently used strategies were associated with treatment. These results suggest that sites that used a greater number of implementation strategies were able to deliver more evidence-based treatment in HCV. The current assessment also demonstrates the feasibility of electronic self-reporting to evaluate ERIC strategies on a large scale. These results provide initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale. This is an initial step in identifying which strategies are associated with the uptake of evidence-based practices in nationwide healthcare systems.

Professional Practice, Student Surveys, and Value-Added: Multiple Measures of Teacher Effectiveness in the Pittsburgh Public Schools. REL 2014-024

ERIC Educational Resources Information Center

Chaplin, Duncan; Gill, Brian; Thompkins, Allison; Miller, Hannah

2014-01-01

Responding to federal and state prompting, school districts across the country are implementing new teacher evaluation systems that aim to increase the rigor of evaluation ratings, better differentiate effective teaching, and support personnel and staff development initiatives that promote teacher effectiveness and ultimately improve student…

Information Comparisons in Example-Based Hypermedia Environments: Supporting Learners with Processing Prompts and an Interactive Comparison Tool

ERIC Educational Resources Information Center

Gerjets, Peter; Scheiter, Katharina; Schuh, Julia

2008-01-01

Global comparisons of learning from hypertext/hypermedia and traditional presentation formats like text have yet failed to show major advantages concerning the effectiveness of hypermedia learning. Thus, it is proposed in the current paper to evaluate hypermedia environments more specifically with regard to their potential to implement and support…

A Comparison of Two Reading Programs on Third Grade Reading Achievement

ERIC Educational Resources Information Center

Miller, Tawana D.

2008-01-01

Background: The No Child Left Behind Act legislation requires both higher standards and higher success rates at the same time. Failure of students to learn to read adequately as shown by national and state test results and the need for continued school success had prompted education officials to implement two reading programs--Voyager Universal…

Transparency and Accountability: "Implementing a Postsecondary Institution Rating System That Empowers Students While Avoiding Unintended Consequences"

ERIC Educational Resources Information Center

Harmon, Tim; Cielinski, Anna

2014-01-01

In an economy that increasingly demands postsecondary credentials to access high-paying jobs with the potential for career advancement, students need comprehensive and reliable information to make better college and career choices. This need has prompted a vigorous national dialogue about the best way to provide information on the performance of…

Emergency medicine: beyond the basics.

PubMed

Malamed, S F

1997-07-01

Medical emergencies can arise in the dental office. Preparedness for these emergencies is predicated on an ability to rapidly recognize a problem and to effectively institute prompt and proper management. In all emergency situations, management is based on implementation of basic life support, as needed. The author describes the appropriate management of two common emergency situations: allergy and chest pain.

Hydraulic modeling and meander migration of the Middle Rio Grande, New Mexico

Treesearch

Michael J. Sixta

2004-01-01

The dynamic characteristics of the Middle Rio Grande (MRG) in central New Mexico have been of both interest and concern for the regulatory agencies involved with its management. The MRG has experienced sedimentation problems, prompting the development and implementation of sediment detention and flood control features, including the construction of Cochiti Dam in 1973...

Prompting Undergraduate Students' Metacognition of Learning: Implementing "Meta-Learning" Assessment Tasks in the Biomedical Sciences

ERIC Educational Resources Information Center

Colthorpe, Kay; Sharifirad, Tania; Ainscough, Louise; Anderson, Stephen; Zimbardi, Kirsten

2018-01-01

To succeed at post-secondary education, it is essential that students develop an understanding of their own knowledge and learning processes. This metacognition of learning, or "meta-learning," helps students to become more effective learners, as they become more aware of their self-regulatory processes and recognise the effectiveness of…

In Search of the Excellent Literature Teacher: An Inductive Approach to Constructing Professional Teaching Standards

ERIC Educational Resources Information Center

Witte, T. C. H.; Jansen, E. P. W. A.

2015-01-01

This study makes a contribution to the development of empirically based, domain-specific teaching standards that are acknowledged by the professional community of teachers and which, therefore, have a good chance of being successfully implemented and used for professional development purposes. It was prompted by the resistance on the part of many…

Opportunity Knocks? The Impact of Bursary Schemes on Students from Low-Income Backgrounds

ERIC Educational Resources Information Center

Hatt, Sue; Hannan, Andrew; Baxter, Arthur; Harrison, Neil

2005-01-01

In England, the government target that 50% of young people should gain experience of higher education has prompted many initiatives to widen participation. National policies, however, are often implemented at institutional or local level. As a result, the impact upon the individual participants can vary according to the context in which the…

Design and Implementation of C-iLearning: A Cloud-Based Intelligent Learning System

ERIC Educational Resources Information Center

Xiao, Jun; Wang, Minjuan; Wang, Lamei; Zhu, Xiaoxiao

2013-01-01

The gradual development of intelligent learning (iLearning) systems has prompted the changes of teaching and learning. This paper presents the architecture of an intelligent learning (iLearning) system built upon the recursive iLearning model and the key technologies associated with this model. Based on this model and the technical structure of a…

77 FR 36400 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Determination of Failure To...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

... contingency measures [section 172(c)(9)] and a major stationary source fee provision [sections 182(d)(3) and... Under Subpart 1: Revision to the Anti- backsliding Provisions to Address 1-Hour Contingency Measure... contingency measures. While BCCA claims that its comment was prompted by EPA's May 14 Rulemaking, that...

The Significance of Intercultural Understanding in the English Modern Foreign Languages Curriculum: A Pupil Perspective

ERIC Educational Resources Information Center

Peiser, Gillian; Jones, Marion

2013-01-01

This study has been prompted by a concern that the term intercultural understanding (IU) has appeared in English curriculum policy texts in order to address macro issues with scant pedagogical attention to its effective implementation at the micro level in the modern foreign languages (MFL) classroom. The article investigates pupils' perceptions…

Surveillance for West Nile, Dengue, and Chikungunya Virus Infections, Veneto Region, Italy, 2010

PubMed Central

Barzon, Luisa; Capelli, Gioia; Angheben, Andrea; Pacenti, Monia; Napoletano, Giuseppina; Piovesan, Cinzia; Montarsi, Fabrizio; Martini, Simone; Rigoli, Roberto; Cattelan, Anna M.; Rinaldi, Roberto; Conforto, Mario; Russo, Francesca; Palù, Giorgio; Bisoffi, Zeno

2012-01-01

In 2010, in Veneto Region, Italy, surveillance of summer fevers was conducted to promptly identify autochthonous cases of West Nile fever and increase detection of imported dengue and chikungunya in travelers. Surveillance highlighted the need to modify case definitions, train physicians, and when a case is identified, implement vector control measures PMID:22469230

Two for One: Using QAR to Increase Reading Comprehension and Improve Test Scores

ERIC Educational Resources Information Center

Green, Susan

2016-01-01

This teaching tip describes an intervention used in a third-grade classroom implemented to help students pass an end-of-grade reading comprehension test. Low scores on a practice end-of-grade comprehension test prompted a re-examination of classroom reading instruction and a plan for intervention. This teaching tip describes the phases implemented…

Implementing Statewide Longitudinal Student Data Systems: Lessons from the States. Working Paper #22

ERIC Educational Resources Information Center

Anagnostopoulos, Dorothea; Bali, Valentina A.

2011-01-01

Providing accurate and useful information on student achievement is a rising challenge for state educational agencies. With the passage of the No Child Left Behind Act (NCLB) in 2001, such challenges have become more pressing. A centerpiece of the educational accountability movement, NCLB has prompted states to improve their reporting on student…

Is 8:30 a.m. Still Too Early to Start School? A 10:00 a.m. School Start Time Improves Health and Performance of Students Aged 13-16.

PubMed

Kelley, Paul; Lockley, Steven W; Kelley, Jonathan; Evans, Mariah D R

2017-01-01

While many studies have shown the benefits of later school starts, including better student attendance, higher test scores, and improved sleep duration, few have used starting times later than 9:00 a.m. Here we report on the implementation and impact of a 10 a.m. school start time for 13 to 16-year-old students. A 4-year observational study using a before-after-before (A-B-A) design was carried out in an English state-funded high school. School start times were changed from 8:50 a.m. in study year 0, to 10 a.m. in years 1-2, and then back to 8:50 a.m. in year 3. Measures of student health (absence due to illness) and academic performance (national examination results) were used for all students. Implementing a 10 a.m. start saw a decrease in student illness after 2 years of over 50% ( p < 0.0005 and effect size: Cohen's d = 1.07), and reverting to an 8:50 a.m. start reversed this improvement, leading to an increase of 30% in student illness ( p < 0.0005 and Cohen's d = 0.47). The 10:00 a.m. start was associated with a 12% increase in the value-added number of students making good academic progress (in standard national examinations) that was significant (<0.0005) and equivalent to 20% of the national benchmark. These results show that changing to a 10:00 a.m. high school start time can greatly reduce illness and improve academic performance. Implementing school start times later than 8:30 a.m., which may address the circadian delay in adolescents' sleep rhythms more effectively for evening chronotypes, appears to have few costs and substantial benefits.

Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society

PubMed Central

Cuchel, Marina; Bruckert, Eric; Ginsberg, Henry N.; Raal, Frederick J.; Santos, Raul D.; Hegele, Robert A.; Kuivenhoven, Jan Albert; Nordestgaard, Børge G.; Descamps, Olivier S.; Steinhagen-Thiessen, Elisabeth; Tybjærg-Hansen, Anne; Watts, Gerald F.; Averna, Maurizio; Boileau, Catherine; Borén, Jan; Catapano, Alberico L.; Defesche, Joep C.; Hovingh, G. Kees; Humphries, Steve E.; Kovanen, Petri T.; Masana, Luis; Pajukanta, Päivi; Parhofer, Klaus G.; Ray, Kausik K.; Stalenhoef, Anton F. H.; Stroes, Erik; Taskinen, Marja-Riitta; Wiegman, Albert; Wiklund, Olov; Chapman, M. John; Cuchel, Marina; Bruckert, Eric; Chapman, M. John; Descamps, Olivier S.; Ginsberg, Henry N.; Hegele, Robert A.; Kuivenhoven, Jan Albert; Nordestgaard, Børge G.; Raal, Frederick J.; Santos, Raul D.; Steinhagen-Thiessen, Elisabeth; Tybjærg-Hansen, Anne; Watts, Gerald F.; Chapman, M. John; Ginsberg, Henry N.; Averna, Maurizio; Boileau, Catherine; Borén, Jan; Catapano, Alberico L.; Defesche, Joep C.; Hovingh, G. Kees; Humphries, Steve E.; Kovanen, Petri T.; Masana, Luis; Pajukanta, Päivi; Parhofer, Klaus G.; Ray, Kausik K.; Stalenhoef, Anton F. H.; Stroes, Erik; Taskinen, Marja-Riitta; Wiegman, Albert; Wiklund, Olov

2014-01-01

Aims Homozygous familial hypercholesterolaemia (HoFH) is a rare life-threatening condition characterized by markedly elevated circulating levels of low-density lipoprotein cholesterol (LDL-C) and accelerated, premature atherosclerotic cardiovascular disease (ACVD). Given recent insights into the heterogeneity of genetic defects and clinical phenotype of HoFH, and the availability of new therapeutic options, this Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society (EAS) critically reviewed available data with the aim of providing clinical guidance for the recognition and management of HoFH. Methods and results Early diagnosis of HoFH and prompt initiation of diet and lipid-lowering therapy are critical. Genetic testing may provide a definitive diagnosis, but if unavailable, markedly elevated LDL-C levels together with cutaneous or tendon xanthomas before 10 years, or untreated elevated LDL-C levels consistent with heterozygous FH in both parents, are suggestive of HoFH. We recommend that patients with suspected HoFH are promptly referred to specialist centres for a comprehensive ACVD evaluation and clinical management. Lifestyle intervention and maximal statin therapy are the mainstays of treatment, ideally started in the first year of life or at an initial diagnosis, often with ezetimibe and other lipid-modifying therapy. As patients rarely achieve LDL-C targets, adjunctive lipoprotein apheresis is recommended where available, preferably started by age 5 and no later than 8 years. The number of therapeutic approaches has increased following approval of lomitapide and mipomersen for HoFH. Given the severity of ACVD, we recommend regular follow-up, including Doppler echocardiographic evaluation of the heart and aorta annually, stress testing and, if available, computed tomography coronary angiography every 5 years, or less if deemed necessary. Conclusion This EAS Consensus Panel highlights the need for early identification of HoFH patients, prompt referral to specialized centres, and early initiation of appropriate treatment. These recommendations offer guidance for a wide spectrum of clinicians who are often the first to identify patients with suspected HoFH. PMID:25053660

Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society.

PubMed

Cuchel, Marina; Bruckert, Eric; Ginsberg, Henry N; Raal, Frederick J; Santos, Raul D; Hegele, Robert A; Kuivenhoven, Jan Albert; Nordestgaard, Børge G; Descamps, Olivier S; Steinhagen-Thiessen, Elisabeth; Tybjærg-Hansen, Anne; Watts, Gerald F; Averna, Maurizio; Boileau, Catherine; Borén, Jan; Catapano, Alberico L; Defesche, Joep C; Hovingh, G Kees; Humphries, Steve E; Kovanen, Petri T; Masana, Luis; Pajukanta, Päivi; Parhofer, Klaus G; Ray, Kausik K; Stalenhoef, Anton F H; Stroes, Erik; Taskinen, Marja-Riitta; Wiegman, Albert; Wiklund, Olov; Chapman, M John

2014-08-21

Homozygous familial hypercholesterolaemia (HoFH) is a rare life-threatening condition characterized by markedly elevated circulating levels of low-density lipoprotein cholesterol (LDL-C) and accelerated, premature atherosclerotic cardiovascular disease (ACVD). Given recent insights into the heterogeneity of genetic defects and clinical phenotype of HoFH, and the availability of new therapeutic options, this Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society (EAS) critically reviewed available data with the aim of providing clinical guidance for the recognition and management of HoFH. Early diagnosis of HoFH and prompt initiation of diet and lipid-lowering therapy are critical. Genetic testing may provide a definitive diagnosis, but if unavailable, markedly elevated LDL-C levels together with cutaneous or tendon xanthomas before 10 years, or untreated elevated LDL-C levels consistent with heterozygous FH in both parents, are suggestive of HoFH. We recommend that patients with suspected HoFH are promptly referred to specialist centres for a comprehensive ACVD evaluation and clinical management. Lifestyle intervention and maximal statin therapy are the mainstays of treatment, ideally started in the first year of life or at an initial diagnosis, often with ezetimibe and other lipid-modifying therapy. As patients rarely achieve LDL-C targets, adjunctive lipoprotein apheresis is recommended where available, preferably started by age 5 and no later than 8 years. The number of therapeutic approaches has increased following approval of lomitapide and mipomersen for HoFH. Given the severity of ACVD, we recommend regular follow-up, including Doppler echocardiographic evaluation of the heart and aorta annually, stress testing and, if available, computed tomography coronary angiography every 5 years, or less if deemed necessary. This EAS Consensus Panel highlights the need for early identification of HoFH patients, prompt referral to specialized centres, and early initiation of appropriate treatment. These recommendations offer guidance for a wide spectrum of clinicians who are often the first to identify patients with suspected HoFH. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship.

PubMed

Messacar, Kevin; Parker, Sarah K; Todd, James K; Dominguez, Samuel R

2017-03-01

New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside. This minireview outlines the roles of diagnostic stewardship and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics. Copyright © 2017 American Society for Microbiology.

Evidence-Based Program Service Deserts: A Geographic Information Systems (GIS) Approach to Identifying Service Gaps for State-Level Implementation Planning.

PubMed

Walker, Sarah Cusworth; Hurvitz, Philip M; Leith, Jessica; Rodriguez, Felix I; Endler, Gregory C

2016-11-01

The long term effects of untreated mental health need for individuals, families and society has prompted a number of federal policy statements encouraging the use of evidence-based programs (EBP) in children's healthcare. However, among other challenges of evidence-based practice implementation, states often do not know where to make investments based on population need. In this paper we present the use of a Geographic Information System approach to undertake a mental health needs assessment for Washington State. Our study found that this technology can be beneficially applied to conducting needs assessment for EBP implementation, and we provide recommendations for future applications.

45 CFR 1306.34 - Combination program option.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Combination program option. 1306.34 Section 1306... START PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.34 Combination program option. (a) Combination program option requirements: (1) Grantees implementing a...

Impact of meningococcal C conjugate vaccination four years after introduction of routine childhood immunization in Brazil.

PubMed

Andrade, Ana Lucia; Minamisava, Ruth; Tomich, Lisia Moura; Lemos, Ana Paula; Gorla, Maria Cecilia; de Cunto Brandileone, Maria Cristina; Domingues, Carla Madga S; de Moraes, Camile; Policena, Gabriela; Bierrenbach, Ana Luiza

2017-04-11

Routine infant immunization with meningococcal C conjugate (MCC) vaccination started in Brazil in November 2010, scheduled at three and five months plus a booster at 12-15months of age. No catch-up was implemented. We assessed the impact of vaccination on meningococcal C disease (MenC) four years after vaccination start in the National Immunization Program. We performed an ecological quasi-experimental design from 2008 to 2014 using a deterministic linkage between the National Notification and the National Reference Laboratory databases for meningitis. We conducted an interrupted time-series analysis considering Brazil except for Salvador municipality, because an epidemic of serogroup C disease occurred in this city, which prompted a mass vaccination campaign with catch-up for adolescents in 2010. Observed MenC rates in the post-vaccination period were compared to expected rates calculated from the pre-vaccination years. Results for Salvador were presented as descriptive data. An additional time-series analysis was performed for the state of São Paulo. A total of 18,136 MenC cases were analyzed. The highest incidence rates were observed for infants aged <12months and no second incident peak was observed for adolescents. For Brazil, MenC rates were reduced by 67.2% (95%CI 43.0-91.4%) for infants <12months of age, 92.0% (77.3-106.8%) for the age-group 12-23months, and 64.6% (24.6-104.5%) for children aged 2-4years. For children 5-9years old, MenC rates reduced 19.2% (9.5-28.9%). Overall, 955 MenC cases were averted in Brazil in individuals aged <40years after MCC vaccination. Results from São Paulo State, mirror the patterns seen in Brazil. After four years of infants and toddlers vaccination start, MenC invasive disease reduced in the target population. This investigation provide a robust baseline to ascertain how much the upcoming catch-up dose in 12-13years of age will accelerate the decrease in MenC incidence rates among youths in Brazil. Copyright © 2017. Published by Elsevier Ltd.

Evaluation of interactive computerized training to teach parents to implement photographic activity schedules with children with autism spectrum disorder.

PubMed

Gerencser, Kristina R; Higbee, Thomas S; Akers, Jessica S; Contreras, Bethany P

2017-07-01

Training parents of children with autism spectrum disorder can be a challenge due to limited resources, time, and money. Interactive computerized training (ICT)-a self-paced program that incorporates instructions, videos, and interactive questions-is one method professionals can use to disseminate trainings to broader populations. This study extends previous research on ICT by assessing the effect of ICT to teach three parents how to implement a photographic activity schedule using a systematic prompting procedure with their child. Following ICT, all parents increased their fidelity to implementation of an activity schedule during role-play sessions with an adult. Fidelity remained high during implementation with their child and maintained during a 2-week follow-up. © 2017 Society for the Experimental Analysis of Behavior.

Overweight Kidney Transplant Recipients Are at Risk of Being Overdosed Following Standard Bodyweight-Based Tacrolimus Starting Dose.

PubMed

Andrews, Louise M; de Winter, Brenda C M; Tang, Jiang-Tao; Shuker, Nauras; Bouamar, Rachida; van Schaik, Ron H N; Koch, Birgit C P; van Gelder, Teun; Hesselink, Dennis A

2017-02-01

Bodyweight-based dosing of tacrolimus (Tac) is considered standard care, even though the available evidence is thin. An increasing proportion of transplant recipients is overweight, prompting the question if the starting dose should always be based on bodyweight. For this analysis, data were used from a randomized-controlled trial in which patients received either a standard Tac starting dose or a dose that was based on CYP3A5 genotype. The hypothesis was that overweight patients would have Tac overexposure following standard bodyweight-based dosing. Data were available for 203 kidney transplant recipients, with a median body mass index (BMI) of 25.6 (range, 17.2-42.2). More than 50% of the overweight or obese patients had a Tac predose concentration above the target range. The CYP3A5 nonexpressers tended to be above target when they weighed more than 67.5 kg or had a BMI of 24.5 or higher. Dosing guidelines were proposed with a decrease up to 40% in Tac starting doses for different BMI groups. The dosing guideline for patients with an unknown genotype was validated using the fixed-dose versus concentration controlled data set. This study demonstrates that dosing Tac solely on bodyweight results in overexposure in more than half of overweight or obese patients.

Prompt payment depends on revenue-cycle diligence.

PubMed

Barber, Robert L

2002-12-01

How effectively you manage the revenue cycle is reflected in the cycle's outcome-whether you receive full and timely payment for all services billed to payers. To ensure prompt and full payment, you should: Educate your patient financial services (PFS) staff on all relevant laws and regulations regarding payment for healthcare services. Make sure your staff is well versed in all of the provisions of your payer contracts. Implement a state-of-the-art patient accounting system that is capable of producing drill-down reports of all aspects of contract performance by payer. Enforce payer compliance by maintaining complete records of dates of service, final billing dates, dates claims were mailed or electronically submitted to the payer, all actions performed by your staff regarding claims, and all communications with the payer.

Sensitivity Analysis of Cf-252 (sf) Neutron and Gamma Observables in CGMF

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

Carter, Austin Lewis; Talou, Patrick; Stetcu, Ionel

CGMF is a Monte Carlo code that simulates the decay of primary fission fragments by emission of neutrons and gamma rays, according to the Hauser-Feshbach equations. As the CGMF code was recently integrated into the MCNP6.2 transport code, great emphasis has been placed on providing optimal parameters to CGMF such that many different observables are accurately represented. Of these observables, the prompt neutron spectrum, prompt neutron multiplicity, prompt gamma spectrum, and prompt gamma multiplicity are crucial for accurate transport simulations of criticality and nonproliferation applications. This contribution to the ongoing efforts to improve CGMF presents a study of the sensitivitymore » of various neutron and gamma observables to several input parameters for Californium-252 spontaneous fission. Among the most influential parameters are those that affect the input yield distributions in fragment mass and total kinetic energy (TKE). A new scheme for representing Y(A,TKE) was implemented in CGMF using three fission modes, S1, S2 and SL. The sensitivity profiles were calculated for 17 total parameters, which show that the neutron multiplicity distribution is strongly affected by the TKE distribution of the fragments. The total excitation energy (TXE) of the fragments is shared according to a parameter RT, which is defined as the ratio of the light to heavy initial temperatures. The sensitivity profile of the neutron multiplicity shows a second order effect of RT on the mean neutron multiplicity. A final sensitivity profile was produced for the parameter alpha, which affects the spin of the fragments. Higher values of alpha lead to higher fragment spins, which inhibit the emission of neutrons. Understanding the sensitivity of the prompt neutron and gamma observables to the many CGMF input parameters provides a platform for the optimization of these parameters.« less

Views of general practitioners on the use of STOPP&START in primary care: a qualitative study.

PubMed

Dalleur, O; Feron, J-M; Spinewine, A

2014-08-01

STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners' (GPs) perceptions regarding the use of the STOPP&START tool in their practice. We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes. Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes. Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.

Sobriety Treatment and Recovery Teams: Implementation Fidelity and Related Outcomes.

PubMed

Huebner, Ruth A; Posze, Lynn; Willauer, Tina M; Hall, Martin T

2015-01-01

Although integrated programs between child welfare and substance abuse treatment are recommended for families with co-occurring child maltreatment and substance use disorders, implementing integrated service delivery strategies with fidelity is a challenging process. This study of the first five years of the Sobriety Treatment and Recovery Team (START) program examines implementation fidelity using a model proposed by Carroll et al. (2007). The study describes the process of strengthening moderators of implementation fidelity, trends in adherence to START service delivery standards, and trends in parent and child outcomes. Qualitative and quantitative measures were used to prospectively study three START sites serving 341 families with 550 parents and 717 children. To achieve implementation fidelity to service delivery standards required a pre-service year and two full years of operation, persistent leadership, and facilitative actions that challenged the existing paradigm. Over four years of service delivery, the time from the child protective services report to completion of five drug treatment sessions was reduced by an average of 75 days. This trend was associated with an increase in parent retention, parental sobriety, and parent retention of child custody. Conclusions/Importance: Understanding the implementation processes necessary to establish complex integrated programs may support realistic allocation of resources. Although implementation fidelity is a moderator of program outcome, complex inter-agency interventions may benefit from innovative measures of fidelity that promote improvement without extensive cost and data collection burden. The implementation framework applied in this study was useful in examining implementation processes, fidelity, and related outcomes.

Headache and neuropsychic disorders in the puerperium: a case report with suspected deficiency of urea cycle enzymes.

PubMed

Tonini, Maria Clara; Bignamini, V; Mattioli, M

2011-05-01

An enzymatic abnormality of the urea cycle is a metabolic disorder occasionally seen in adults, but particularly in the puerperium. The main risk is acute hyperammoniemic encephalopathy, leading to psychosis, coma and even death if not diagnosed promptly and treated appropriately. Headache is frequent in the puerperium normally manifesting between 3 and 6 days after delivery. We describe here a 39-year-old woman, who 3 days after delivery presented diffuse tension-type headache and depression, followed by behavioral disorders, psychomotor agitation, epileptic seizures, and finally coma 2 days later. Pregnancy and normal delivery: routine blood chemistry findings, CT scan, MR imaging, angio-MR of the brain, and lumbar puncture were normal. EEG when seizures started, it showed diffuse slowing, as in the case of metabolic encephalopathy. This led us to assay blood ammonia, which was high at >400 mmol. Liver function and abdominal US were normal; hence, we suspected a urea cycle enzymatic abnormality, and requested for genetic tests. These confirmed a congenital primary metabolic deficiency of arginine succinate synthetase, with high citrullinemia (type II, adult form). Dialysis was started promptly, with initially iv arginine, then orally, plus medical therapy for the hyperammoniemia and a low protein diet; plasma ammonia dropped swiftly to normal, and her state of consciousness gradually improved until all the clinical symptoms had resolved. Ammonia assay should always be considered in the first few days of the puerperium in women with headache and behavioral disorders, to exclude an inborn deficiency of the urea cycle, which may have gone unnoticed until then.

Effectiveness of two community-based strategies on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia in Ghana.

PubMed

Escribano-Ferrer, Blanca; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

2017-12-12

Ghana has developed two community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: integrated Community Case Management (iCCM) and Community-based Health Planning and Services (CHPS). The objective of the study was to assess the effectiveness of iCCM and CHPS on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia. A household survey was conducted two and eight years after implementation of iCCM in the Volta and Northern Regions of Ghana respectively, and more than ten years of CHPS implementation in both regions. The study population included 1356 carers of children under- five years of age who had fever, diarrhoea and/or cough in the two weeks prior to the interview. Disease knowledge was assessed based on the knowledge of causes and identification of signs of severe disease and its association with the sources of health education messages received. Health behaviour was assessed based on reported prompt care seeking behaviour, adherence to treatment regime, utilization of mosquito nets and having improved sanitation facilities, and its association with the sources of health education messages received. Health education messages from community-based agents (CBAs) in the Northern Region were associated with the identification of at least two signs of severe malaria (adjusted Odds Ratio (OR) 1.8, 95%CI 1.0, 3.3, p = 0.04), two practices that can cause diarrhoea (adjusted OR 4.7, 95%CI 1.4, 15.5, p = 0.02) 0and two signs of severe pneumonia (adjusted OR 7.7, 95%CI2.2, 26.5, p = 0.01)-the later also associated with prompt care seeking behaviour (p = 0.04). In the Volta Region, receiving messages on diarrhoea from CHPS was associated with the identification of at least two signs of severe diarrhoea (adjusted OR 3.6, 95%CI 1.4, 9.0), p = 0.02). iCCM was associated with prompt care seeking behaviour in the Volta Region and CHPS with prompt care seeking behaviour in the Northern Region (p < 0.5). Both iCCM and CHPS were associated with disease knowledge and health behaviour, but this was more pronounced for iCCM and in the Northern Region. HBC should continue to be considered as the strategy through which community-IMCI is implemented.

Colorado Even Start Progress Report, 2001-2002.

ERIC Educational Resources Information Center

Anderson, Beckie

Even Start programs integrate early childhood education, adult literacy or basic education, parenting education and support, and parent and child time together to help break the cycle of poverty and illiteracy. This progress report describes the Even Start program in Colorado and presents evaluation findings from the 2001-2002 implementation year,…

Kansas: Early Head Start Initiative

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

Kansas Early Head Start (KEHS) provides comprehensive services following federal Head Start Program Performance Standards for pregnant women and eligible families with children from birth to age 4. KEHS was implemented in 1998 using Child Care and Development Block Grant (CCDBG) quality set-aside dollars augmented by a transfer of federal…

Transforming Security Screening With Biometrics

DTIC Science & Technology

2003-04-09

prompted the Defense Advanced Research Projects Agency to experiment with facial recognition technology for identification of known terrorists. While DoD...screening of individuals. Facial recognition technology has been tested to some degree for accessing highly sensitive military areas, but not for...the military can implement facial recognition to screen personnel requesting access to bases and stations, DoD is not likely to use biometrics to

Microcomputer and Bibliographic Information Systems in Latin America: Problems, Experiences and Projections. Proceedings of a Meeting (Santiago, Chile, April 24-27, 1984).

ERIC Educational Resources Information Center

Economic Commission for Latin America and the Caribbean, Santiago (Chile).

In areas such as Latin America and the Caribbean, many institutions are setting up databases using existing computerized information and documentation networks, and relying on new microcomputer equipment for their implementation. Increasing awareness of the implications of this practice prompted this conference, which provided the first step of a…

Monitoring white pine blister rust infection and mortality in whitebark pine in the Greater Yellowstone ecosystem

Treesearch

Cathie Jean; Erin Shanahan; Rob Daley; Gregg DeNitto; Dan Reinhart; Chuck Schwartz

2011-01-01

There is a critical need for information on the status and trend of whitebark pine (Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE). Concerns over the combined effects of white pine blister rust (WPBR, Cronartium ribicola), mountain pine beetle (MPB, Dendroctonus ponderosae), and climate change prompted an interagency working group to design and implement...

Pre-Service Preschool Teachers' Beliefs about Foreign Language Learning and Early Foreign Language Teaching in Slovenia

ERIC Educational Resources Information Center

Fojkar, Mateja Dagarin; Skubic, Darija

2017-01-01

The implementation of foreign languages in preschool education has prompted the need for qualified teachers. However, most recent studies report a gap between the supply of qualified foreign language teachers of young learners and the demand for such teachers as foreign languages are introduced earlier and earlier. The authors of this paper…

Strength in Numbers: State Spending on K-12 Assessment Systems

ERIC Educational Resources Information Center

Chingos, Matthew M.

2012-01-01

In the coming years, states will need to make the most significant changes to their assessment systems in a decade as they implement the Common Core State Standards, a common framework for what students are expected to know that will replace existing standards in 45 states and the District of Columbia. The Common Core effort has prompted concerns…

Teachers' Perceptions of Administrative Autonomy-Supportive versus Controlling Behaviors: Factors That Influence Teacher Intrinsic Motivation and Relationships with Administrators

ERIC Educational Resources Information Center

Scudella, Christine M.

2015-01-01

Federal policy around supervision and evaluation has prompted state action to develop new evaluation systems to increase student achievement. Systems, such as the Framework for Educator Effectiveness implemented in Wisconsin, are tied to teacher performance as well as student achievement. This type of performance-based evaluation system relies on…

75 FR 36023 - Approval and Promulgation of Implementation Plans; Designation of Areas for Air Quality Planning...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

... a Maintenance Plan, Including a Contingency Plan, for the Area Under Section 175a of the CAA 1. An.... Contingency Provisions That EPA Deems Necessary to Promptly Correct Any Violation of the NAAQS That Occurs... available control measures, and contingency measures) no longer applies for so long as the area continues to...

Multi-Ethnicity in the Malaysian Workplace: The Net Balance of 35 Years of Affirmative Policies as Observed by a Foreign Visitor

ERIC Educational Resources Information Center

Montesino, Max U.

2007-01-01

This paper looks at the net societal balance of post-independence affirmative action policies in Malaysia. Social imbalances prompted the country to implement affirmative policies to uplift the majority natives (Malays, Indigenous people of Sabah and Sarawak, etc.). These policies were reluctantly accepted by the immigrant communities (Chinese,…

Design and implementation of an interactive website to support long-term maintenance of weight loss.

PubMed

Stevens, Victor J; Funk, Kristine L; Brantley, Phillip J; Erlinger, Thomas P; Myers, Valerie H; Champagne, Catherine M; Bauck, Alan; Samuel-Hodge, Carmen D; Hollis, Jack F

2008-01-25

For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use. Developing interactive websites is expensive, complex, and time consuming. We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient. clinicaltrials.gov NCT00054925.

Brain electric microstates and momentary conscious mind states as building blocks of spontaneous thinking: I. Visual imagery and abstract thoughts.

PubMed

Lehmann, D; Strik, W K; Henggeler, B; Koenig, T; Koukkou, M

1998-06-01

Prompted reports of recall of spontaneous, conscious experiences were collected in a no-input, no-task, no-response paradigm (30 random prompts to each of 13 healthy volunteers). The mentation reports were classified into visual imagery and abstract thought. Spontaneous 19-channel brain electric activity (EEG) was continuously recorded, viewed as series of momentary spatial distributions (maps) of the brain electric field and segmented into microstates, i.e. into time segments characterized by quasi-stable landscapes of potential distribution maps which showed varying durations in the sub-second range. Microstate segmentation used a data-driven strategy. Different microstates, i.e. different brain electric landscapes must have been generated by activity of different neural assemblies and therefore are hypothesized to constitute different functions. The two types of reported experiences were associated with significantly different microstates (mean duration 121 ms) immediately preceding the prompts; these microstates showed, across subjects, for abstract thought (compared to visual imagery) a shift of the electric gravity center to the left and a clockwise rotation of the field axis. Contrariwise, the microstates 2 s before the prompt did not differ between the two types of experiences. The results support the hypothesis that different microstates of the brain as recognized in its electric field implement different conscious, reportable mind states, i.e. different classes (types) of thoughts (mentations); thus, the microstates might be candidates for the 'atoms of thought'.

The Struggle Begins Early: Head Start and the Mississippi Freedom Movement

ERIC Educational Resources Information Center

Hale, Jon N.

2012-01-01

This article examines the history of Head Start, a federally funded program, whose conceptualization emerged in earlier phases of the Civil Rights Movement in order to provide education, nourishing meals, medical services, and a positive social environment for children about to enter the first grade. While Head Start was implemented in states…

Working with a Head Start Population with Asthma: Lessons Learned

ERIC Educational Resources Information Center

Nelson, Belinda W.; Clark, Noreen M.; Valerio, Melissa A.; Houle, Christy R.; Brown, Randall W.; Brown, Clive

2006-01-01

The Early Childhood Asthma Project involved asthma case identification in 35 Head Start centers in Detroit, MI, and attempted implementation of an intervention designed to help families manage a child's asthma more effectively. Surveys were distributed to the parents of all Head Start children (3408), and 2198 complete surveys were returned. Case…

Involvement of Black Fathers in Head Start. Final Report 1987.

ERIC Educational Resources Information Center

Gary, Lawrence E.; And Others

This report evaluates the implementation of a demonstration model of a father-involvement component of Head Start programs in Washington (District of Columbia). Since well over 90 percent of the children in area Head Start programs are Black, the target group for this project was Black fathers. The following recommendations for program improvement…

Corneal edema and keratitis following selective laser trabeculoplasty.

PubMed

Liu, Erica Tan; Seery, Loren S; Arosemena, Analisa; Lamba, Tania; Chaya, Craig J

2017-06-01

To describe three cases of keratitis following Selective Laser Trabeculoplasty (SLT). Three females with a history of glaucoma presented with corneal edema, keratitis (endothelial, epithelial) and decreased visual acuity shortly after SLT. There was variable resolution of symptoms after starting treatment with oral antiherpetics and topical steroids. With the increase in usage of SLT as a treatment for glaucoma and subsequent reports of keratitis, it is imperative for ophthalmic surgeons to be aware of herpes simplex as a possible risk factor. Prompt treatment with antivirals and steroids can potentially prevent scarring and permanent damage to the cornea.

After APOD: From the Website to the Classroom and Beyond

NASA Astrophysics Data System (ADS)

Wilson, Teresa; APOD

2017-01-01

Astronomy Picture of the Day (APOD) images may start on the apod.nasa.gov website, but their reach goes much further than the individual sitting at their computer screen. They provoke questions that then prompts the reader to email the authors; teachers use the images in their classrooms; students use them in their projects. This presentation will take a look at some of the work done using APOD images and text, including public outreach via middle school presentations and email communications, and academic uses beyond astronomy such as lesson plans on atmospheric refraction and even plagiarism, copyright and fair use.

On the Lienard-Wiechert potentials

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

Whitney, C.K.

1988-09-01

Very recently, questions have started to surface concerning the well-known Lienard-Wiechert potentials describing relativistically moving point sources in classical electrodynamics. The existence of questions prompts a review of the original derivations by Lienard and Wiechert. These were done at the turn of the present century, and so predate the development of relevant modern techniques from special relativity theory and generalized function theory. Only purely geometric reasoning was used. That reasoning is reviewed here, and a previously unrecognized flaw is noted. When this flaw is remedied, the potentials are slightly altered and become consistent with other new results reported elsewhere.

Cues Matter: Learning Assistants Influence Introductory Biology Student Interactions during Clicker-Question Discussions

PubMed Central

Knight, Jennifer K.; Wise, Sarah B.; Rentsch, Jeremy; Furtak, Erin M.

2015-01-01

The cues undergraduate biology instructors provide to students before discussions of clicker questions have previously been shown to influence student discussion. We further explored how student discussions were influenced by interactions with learning assistants (LAs, or peer coaches). We recorded and transcribed 140 clicker-question discussions in an introductory molecular biology course and coded them for features such as the use of reasoning and types of questions asked. Students who did not interact with LAs had discussions that were similar in most ways to students who did interact with LAs. When students interacted with LAs, the only significant changes in their discussions were the use of more questioning and more time spent in discussion. However, when individual LA–student interactions were examined within discussions, different LA prompts were found to generate specific student responses: question prompts promoted student use of reasoning, while students usually stopped their discussions when LAs explained reasons for answers. These results demonstrate that LA prompts directly influence student interactions during in-class discussions. Because clicker discussions can encourage student articulation of reasoning, instructors and LAs should focus on how to effectively implement questioning techniques rather than providing explanations. PMID:26590204

Engaging older adults with dementia in creative occupations using artificially intelligent assistive technology.

PubMed

Leuty, Valerie; Boger, Jennifer; Young, Laurel; Hoey, Jesse; Mihailidis, Alex

2013-01-01

Engagement in creative occupations has been shown to promote well-being for older adults with dementia. Providing access to such occupations is often difficult, as successful participation requires face-time with a person who is knowledgeable in facilitating engagement as well as access to any required resources, such as an arts studio. In response, a computer-based device, the Engaging Platform for Art Development (ePAD), was created to with the aim of enabling more independent access to art creation, ePAD is a an artificially intelligent touch-screen device that estimates a client's level of engagement and provides prompts to encourage engagement if the client becomes disengaged. ePAD is customizable such that an art therapist can choose themes and tools that they feel reflect their client's needs and preferences. This article presents a mixed-methods study that evaluated ePAD's usability by six older adult (with mild-to-moderate dementia) and art therapist dyads. Usability measures suggest that all participants found ePAD engaging but did not find prompts effective. Future development of ePAD includes improving the prompts, implementing the recommendations made by participants in this research, and long-term testing in more naturalistic art therapy contexts.

Student Characteristics as Predictors of Teachers’ Implementation of a Kindergarten Readiness Program

PubMed Central

Voegler-Lee, Mary Ellen; Kupersmidt, Janis B.; Field, Samuel; Willoughby, Michael T.

2017-01-01

Recent years have seen increasing numbers of classroom-based interventions designed to enhance the school readiness of at-risk preschoolers. Even the most comprehensive, well-designed programs can suffer from limited effectiveness due to low-frequency implementation by teachers. The current study presents findings from the Building Bridges project (BB), an integrated program targeting school readiness in Head Start and low-income child care centers. Previous studies have reported the role of teacher-level and program-level characteristics in predicting teacher implementation of an intervention. The present study examines the role of student characteristics—language and math ability, social skills, and behavioral functioning—in predicting implementation exposure. These associations were examined in the context of program type (Head Start, child care) and intervention condition (consultation, no consultation). 88 classrooms (41 Head Start, 47 child care) participated in the BB intervention. Implementation exposure was predicted by several distinct student characteristics. Teachers whose students exhibited poorer language skills implemented significantly more BB activities, a finding that was consistent across program types and intervention conditions. A marginally significant trend was identified for oppositional behavior when interacted with intervention group in that teachers whose students demonstrated higher rates of oppositional behavior implemented fewer intervention activities when they did not have a consultant. Teachers in child care centers with a BB consultant had higher rates of implementation than did teachers in all other groups. These findings provide important information regarding the student-level characteristics that should be evaluated in order to optimize implementation of an intervention. PMID:22615022

Brief Report: A Mobile Application to Treat Prosodic Deficits in Autism Spectrum Disorder and Other Communication Impairments: A Pilot Study.

PubMed

Simmons, Elizabeth Schoen; Paul, Rhea; Shic, Frederick

2016-01-01

This study examined the acceptability of a mobile application, SpeechPrompts, designed to treat prosodic disorders in children with ASD and other communication impairments. Ten speech-language pathologists (SLPs) in public schools and 40 of their students, 5-19 years with prosody deficits participated. Students received treatment with the software over eight weeks. Pre- and post-treatment speech samples and student engagement data were collected. Feedback on the utility of the software was also obtained. SLPs implemented the software with their students in an authentic education setting. Student engagement ratings indicated students' attention to the software was maintained during treatment. Although more testing is warranted, post-treatment prosody ratings suggest that SpeechPrompts has potential to be a useful tool in the treatment of prosodic disorders.

Promoting interaction during sociodramatic play: teaching scripts to typical preschoolers and classmates with disabilities.

PubMed

Goldstein, H; Cisar, C L

1992-01-01

We investigated the effects of teaching sociodramatic scripts on subsequent interaction among three triads, each containing 2 typical children and 1 child with autistic characteristics. The same type and rate of teacher prompts were implemented throughout structured play observations to avoid the confounding effects of script training and teacher prompting. After learning the scripts, all children demonstrated more frequent theme-related social behavior. These improvements in social-communicative interaction were replicated with the training of three sociodramatic scripts (i.e., pet shop, carnival, magic show) according to a multiple baseline design. These effects were maintained during the training of successive scripts and when the triads were reconstituted to include new but similarly trained partners. Results provided support for the inclusion of systematic training of scripts to enhance interaction among children with and without disabilities during sociodramatic play.

Acute bacterial and viral meningitis.

PubMed

Bartt, Russell

2012-12-01

Most cases of acute meningitis are infectious and result from a potentially wide range of bacterial and viral pathogens. The organized approach to the patient with suspected meningitis enables the prompt administration of antibiotics, possibly corticosteroids, and diagnostic testing with neuroimaging and spinal fluid analysis. Acute meningitis is infectious in most cases and caused by a potentially wide range of bacterial and viral pathogens. Shifts in the epidemiology of bacterial pathogens have been influenced by changes in vaccines and their implementation. Seasonal and environmental changes influence the likely viral and rickettsial pathogens. The organized approach to the patient with suspected meningitis enables the prompt administration of antibiotics, possibly corticosteroids, and diagnostic testing with neuroimaging and spinal fluid analysis. Pertinent testing and treatment can vary with the clinical presentation, season, and possible exposures. This article reviews the epidemiology, clinical presentation, diagnosis, and treatment of acute meningitis.

Attitudes of women from five European countries regarding tobacco control policies.

PubMed

Dresler, Carolyn; Wei, Mei; Heck, Julia E; Allwright, Shane; Haglund, Margaretha; Sanchez, Sara; Kralikova, Eva; Stücker, Isabelle; Tamang, Elizabeth; Gritz, Ellen R; Hashibe, Mia

2013-03-01

Tobacco-related cancers and, in particular, lung cancer still represents a substantial public health epidemic across Europe as a result of high rates of smoking prevalence. Countries in Europe have proposed and implemented tobacco control policies to reduce smoking prevalence, with some countries being more progressive than others. The aim of this study was to examine factors that influenced women's attitudes across five European countries relative to comprehensive smokefree laws in their countries. A cross-sectional landline telephone survey on attitudes towards tobacco control laws was conducted in five European countries: France, Ireland, Italy, the Czech Republic, and Sweden. Attitudinal scores were determined for each respondent relative to questions about smokefree laws. Logistic regression models were used to obtain odds ratios with 95% confidence intervals. A total of 5000 women were interviewed (1000 women from each country). The majority of women, regardless of smoking history, objected to smoking in public buses, enclosed shopping centers, hospitals, and other indoor work places. More women who had quit smoking believed that new tobacco control laws would prompt cessation - as compared with women who still smoked. In general, there is very high support for national smokefree laws that cover bars, restaurants, and public transport systems. As such laws are implemented, attitudes do change, as demonstrated by the differences between countries such as Ireland and the Czech Republic. Implementing comprehensive smokefree laws will gain high approval and will be associated with prompting people to quit.

Development of the FITS tools package for multiple software environments

NASA Technical Reports Server (NTRS)

Pence, W. D.; Blackburn, J. K.

1992-01-01

The HEASARC is developing a package of general purpose software for analyzing data files in FITS format. This paper describes the design philosophy which makes the software both machine-independent (it runs on VAXs, Suns, and DEC-stations) and software environment-independent. Currently the software can be compiled and linked to produce IRAF tasks, or alternatively, the same source code can be used to generate stand-alone tasks using one of two implementations of a user-parameter interface library. The machine independence of the software is achieved by writing the source code in ANSI standard Fortran or C, using the machine-independent FITSIO subroutine interface for all data file I/O, and using a standard user-parameter subroutine interface for all user I/O. The latter interface is based on the Fortran IRAF Parameter File interface developed at STScI. The IRAF tasks are built by linking to the IRAF implementation of this parameter interface library. Two other implementations of this parameter interface library, which have no IRAF dependencies, are now available which can be used to generate stand-alone executable tasks. These stand-alone tasks can simply be executed from the machine operating system prompt either by supplying all the task parameters on the command line or by entering the task name after which the user will be prompted for any required parameters. A first release of this FTOOLS package is now publicly available. The currently available tasks are described, along with instructions on how to obtain a copy of the software.

Pilot Implementation and Preliminary Evaluation of START:AV Assessments in Secure Juvenile Correctional Facilities

PubMed Central

Sellers, Brian G; Viljoen, Jodi L.; Cruise, Keith R.; Nicholls, Tonia L.; Dvoskin, Joel A.

2012-01-01

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) is a new structured professional judgment guide for assessing short-term risks in adolescents. The scheme may be distinguished from other youth risk assessment and treatment planning instruments by its inclusion of 23 dynamic factors that are each rated for both vulnerability and strength. In addition, START:AV is also unique in that it focuses on multiple adverse outcomes—namely, violence, self-harm, suicide, unauthorized leave, substance abuse, self-neglect, victimization, and general offending—over the short-term (i.e., weeks to months) rather than long-term (i.e., years). This paper describes a pilot implementation and preliminary evaluation of START:AV in three secure juvenile correctional facilities in the southern United States. Specifically, we examined the descriptive characteristics and psychometric properties of START:AV assessments completed by 21 case managers on 291 adolescent offenders (250 boys and 41 girls) at the time of admission. Results provide preliminary support for the feasibility of completing START:AV assessments as part of routine practice. Findings also highlight differences in the characteristics of START:AV assessments for boys and girls and differential associations between the eight START:AV risk domains. Though results are promising, further research is needed to establish the reliability and validity of START:AV assessments completed in the field. PMID:23316116

Patient and public involvement: how much do we spend and what are the benefits?

PubMed

Pizzo, Elena; Doyle, Cathal; Matthews, Rachel; Barlow, James

2015-12-01

Patient and public involvement (PPI) is seen as a way of helping to shape health policy and ensure a patient-focused health-care system. While evidence indicates that PPI can improve health-care decision making, it also consumes monetary and non-monetary resources. Given the financial climate, it is important to start thinking about the costs and benefits of PPI and how to evaluate it in economic terms. We conducted a literature review to assess the potential benefits and costs of involvement and the challenges in carrying out an economic evaluation of PPI. The benefits of PPI include effects on the design of new projects or services, on NHS governance, on research design and implementation and on citizenship and equity. Economic evaluation of PPI activities is limited. The lack of an appropriate analytical framework, data recording and understanding of the potential costs and benefits of PPI, especially from participants' perspectives, represent serious constraints on the full evaluation of PPI. By recognizing the value of PPI, health-care providers and commissioners can embed it more effectively within their organizations. Better knowledge of costs may prompt organizations to effectively plan, execute, evaluate and target resources. This should increase the likelihood of more meaningful activity, avoid tokenism and enhance organizational efficiency and reputation. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Cost benefit analysis of Haemophilus influenzae type b vaccination programme in Israel.

PubMed Central

Ginsberg, G M; Kassis, I; Dagan, R

1993-01-01

STUDY OBJECTIVE--The recent availability of Haemophilus influenzae type b (HIB) conjugate vaccines prompted an examination of the costs and benefits of four and three dose HIB prevention programmes targeting all newborns in Israel. MEASUREMENTS AND MAIN RESULTS--A four dose programme would reduce the number of childhood (aged 0-13) HIB cases from 184.2 to 31.3 per year, yielding a benefit ($1.03 million) to cost ($3.55 million) ratio of just 0.29/l for health services only, based on a vaccine price of $7.74 per dose. When benefits resulting from a reduction in mild handicaps and severe neurological sequelae are included, the benefit ($4.48 million) to cost ratio rises to 1.26/l and it reaches 1.45/l when the $0.66 million indirect benefits of reduced work absences and mortality are also included. Break even vaccine costs are $2.24 when health service benefits only are considered and $11.21 when all the benefits are included. CONCLUSION--In the absence of other projects with higher benefit to cost ratios, Israel should start to provide a nationwide HIB vaccination programme since the monetary benefits to society of such a programme will exceed the costs to society. A barrier to implementation may occur, however, because the costs of the programme exceed the benefits to the health services alone. PMID:8120505

[Cognitive rehabilitation of amusia].

PubMed

Weill-Chounlamountry, A; Soyez-Gayout, L; Tessier, C; Pradat-Diehl, P

2008-06-01

The cognitive model of music processing has a modular architecture with two main pathways (a melody pathway and a time pathway) for processing the musical "message" and thus enabling music recognition. It also features a music-specific module for tonal encoding of pitch which stands apart from all other known cognitive systems (including language processing). To the best of our knowledge, rehabilitation therapy for amusia has not yet been reported. We developed a therapeutic method (inspired by work on word deafness) in order to determine whether specific rehabilitation based on melody discrimination could prompt the regression of amusia. We report the case of a patient having developed receptive, acquired amusia four years previously. His tone deafness disorder was assessed using the Montreal Battery of Evaluation of Amusia (MBEA), which revealed impairment of the melody pathway but no deficiency in the time pathway. A computer-assisted rehabilitation method was implemented; it used melody discrimination tasks and an errorless learning paradigm with progressively fading visual cues. After therapy, we noted an improvement in the overall MBEA score and its component subscores which could not be explained by spontaneous recovery (in view of the number of years since the neurological accident). The improvement was maintained at seven months post-therapy. Although post-therapy improvement in daily life was not systematically assessed, the patient started listening to his favourite music again. Specific amusia therapy has shown efficacy.

Office of Elementary and Secondary Education Webcast Introduction: Identifying, Recognizing, and Learning From Effective Schools

ERIC Educational Resources Information Center

Simon, Ray; Jung, Britt; Johnson, Joseph; Wallinger, Linda; Bamberg, Wanda

2004-01-01

The purpose of this series of webcasts is to communicate directly with state educational agency (SEA) and local educational agency (LEA) staff - those who guide and support the work of schools - on issues related to the implementation of NCLB. The goal of this webcast is to prompt SEAs and LEAs to think about how to identify the qualities of…

Implementing dashboards as a business intelligence tool in the forest inventory and analysis program

Treesearch

Scott A. Pugh; Randall S. Morin; Barbara A. Johnson

2015-01-01

Today is the era of “big data” where businesses have access to enormous amounts of often complex and sometimes unwieldy data. Businesses are using business intelligence (BI) systems to transform this data into useful information for management decisions. BI systems integrate applications, processes, data, and people to deliver prompt and robust analyses. A number of...

NAP SACC: Implementation of an Obesity Prevention Intervention in an American Indian Head Start Program.

PubMed

Mattingly, Julie A; Andresen, Pamela A

2016-01-01

Low-income American Indian preschoolers are at greatest risk for overweight and obesity among children aged 2-5 years. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program is an evidence-based intervention that promotes healthy weight development for children enrolled in child care centers. The goal of this continuous quality improvement program is for the child care staff to establish environmental policies and practices that positively influence nutrition and physical activity-related behaviors. A community needs assessment of a Head Start program on an American Indian reservation identified obesity as a priority issue. This project implemented NAP SACC at 15 Head Start sites on the reservation.

Evaluating the Efficacy of Children Participating in Home Instruction for Parents of Preschool Youngsters and Head Start

ERIC Educational Resources Information Center

Brown, Amber L; Lee, Joohi

2017-01-01

The purpose of this study was to evaluate the efficacy of the Home Instruction for Parents of Preschool Youngsters program when implemented within Head Start programs by measuring children's language proficiency scores. Participants were kindergarteners concurrently enrolled in both a Head Start program and the Home Instruction for Parents of…

Home Start Evaluation Study. Interim Report II: Program Analysis. Revised Draft.

ERIC Educational Resources Information Center

Deloria, Dennis; And Others

This document is the second in a series of evaluative reports directed to evaluation needs of Home Start planners and administrators. It focuses on implementation data about programs gathered during local site visits conducted in the spring and fall of 1972. The two basic evaluative questions asked are: (1) What was Home Start intended by its…

The Ultra-long GRB 111209A. II. Prompt to Afterglow and Afterglow Properties

NASA Astrophysics Data System (ADS)

Stratta, G.; Gendre, B.; Atteia, J. L.; Boër, M.; Coward, D. M.; De Pasquale, M.; Howell, E.; Klotz, A.; Oates, S.; Piro, L.

2013-12-01

The "ultra-long" gamma-ray burst GRB 111209A at redshift z = 0.677 is the longest GRB ever observed thus far, with a rest frame prompt emission duration of ~4 hr. In order to explain the burst exceptional longevity, a low-metallicity blue supergiant progenitor was invoked. In this article we further constrain the phenomenology and progenitor properties of this peculiar GRB by performing a multiband temporal and spectral analysis of both the prompt and the afterglow emission. We use proprietary and publicly available data from Swift, Konus WIND, XMM-Newton, and TAROT, as well as from other ground-based optical and radio telescopes. We find some peculiar properties that are possibly connected to the exceptional nature of this burst, namely: (1) an unprecedented large optical delay of 410 ± 50 s between the peak time in gamma-rays and the peak time in the optical of a marked multiwavelength flare; (2) multiwavelength prompt emission spectral modeling requires a certain amount of dust in the circumburst environment. The dust produces a rest frame visual extinction of AV = 0.3-1.5 mag, and may undergo destruction at late times; and (3) we detect the presence of a hard spectral extra power-law component at the end of the X-ray steep steep decay phase and before the start of the X-ray afterglow, which has never been revealed thus far in past GRBs. The optical afterglow shows more usual properties; it has a flux power-law decay with an index of 1.6 ± 0.1 and a late rebrightening feature observed at ~1.1 the day after the first Burst Alert Telescope trigger. We discuss our findings in the context of several possible interpretations that have been given thus far of the complex multiband GRB phenomenology and propose a binary channel formation for the blue supergiant progenitor.

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

Verburg, J; Bortfeld, T

Purpose: We present a new system to perform prompt gamma-ray spectroscopy during proton pencil-beam scanning treatments, which enables in vivo verification of the proton range. This system will be used for the first clinical studies of this technology. Methods: After successful pre-clinical testing of prompt gamma-ray spectroscopy, a full scale system for clinical studies is now being assembled. Prompt gamma-rays will be detected during patient treatment using an array of 8 detector modules arranged behind a tungsten collimator. Each detector module consists of a lanthanum(III) bromide scintillator, a photomultiplier tube, and custom electronics for stable high voltage supply and signalmore » amplification. A new real-time data acquisition and control system samples the signals from the detectors with analog-to-digital converters, analyses events of interest, and communicates with the beam delivery systems. The timing of the detected events was synchronized to the cyclotron radiofrequency and the pencil-beam delivery. Range verification is performed by matching measured energy- and timeresolved gamma-ray spectra to nuclear reaction models based on the clinical treatment plan. Experiments in phantoms were performed using clinical beams in order to assess the performance of the systems. Results: The experiments showed reliable real-time analysis of more than 10 million detector events per second. The individual detector modules acquired accurate energy- and time-resolved gamma-ray measurements at a rate of 1 million events per second, which is typical for beams delivered with a clinical dose rate. The data acquisition system successfully tracked the delivery of the scanned pencil-beams to determine the location of range deviations within the treatment field. Conclusion: A clinical system for proton range verification using prompt gamma-ray spectroscopy has been designed and is being prepared for use during patient treatments. We anticipate to start a first clinical study in the near future. This work was supported by the Federal Share of program income earned by Massachusetts; General Hospital on C06-CA059267, Proton Therapy Research and Treatment Center.« less

Overweight Kidney Transplant Recipients Are at Risk of Being Overdosed Following Standard Bodyweight-Based Tacrolimus Starting Dose

PubMed Central

Andrews, Louise M.; de Winter, Brenda C.M.; Tang, Jiang-Tao; Shuker, Nauras; Bouamar, Rachida; van Schaik, Ron H.N.; Koch, Birgit C.P.; van Gelder, Teun; Hesselink, Dennis A.

2017-01-01

Background Bodyweight-based dosing of tacrolimus (Tac) is considered standard care, even though the available evidence is thin. An increasing proportion of transplant recipients is overweight, prompting the question if the starting dose should always be based on bodyweight. Methods For this analysis, data were used from a randomized-controlled trial in which patients received either a standard Tac starting dose or a dose that was based on CYP3A5 genotype. The hypothesis was that overweight patients would have Tac overexposure following standard bodyweight-based dosing. Results Data were available for 203 kidney transplant recipients, with a median body mass index (BMI) of 25.6 (range, 17.2-42.2). More than 50% of the overweight or obese patients had a Tac predose concentration above the target range. The CYP3A5 nonexpressers tended to be above target when they weighed more than 67.5 kg or had a BMI of 24.5 or higher. Dosing guidelines were proposed with a decrease up to 40% in Tac starting doses for different BMI groups. The dosing guideline for patients with an unknown genotype was validated using the fixed-dose versus concentration controlled data set. Conclusions This study demonstrates that dosing Tac solely on bodyweight results in overexposure in more than half of overweight or obese patients. PMID:28361113

Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency.

PubMed

Agarwal, Shikhar; Gallo, Justin J; Parashar, Akhil; Agarwal, Kanika K; Ellis, Stephen G; Khot, Umesh N; Spooner, Robin; Murat Tuzcu, Emin; Kapadia, Samir R

2016-03-01

Operational inefficiencies are ubiquitous in several healthcare processes. To improve the operational efficiency of our catheterization laboratory (Cath Lab), we implemented a lean six sigma process improvement initiative, starting in June 2010. We aimed to study the impact of lean six sigma implementation on improving the efficiency and the patient throughput in our Cath Lab. All elective and urgent cardiac catheterization procedures including diagnostic coronary angiography, percutaneous coronary interventions, structural interventions and peripheral interventions performed between June 2009 and December 2012 were included in the study. Performance metrics utilized for analysis included turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start and manual sheath-pulls inside the Cath Lab. After implementation of lean six sigma in the Cath Lab, we observed a significant improvement in turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. The percentage of cases with optimal turn-time increased from 43.6% in 2009 to 56.6% in 2012 (p-trend<0.001). Similarly, the percentage of cases with an aggregate on-time start increased from 41.7% in 2009 to 62.8% in 2012 (p-trend<0.001). In addition, the percentage of manual sheath-pulls performed in the Cath Lab decreased from 60.7% in 2009 to 22.7% in 2012 (p-trend<0.001). The current longitudinal study illustrates the impact of successful implementation of a well-known process improvement initiative, lean six sigma, on improving and sustaining efficiency of our Cath Lab operation. After the successful implementation of this continuous quality improvement initiative, there was a significant improvement in the selected performance metrics namely turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. Copyright © 2016 Elsevier Inc. All rights reserved.

Creating regional consensus for starting school later: a physician-driven approach in southern Maine.

PubMed

Collins, Tracey Ann; Indorf, Christopher; Klak, Thomas

2017-12-01

In April 2016, several contiguous school districts and an independent high school academy in southern Maine voted simultaneously to start school later, beginning with the 2016-17 academic year. They became Maine's first school districts to implement the American Academy of Pediatrics' 1 and the American Medical Association's 2 health policy recommendations that middle and high schools should not start before 8:30 AM. Local physicians' presentations to school staff and parents on the medical evidence of the health benefits of a later start solidified early consensus. The action required special permission from the Maine Municipal Association to hold a joint school board vote, impacted approximately 6500 students across the region, resulted in no increase in busing costs, and took 8 months to implement after the first formal school board discussions. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Implementation science: how to jump‐start infection prevention.

PubMed

Saint, Sanjay; Howell, Joel D; Krein, Sarah L

2010-11-01

Implementing evidence‐based infection prevention practices is challenging. Implementation science, which is the study of methods promoting the uptake of evidence into practice, addresses the gap between theory and practice. Just as healthcare epidemiology has emerged as a paradigm for patient safety, infection prevention may serve as a clinical model for implementation researchers.

Promoting physical activity, healthy eating and gross motor skills development among preschoolers attending childcare centers: Process evaluation of the Healthy Start-Départ Santé intervention using the RE-AIM framework.

PubMed

Ward, Stéphanie; Chow, Amanda Froehlich; Humbert, M Louise; Bélanger, Mathieu; Muhajarine, Nazeem; Vatanparast, Hassan; Leis, Anne

2018-06-01

The Healthy Start-Départ Santé intervention was developed to promote physical activity, gross motor skills and healthy eating among preschoolers attending childcare centers. This process evaluation aimed to report the reach, effectiveness, adoption, implementation and maintenance of the Healthy Start-Départ Santé intervention. The RE-AIM framework was used to guide this process evaluation. Data were collected across 140 childcare centers who received the Healthy Start-Départ Santé intervention in the provinces of Saskatchewan and New Brunswick, Canada. Quantitative data were collected through director questionnaires at 10 months and 2 years after the initial training and analyzed using descriptive statistics. Qualitative data were collected throughout the intervention. The intervention was successful in reaching a large number of childcare centres and engaging both rural and urban communities across Saskatchewan and New Brunswick. Centres reported increasing opportunities for physical activity and healthy eating, which were generally low-cost, easy and quick to implement. However, these changes were rarely transformed into formal written policies. A total of 87% of centers reported using the physical activity resource and 68% using the nutrition resource on a weekly basis. Implementation fidelity of the initial training was high. Of those centers who received the initial training, 75% participated in the mid-point booster session training. Two year post-implementation questionnaires indicated that 47% of centers were still using the Active Play Equipment kit, while 42% were still using the physical activity resource and 37% were still using the nutrition resource. Key challenges to implementation and sustainability identified during the evaluation were consistent among all of the REAIM elements. These challenges included lack of time, lack of support from childcare staff and low parental engagement. Findings from this study suggest the implementation of Healthy Start-Départ Santé may be improved further by addressing resistance to change and varied levels of engagement among childcare staff. In addition, further work is needed to provide parents with opportunities to engage in HSDS with their children. Copyright © 2018 Elsevier Ltd. All rights reserved.

Targeting Classrooms' Emotional Climate and Preschoolers' Socioemotional Adjustment: Implementation of the Chicago School Readiness Project

PubMed Central

Li-Grining, Christine P.; Raver, C. Cybele; Jones-Lewis, Darlene; Madison-Boyd, Sybil; Lennon, Jaclyn

2015-01-01

Children living in low-income families are more likely to experience less self-regulation, greater behavior problems, and lower academic achievement than higher income children. To help prevent children's later socioemotional and academic difficulties, the Chicago School Readiness Project (CSRP) team implemented a clustered, randomized controlled trial (RCT) in early childhood programs with Head Start funding. Head Start sites were randomly assigned to receive CSRP services, which were offered as part of a multi-component, classroom-based mental health intervention. Here, we provide an overview of the CSRP model, its components, and a descriptive portrait of its implementation. In so doing, we address various aspects of the implementation of three of its components: 1) the training of teachers, 2) MHCs' coaching of teachers, and 3) teachers' behavior management of children. We conclude with a discussion of factors potentially related to the implementation of CSRP and directions for future research. PMID:25321641

Using simulation modeling to improve patient flow at an outpatient orthopedic clinic.

PubMed

Rohleder, Thomas R; Lewkonia, Peter; Bischak, Diane P; Duffy, Paul; Hendijani, Rosa

2011-06-01

We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced.

Columbia River Basin Fish and Wildlife Program Work Plan for Fiscal Year 1989.

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

United States. Bonneville Power Administration. Division of Fish and Wildlife.

1988-11-01

The FY 1989 Columbia River Basin Fish and Wildlife Program Work Plan (Work Plan) presents Bonneville Power Administration's plans for implementing the Columbia River Basin Fish and Wildlife Program (Program) in FY 1989. The Work Plan focuses on individual Action Items found in the 1987 Program for which Bonneville Power Administration (BPA) has determined that it has authority and responsibility to implement. Each of the entries in the Work Plan includes objectives, background, and progress to date in achieving those objectives, and a summary of plans for implementation in FY 1989. Most Action Items are implemented through one or moremore » BPA-funded projects. Each Action Item entry is followed by a list of completed, ongoing, and planned projects, along with objectives, results, schedules, and milestones for each project. The FY 1989 Work Plan emphasizes continuation of 113 projects, most of which involve protection, mitigation, or enhancement of anadromous fishery resources. BPA also plans to start 20 new projects in FY 1989. The number of ongoing FY 1988 projects to be continued in FY 1989 and the number of new projects planned to start in FY 1989 are based on current (September 7, 1988) procurement expectations. Several projects presently in BPA's procurement process are expected to be contracted by September 30, 1988, the last day of FY 1988. Although these projects have not yet started, they have been listed in the Work Plan as ongoing FY 1988 projects, based on projected start dates in late September 1988. Throughout the Work Plan, those projects with projected start dates in September 1988 have been noted.« less

Evaluating Systemic Change in the National Head Start-Public School Transition Project: Perspectives from Five States.

ERIC Educational Resources Information Center

Greene, Andrea; And Others

In 1991 the Department of Health and Human Services funded 32 sites throughout the United States to develop and implement Head Start-Public School Early Childhood Transition Demonstration Projects. The purpose of 31 projects, which are in their fourth year of operation, is to stimulate partnerships among Head Start agencies, public schools, and…

Legal Challenges and Pitfalls for Start-up Companies - 48 Common Questions and Answers.

PubMed

Staehelin, Matthias

2014-12-01

Transforming a business idea into reality requires a legal implementation plan. The following 48 questions and answers address key issues that typically arise in start-up situations. Early planning can help avoid costly mistakes.

West Nile virus: the Italian national transplant network reaction to an alert in the north-eastern region, Italy 2011.

PubMed

Costa, A Nanni; Capobianchi, M R; Ippolito, G; Palù, G; Barzon, L; Piccolo, G; Andreetta, B; Filippetti, M; Fehily, D; Lombardini, L; Grossi, P

2011-10-13

We report four cases of West Nile virus (WNV) transmission following a single multiorgan donation in north-eastern Italy. The transmissions were promptly detected by local transplant centres. The donor had been tested for WNV by nucleic acid amplification test (NAT) prior to transplantation and was negative. There were no detected errors in the nationally implemented WNV safety protocols.

Deep space network software cost estimation model

NASA Technical Reports Server (NTRS)

Tausworthe, R. C.

1981-01-01

A parametric software cost estimation model prepared for Jet PRopulsion Laboratory (JPL) Deep Space Network (DSN) Data System implementation tasks is described. The resource estimation mdel modifies and combines a number of existing models. The model calibrates the task magnitude and difficulty, development environment, and software technology effects through prompted responses to a set of approximately 50 questions. Parameters in the model are adjusted to fit JPL software life-cycle statistics.

From Policy to Practice: Tracing the Development and Implementation of Placement and Diagnostic Assessments across States, Systems, and Community Colleges. Lessons from Florida and Virginia Community Colleges -- Phase 2 Report

ERIC Educational Resources Information Center

Duffy, Mark; Tandberg, David A.; Harrill, Sandra; Jack, James; Park, Elizabeth; Shaw, Kathleen M.

2013-01-01

National initiatives to raise K-12 standards and align them to postsecondary entrance requirements have prompted states and/or state postsecondary systems to enact policies to improve alignment among postsecondary readiness standards, postsecondary placement and diagnostic exams, and developmental education curricula. This report examines how six…

New Help for Children Raised by Grandparents and Other Relatives: Questions and Answers about the Fostering Connections to Success and Increasing Adoptions Act of 2008

ERIC Educational Resources Information Center

Annie E. Casey Foundation, 2009

2009-01-01

This publication is intended to help ensure full and prompt implementation of the improvements in the Fostering Connections to Success and Increasing Adoptions Act for children being raised by grandparents and other relatives. It was prepared by 18 organizations, many of whom have been working individually and together for a number of years to…

Utilization of the Arkansas Prescription Monitoring Program to combat prescription drug abuse

PubMed Central

Rittenhouse, Rebecca; Wei, Feifei; Robertson, Denise; Ryan, Kevin

2015-01-01

Objective The Arkansas Prescription Monitoring Program (AR PMP) was implemented in 2013 to combat prescription drug abuse. All enrollees were invited to participate in a user survey available in February 2014, to identify makeup of users, utilization of the program, and changes made to health care practices after implementation of the program. Methods Of the 3694 individual enrollees invited to participate, 1541 (41.7%) completed the survey. Data collected were analyzed to identify changes in health care practices by program frequency of use and user profession. Results Medical doctors, advanced practice nurses, and pharmacists are the professions who use the program most frequently. Daily AR PMP users are considerably more likely than infrequent users to be prompted to access the program by the involvement of a controlled substance (CS) prescription or by office/facility policy requirements. Increased frequency of use of the AR PMP results in positive impacts on CS prescribing and dispensing practices. Conclusion Compelling more users of the AR PMP to be prompted to access the program by the involvement of a CS prescription or by requirements per office/facility policy may increase frequency of use of the program and thereby changes in health care practices to combat prescription drug abuse. PMID:26191489

The Euler’s Graphical User Interface Spreadsheet Calculator for Solving Ordinary Differential Equations by Visual Basic for Application Programming

NASA Astrophysics Data System (ADS)

Gaik Tay, Kim; Cheong, Tau Han; Foong Lee, Ming; Kek, Sie Long; Abdul-Kahar, Rosmila

2017-08-01

In the previous work on Euler’s spreadsheet calculator for solving an ordinary differential equation, the Visual Basic for Application (VBA) programming was used, however, a graphical user interface was not developed to capture users input. This weakness may make users confuse on the input and output since those input and output are displayed in the same worksheet. Besides, the existing Euler’s spreadsheet calculator is not interactive as there is no prompt message if there is a mistake in inputting the parameters. On top of that, there are no users’ instructions to guide users to input the derivative function. Hence, in this paper, we improved previous limitations by developing a user-friendly and interactive graphical user interface. This improvement is aimed to capture users’ input with users’ instructions and interactive prompt error messages by using VBA programming. This Euler’s graphical user interface spreadsheet calculator is not acted as a black box as users can click on any cells in the worksheet to see the formula used to implement the numerical scheme. In this way, it could enhance self-learning and life-long learning in implementing the numerical scheme in a spreadsheet and later in any programming language.

Evidence that self-incentives increase fruit consumption: a randomized exploratory trial among high-risk romanian adolescents.

PubMed

Armitage, Christopher J

2014-04-01

High mortality rates associated with cancer and cardiovascular disease in Romania have been partly attributed to low fruit consumption. The aim of the present research was to test whether self-incentives delivered via implementation intentions could increase fruit consumption among 238 high-risk Romanian adolescents. Participants were randomly allocated to either: (1) a control condition (asked to plan to increase their fruit intake but given no further instruction), (2) a standard implementation intention condition (asked to form an implementation intention using standard open-ended instructions), or (3) a self-incentivizing implementation intention condition (asked to reward themselves at the end of the week if they had successfully consumed an extra portion of fruit each day). There were significant increases in fruit consumption in the self-incentivizing implementation intention condition, but not in the control condition or-contrary to predictions-in the standard implementation intention condition. The findings support the use of implementation intentions to deliver self-incentives and increase fruit consumption, and suggest that providing children with a structured prompt might enhance the effectiveness of implementation intention-based interventions compared with standard implementation intention instructions.

Promoting interaction during sociodramatic play: teaching scripts to typical preschoolers and classmates with disabilities.

PubMed Central

Goldstein, H; Cisar, C L

1992-01-01

We investigated the effects of teaching sociodramatic scripts on subsequent interaction among three triads, each containing 2 typical children and 1 child with autistic characteristics. The same type and rate of teacher prompts were implemented throughout structured play observations to avoid the confounding effects of script training and teacher prompting. After learning the scripts, all children demonstrated more frequent theme-related social behavior. These improvements in social-communicative interaction were replicated with the training of three sociodramatic scripts (i.e., pet shop, carnival, magic show) according to a multiple baseline design. These effects were maintained during the training of successive scripts and when the triads were reconstituted to include new but similarly trained partners. Results provided support for the inclusion of systematic training of scripts to enhance interaction among children with and without disabilities during sociodramatic play. PMID:1386068

High dose of prokinetics for refractory hiccups after chemotherapy or the return to a simple drug.

PubMed

Uña, Esther; Alonso, Pilar

2013-10-29

Hiccups in patients with cancer might be difficult to treat, impacting negatively on the quality of life. Many therapies are available, but they are usually started empirically, and often they are unsuccessful. We report a case of a man with metastatic colon cancer who after the first cycle of chemotherapy developed persistent hiccups refractory to neuroleptics and low dose of metoclopramide. After searching for the potential cause, a high dose of prokinetics was initiated in the hospital and his symptoms disappeared. This case shows how searching for potential causes helps start the right treatment immediately, and therefore it is relevant for the prompt relief from this bothersome symptom. So far, no cases reporting high doses of prokinetics to treat persistent hiccups after chemotherapy have been published. This option should be taken into account when developing hiccups and gastro-oesophageal reflux after chemotherapy, especially if low doses of prokinetics have already been tried.

A Strong Limit on the Very-high-energy Emission from GRB 150323A

NASA Astrophysics Data System (ADS)

Abeysekara, A. U.; Archer, A.; Benbow, W.; Bird, R.; Brose, R.; Buchovecky, M.; Bugaev, V.; Connolly, M. P.; Cui, W.; Errando, M.; Falcone, A.; Feng, Q.; Finley, J. P.; Flinders, A.; Fortson, L.; Furniss, A.; Gillanders, G. H.; Hütten, M.; Hanna, D.; Hervet, O.; Holder, J.; Hughes, G.; Humensky, T. B.; Johnson, C. A.; Kaaret, P.; Kar, P.; Kelley-Hoskins, N.; Kertzman, M.; Kieda, D.; Krause, M.; Krennrich, F.; Lang, M. J.; Lin, T. T. Y.; Maier, G.; McArthur, S.; Moriarty, P.; Mukherjee, R.; O’Brien, S.; Ong, R. A.; Park, N.; Perkins, J. S.; Petrashyk, A.; Pohl, M.; Popkow, A.; Pueschel, E.; Quinn, J.; Ragan, K.; Reynolds, P. T.; Richards, G. T.; Roache, E.; Rulten, C.; Sadeh, I.; Santander, M.; Sembroski, G. H.; Shahinyan, K.; Tyler, J.; Wakely, S. P.; Weiner, O. M.; Weinstein, A.; Wells, R. M.; Wilcox, P.; Wilhelm, A.; Williams, D. A.; Zitzer, B.; VERITAS Collaboration; Vurm, Indrek; Beloborodov, Andrei

2018-04-01

On 2015 March 23, the Very Energetic Radiation Imaging Telescope Array System (VERITAS) responded to a Swift-Burst Alert Telescope (BAT) detection of a gamma-ray burst, with observations beginning 270 s after the onset of BAT emission, and only 135 s after the main BAT emission peak. No statistically significant signal is detected above 140 GeV. The VERITAS upper limit on the fluence in a 40-minute integration corresponds to about 1% of the prompt fluence. Our limit is particularly significant because the very-high-energy (VHE) observation started only ∼2 minutes after the prompt emission peaked, and Fermi-Large Area Telescope observations of numerous other bursts have revealed that the high-energy emission is typically delayed relative to the prompt radiation and lasts significantly longer. Also, the proximity of GRB 150323A (z = 0.593) limits the attenuation by the extragalactic background light to ∼50% at 100–200 GeV. We conclude that GRB 150323A had an intrinsically very weak high-energy afterglow, or that the GeV spectrum had a turnover below ∼100 GeV. If the GRB exploded into the stellar wind of a massive progenitor, the VHE non-detection constrains the wind density parameter to be A ≳ 3 × 1011 g cm‑1, consistent with a standard Wolf–Rayet progenitor. Alternatively, the VHE emission from the blast wave would be weak in a very tenuous medium such as the interstellar medium, which therefore cannot be ruled out as the environment of GRB 150323A.

A web-based computer-tailored smoking prevention programme for primary school children: intervention design and study protocol

PubMed Central

2012-01-01

Background Although the number of smokers has declined in the last decade, smoking is still a major health problem among youngsters and adolescents. For this reason, there is a need for effective smoking prevention programmes targeting primary school children. A web-based computer-tailored feedback programme may be an effective intervention to stimulate youngsters not to start smoking, and increase their knowledge about the adverse effects of smoking and their attitudes and self-efficacy regarding non-smoking. Methods & design This paper describes the development and evaluation protocol of a web-based out-of-school smoking prevention programme for primary school children (age 10-13 years) entitled ‘Fun without Smokes’. It is a transformation of a postal mailed intervention to a web-based intervention. Besides this transformation the effects of prompts will be examined. This web-based intervention will be evaluated in a 2-year cluster randomised controlled trial (c-RCT) with three study arms. An intervention and intervention + prompt condition will be evaluated for effects on smoking behaviour, compared with a no information control condition. Information about pupils’ smoking status and other factors related to smoking will be obtained using a web-based questionnaire. After completing the questionnaire pupils in both intervention conditions will receive three computer-tailored feedback letters in their personal e-mail box. Attitudes, social influences and self-efficacy expectations will be the content of these personalised feedback letters. Pupils in the intervention + prompt condition will - in addition to the personalised feedback letters - receive e-mail and SMS messages prompting them to revisit the ‘Fun without Smokes’ website. The main outcome measures will be ever smoking and the utilisation of the ‘Fun without Smokes’ website. Measurements will be carried out at baseline, 12 months and 24 months of follow-up. Discussion The present study protocol describes the purpose, intervention design and study protocol of ‘Fun without Smokes’. Expectations are that pupils receiving tailored advice will be less likely to smoke after 24 months in contrast to pupils in the control condition. Furthermore, tailored feedback letters and prompting is expected to be more effective than providing tailored feedback letters only. Trial registration Dutch Trial Register NTR3116 PMID:22490110

Implementation of The World Starts With Me, a comprehensive rights-based sex education programme in Uganda.

PubMed

Rijsdijk, Liesbeth E; Bos, Arjan E R; Lie, Rico; Leerlooijer, Joanne N; Eiling, Ellen; Atema, Vera; Gebhardt, Winifred A; Ruiter, Robert A C

2014-04-01

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation according to the manual), as well as to identify the main barriers and facilitators of implementation. Teachers' confidence in teaching WSWM was negatively associated with dose delivered. Confidence in educating and discussing sexuality issues in class was positively associated with fidelity of implementation, whereas the importance teachers attached to open sex education showed a negative association with fidelity. Main barriers for implementing WSWM were lack of time, unavailability of computers, lack of student manuals and lack of financial support and rewards. Other barriers for successful implementation were related to high turnover of staff and insufficient training and guidance of teachers. Teachers' beliefs/attitudes towards sexuality of adolescents, condom use and sex education were found to be important socio-cognitive factors intervening with full fidelity of implementation. These findings can be used to improve the intervention implementation and to better plan for large-scale dissemination of school-based sex education programmes in sub-Saharan Africa.

MASTER OT J015539.85+485955.6 was detected during Fermi alert inspection 3.5h after the trigger time

NASA Astrophysics Data System (ADS)

Rebolo, R.; Lipunov, V.; Gorbovskoy, E.; Serra, M.; Lodieu, N.; Israelian, G.; Suarez-Andres, L.; Shumkov, V.; Tyurina, N.; Kornilov, V.; Balanutsa, P.; Kuznetsov, A.; Vlasenko, D.; Gorbunov, I.; Vladimirov, V.; Popova, E.; Buckley, D.; Potter, S.; Kniazev, A.; Kotze, M.; Tlatov, A.; Parhomenko, A. V.; Dormidontov, D.; Senik, V.; Gress, O.; Ivanov, K.; Budnev, N. M.; Yurkov, V.; Sergienko, Yu.; Gabovich, A.; Sinyakov, E.; Krushinski, V.; Zalozhnih, I.; Shurpakov, S.

2015-11-01

MASTER-IAC, MASTER-Kislovodsk and MASTER-SAAO was pointed to the FERMI GBM GRB151107B (Stanbro, Meegan, GCN #18570 ) at 2015-11-07 20:25:52(/59s/58s) UT (R.Rebolo et al., GCN #18576 ). There were the prompt pointing observations because duration of the GRB was ~140s . After 5 minutes of the alert observations of the error-box center, MASTER telescopes in IAC and Kislovodsk started the inspect survey inside large Fermi error box (ra=00 42 28 dec=+48 48 58 r=4.533300) obtained by GCN socket.

Nano-JASMINE: use of AGIS for the next astrometric satellite

NASA Astrophysics Data System (ADS)

Yamada, Y.; Gouda, N.; Lammers, U.

The core data reduction for the Nano-JASMINE mission is planned to be done with Gaia's Astrometric Global Iterative Solution (AGIS). The collaboration started at 2007 prompted by Uwe Lammers' proposal. In addition to similar design and operating principles of the two missions, this is possible thanks to the encapsulation of all Gaia-specific aspects of AGIS in a Parameter Database. Nano-JASMINE will be the test bench for Gaia AGIS software. We present this idea in detail and the necessary practical steps to make AGIS work with Nano-JASMINE data. We also show the key mission parameters, goals, and status of the data reduction for the Nano-JASMINE.

An unusual cause of febrile hepatitis

PubMed Central

Stelzer, Teresa; Kohler, Sibylle; Marques Maggio, Ewerton; Heuss, Ludwig Theodor

2015-01-01

We describe the case of a 51-year-old man with recently diagnosed ulcerative colitis who developed fever and elevated liver enzymes as well as cholestasis a few weeks after starting treatment with mesalazine. As no obvious cause was found and fever persisted, liver biopsy was performed and revealed granulomatous hepatitis. The patient recovered completely after cessation of mesalazine, so that a drug-induced granulomatous hepatitis after exclusion of other differential diagnoses in an extensive work up was assumed. The present case demonstrates that even though drug-induced liver injury due to mesalazine is rare, it should be considered in unclear cases and lead to prompt discontinuation of mesalazine. PMID:26113581

Ecology: human role in Russian wild fires.

PubMed

Mollicone, Danilo; Eva, Hugh D; Achard, Frédéric

2006-03-23

Anomalies in temperature and precipitation in northern Russia over the past few years have been viewed as manifestations of anthropogenic climate change, prompting suggestions that this may also account for exceptional forest fires in the region. Here we examine the number of forest-fire events across the boreal Russian Federation for the period 2002 to 2005 in 'intact' forests, where human influence is limited, and in 'non-intact' forests, which have been shaped by human activity. Our results show that there were more fires in years during which the weather was anomalous, but that more than 87% of fires in boreal Russia were started by people.

A Case of Lemierre Syndrome Secondary to Otitis Media and Mastoiditis

PubMed Central

Turan, Aynur; Cam, Harun; Dadali, Yeliz; Korkmaz, Serdar; Özdek, Ali; Hekimoğlu, Baki

2014-01-01

Lemierre's syndrome is a rare clinical condition that generally develops secondary to oropharyngeal infection caused by Fusobacterium necrophorum, which is an anaerobic bacteria. A 62-year-old patient with diabetes mellitus presented with internal jugular vein and sigmoid sinus-transverse sinus thrombophlebitis, accompanying otitis media and mastoiditis that developed after an upper airway infection. Interestingly, there were air bubbles in both the internal jugular vein and transverse sinus. Vancomycin and meropenem were started and a right radical mastoidectomy was performed. The patient's clinical picture completely resolved in 14 days. High mortality and morbidity may be prevented with a prompt diagnosis of Lemierre's syndrome. PMID:25431696

Improving rates of screening and prevention by leveraging existing information systems.

PubMed

Neil, Nancy

2003-11-01

In 1997 Virginia Mason Health System (VMMC), a vertically integrated hospital and multispecialty group practice, had no process or system to deliver the right patient clinical data, in the right form, at the right place--when providers needed it for effective patient care. Without any new investment in technology, a work group of five individuals leveraged existing, primarily paper-based information systems to launch development and implementation of a provider prompting tool--a primary care and prevention (PCP) report--which prompted providers to complete screening, prevention, and disease management services at every patient appointment. The work group developed and pilot tested the report and created a mechanism by which the report could be delivered just in time before each patient's appointment. The report integrated information from independent appointment scheduling, laboratory results reporting, patient demographics, and billing data sources. MEASURING THE PCP REPORT'S IMPACT: The results of two separate analyses demonstrate improvement in rates of screening and prevention across VMMC soon after the PCP report became available. These results led senior leadership to make the PCP report's utilization a systemwide imperative. The PCP report is used by nearly all primary care providers as a prompt to complete screening, prevention, and disease management services at every patient appointment.

In-Patient Code Stroke: A Quality Improvement Strategy to Overcome Knowledge-to-Action Gaps in Response Time.

PubMed

Kassardjian, Charles D; Willems, Jacqueline D; Skrabka, Krystyna; Nisenbaum, Rosane; Barnaby, Judith; Kostyrko, Pawel; Selchen, Daniel; Saposnik, Gustavo

2017-08-01

Stroke is a relatively common and challenging condition in hospitalized patients. Previous studies have shown delays in recognition and assessment of inpatient strokes leading to poor outcomes. The goal of this quality improvement initiative was to evaluate an in-hospital code stroke algorithm and educational program aimed at reducing the response times for inpatient stroke. An inpatient code stroke algorithm was developed, and an educational intervention was implemented over 5 months. Data were recorded and compared between the 36-month period before and the 15-month period after the intervention was implemented. Outcome measures included time from last seen normal to initial assessment and from last seen normal to brain imaging. During the study period, there were 218 inpatient strokes (131 before the intervention and 87 after the intervention). Inpatient strokes were more common on cardiovascular wards (45% of cases) and occurred mainly during the perioperative period (60% of cases). After implementation of an inpatient code stroke intervention and educational initiative, there were consistent reductions in all timed outcome measures (median time to initial assessment fell from 600 [109-1460] to 160 [35-630] minutes and time to computed tomographic scan fell from 925 [213-1965] to 348.5 [128-1587] minutes). Our study reveals the efficacy of an inpatient code stroke algorithm and educational intervention directed at nurses and allied health personnel to optimize the prompt management of inpatient strokes. Prompt assessment may lead to faster stroke interventions, which are associated with better outcomes. © 2017 American Heart Association, Inc.

Checklists change communication about key elements of patient care.

PubMed

Newkirk, Michelle; Pamplin, Jeremy C; Kuwamoto, Roderick; Allen, David A; Chung, Kevin K

2012-08-01

Combat casualty care is distributed across professions and echelons of care. Communication within it is fragmented, inconsistent, and prone to failure. Daily checklists used during intensive care unit (ICU) rounds have been shown to improve compliance with evidence-based practices, enhance communication, promote consistency of care, and improve outcomes. Checklists are criticized because it is difficult to establish a causal link between them and their effect on outcomes. We investigated how checklists used during ICU rounds affect communication. We conducted this project in two military ICUs (burn and surgical/trauma). Checklists contained up to 21 questions grouped according to patient population. We recorded which checklist items were discussed during rounds before and after implementation of a "must address" checklist and compared the frequency of discussing items before checklist prompting. Patient discussions addressed more checklist items before prompting at the end of the 2-week evaluation compared with the 2-week preimplementation period (surgical trauma ICU, 36% vs. 77%, p < 0.0001; burn ICU, 47% vs. 72 %, p < 0.001). Most items were addressed more frequently in both ICUs after implementation. Key items such as central line removal, reduction of laboratory testing, medication reconciliation, medication interactions, bowel movements, sedation holidays, breathing trials, and lung protective ventilation showed significant improvements. Checklists modify communication patterns. Improved communication facilitated by checklists may be one mechanism behind their effectiveness. Checklists are powerful tools that can rapidly alter patient care delivery. Implementing checklists could facilitate the rapid dissemination of clinical practice changes, improve communication between echelons of care and between individuals involved in patient care, and reduce missed information.

Developing Service Plans: A Resource Manual for American Indian/Alaska Native Head Start/Early Head Start Grantees

ERIC Educational Resources Information Center

Academy for Educational Development, 2006

2006-01-01

This "Developing Service Plans" guide is a tool to assist grantees in the development of written service plans. It provides a structure that can be tailored to meet the needs of individual grantees. Services Plans are a management tool for planning, organizing and implementing Head Start program services to children and families. As stated in the…

An Evaluation of Fresh Start as a Catch-Up Intervention: A Trial Conducted by Teachers

ERIC Educational Resources Information Center

Gorard, Stephen; Siddiqui, Nadia; See, Beng Huat

2016-01-01

This paper describes a randomised controlled trial conducted with 10 secondary schools in England to evaluate the impact and feasibility of Fresh Start as an intervention to help new entrants with low prior literacy. Fresh Start is a synthetic phonics programme for small groups of pupils, here implemented three times per week over 22 weeks. The…

Design and Implementation of an Interactive Website to Support Long-Term Maintenance of Weight Loss

PubMed Central

Stevens, Victor J; Brantley, Phillip J; Erlinger, Thomas P; Myers, Valerie H; Champagne, Catherine M; Bauck, Alan; Samuel-Hodge, Carmen D; Hollis, Jack F

2008-01-01

Background For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. Objective This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. Methods The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. Results The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use. Conclusions Developing interactive websites is expensive, complex, and time consuming. We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient. Trial Registration clinicaltrials.gov NCT00054925 PMID:18244892

The management of hypertensive crises: a clinical review.

PubMed

Pergolini, M S

2009-01-01

Hypertension is an exceedingly common disorder in Western societies; but, thanks to improved management of chronic hypertension, the number of patients who present with hypertensive crisis (HC) is less than 1%. However, critical elevation of blood pressure (BP) obliges to a proper and immediate management in order to prevent serious injury to organ target of hypertension (brain, heart, kidney and vessels). Moreover, the so called hypertensive emergencies (HE) and the hypertensive urgencies (HU) expect a several therapeutic approach. The HE warrant both prompt admission to an intensive care unit, where it is available a continuous monitoring of BP, and a prompt starting of a therapy with parenteral anti-hypertensive drugs. The treatment of HU can be managed choosing oral anti-hypertensive agents followed by a tight observation of the patient also in ambulatory system, lowering the BP more gradually over 12 to 24-48 hours. The present clinical review is aimed at reporting the current opinions on the management of HC, examining as well the drugs of largest use. Any drug that lowers BP precipitously should be avoided. Choice of the appropriate agent should be based on the underlying pathophysiological and clinical findings, on the mechanism of action, and on its potential side effects.

A fault constitutive relation accounting for thermal pressurization of pore fluid

USGS Publications Warehouse

Andrews, D.J.

2002-01-01

The heat generated in a slip zone during an earthquake can raise fluid pressure and thereby reduce frictional resistance to slip. The amount of fluid pressure rise depends on the associated fluid flow. The heat generated at a given time produces fluid pressure that decreases inversely with the square root of hydraulic diffusivity times the elapsed time. If the slip velocity function is crack-like, there is a prompt fluid pressure rise at the onset of slip, followed by a slower increase. The stress drop associated with the prompt fluid pressure rise increases with rupture propagation distance. The threshold propagation distance at which thermally induced stress drop starts to dominate over frictionally induced stress drop is proportional to hydraulic diffusivity. If hydraulic diffusivity is 0.02 m2/s, estimated from borehole samples of fault zone material, the threshold propagation distance is 300 m. The stress wave in an earthquake will induce an unknown amount of dilatancy and will increase hydraulic diffusivity, both of which will lessen the fluid pressure effect. Nevertheless, if hydraulic diffusivity is no more than two orders of magnitude larger than the laboratory value, then stress drop is complete in large earthquakes.

77 FR 23483 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... for Emotion and Social skill promotion (CARES) project: Impact and Implementation Studies. OMB No. 0970-0364. Description: The Head Start Classroom-based Approaches and Resource for Emotion and Social skill promotion (CARES) project is evaluating social emotional program enhancements within Head Start...

Setting Adolescents Up for Success: Promoting a Policy to Delay High School Start Times.

PubMed

Barnes, Margaux; Davis, Krista; Mancini, Mackenzie; Ruffin, Jasmine; Simpson, Tina; Casazza, Krista

2016-07-01

A unique biological shift in sleep cycles occurs during adolescence causing later sleep and wake times. This shift is not matched by a concurrent modification in school start times, resulting in sleep curtailment for a large majority of adolescents. Chronic inadequate sleep is associated with poor academic performance including executive function impairments, mood, and behavioral issues, as well as adverse health outcomes such as an increased risk of obesity, hypertension, and cardiovascular disease. In order to address sleep deficits and the potential negative outcomes associated with chronic sleep deprivation, the American Academy of Pediatrics (AAP) and US Centers for Disease Control and Prevention (CDC) support delaying school start times for middle and high school students. We summarize current evidence, explicate the need for policy change, and urge school districts to put adolescent students' health as top priority and implement school start times consistent with their developmental needs. Whereas substantial evidence illustrating adverse consequences of inadequate sleep on psychological and physical health, and recommendations exist to adapt daytime school schedules to match sleep needs have been released, actual implementation of these recommendations have been limited. This is a call to action for the implementation of AAP/CDC recommendations across the state and nation. © 2016, American School Health Association.

Development of behaviour change communication strategy for a vaccination-linked malaria control tool in southern Tanzania.

PubMed

Mushi, Adiel K; Schellenberg, Joanna; Mrisho, Mwifadhi; Manzi, Fatuma; Mbuya, Conrad; Mponda, Haji; Mshinda, Hassan; Tanner, Marcel; Alonso, Pedro; Pool, Robert; Schellenberg, David

2008-09-29

Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyrimethamine and linked to the expanded programme on immunization (EPI) is a promising strategy for malaria control in young children. As evidence grows on the efficacy of IPTi as public health strategy, information is needed so that this novel control tool can be put into practice promptly, once a policy recommendation is made to implement it. This paper describes the development of a behaviour change communication strategy to support implementation of IPTi by the routine health services in southern Tanzania, in the context of a five-year research programme evaluating the community effectiveness of IPTi. Mixed methods including a rapid qualitative assessment and quantitative health facility survey were used to investigate communities' and providers' knowledge and practices relating to malaria, EPI, sulphadoxine-pyrimethamine and existing health posters. Results were applied to develop an appropriate behaviour change communication strategy for IPTi involving personal communication between mothers and health staff, supported by a brand name and two posters. Malaria in young children was considered to be a nuisance because it causes sleepless nights. Vaccination services were well accepted and their use was considered the mother's responsibility. Babies were generally taken for vaccination despite complaints about fevers and swellings after the injections. Sulphadoxine-pyrimethamine was widely used for malaria treatment and intermittent preventive treatment of malaria in pregnancy, despite widespread rumours of adverse reactions based on hearsay and newspaper reports. Almost all health providers said that they or their spouse were ready to take SP in pregnancy (96%, 223/242). A brand name, key messages and images were developed and pre-tested as behaviour change communication materials. The posters contained public health messages, which explained the intervention itself, how and when children receive it and safety issues. Implementation of IPTi started in January 2005 and evaluation is ongoing. Behaviour Change Communication (BCC) strategies for health interventions must be both culturally appropriate and technically sound. A mixed methods approach can facilitate an interactive process among relevant actors to develop a BCC strategy.

Recent advances in diagnostic microbiology.

PubMed

Bravo, Lulette Tricia C; Procop, Gary W

2009-07-01

The past decade has seen a surge in the development of a variety of molecular diagnostics designed to rapidly identify or characterize medically important microorganisms. We briefly review important advances in molecular microbiology, and then discuss specific assays that have been implemented in clinical microbiology laboratories throughout the country. We also discuss emerging methods and technologies that will soon be more widely used for the prompt and accurate detection of the agents of infectious diseases.

A Clinical Translation of the Article Titled "Evidence for the Implementation of the Early Start Denver Model for Young Children With Autism Spectrum Disorder".

PubMed

Shannon, Robin Adair

2015-01-01

The purpose of this article is to offer a clinical translation of a literature review titled "Evidence for the Implementation of the Early Start Denver Model for Young Children With Autism Spectrum Disorder" by Ryberg (2015). The literature review was conducted to determine the strength of the research evidence regarding the effectiveness of the Early Start Denver Model in improving cognitive, language, and behavioral functioning of children with autism spectrum disorder. In an effort to narrow the gap between evidence and practice, this clinical translation will discuss the components of the literature review in terms of its rationale for and objectives, methods, results, and implications for evidence-based nursing practice. © The Author(s) 2015.

Successful implementation of a perioperative glycemic control protocol in cardiac surgery: barrier analysis and intervention using lean six sigma.

PubMed

Martinez, Elizabeth A; Chavez-Valdez, Raul; Holt, Natalie F; Grogan, Kelly L; Khalifeh, Katherine W; Slater, Tammy; Winner, Laura E; Moyer, Jennifer; Lehmann, Christoph U

2011-01-01

Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

PubMed Central

Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.

2011-01-01

Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218

75 FR 70931 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-19

... Information Collection Activity; Comment Request Title: Evaluation of Head Start Early Learning Mentor Coach... implementation evaluation of the Head Start Early Learning Mentor-Coach Initiative. The study will collect... awarded funds under the American Recovery and Reinvestment Act of 2009--Early Learning Mentor Coach...

76 FR 34998 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... implementation of the Head Start Safe Families Safe Homes (SFSH) domestic violence training curriculum. The... partnerships with domestic violence service providers in local communities. Teams of trainers in each of five..., state agency staff (e.g., Head Start Collaboration Directors, Domestic Violence Coalition Directors...

NPRM: Head Start Program Performance Standards.

ERIC Educational Resources Information Center

Administration for Children, Youth, and Families (DHHS), Washington, DC. Head Start Bureau.

This document contains the Notice of Proposed Rulemaking (NPRM) on Head Start Program Performance Standards, appearing in the April 22, 1996 "Federal Register." The Administration for Children, Youth, and Families issued this notice to implement the statutory provisions for establishing program performance standards for early Head Start…

Mass transit : implementation of FTA's new starts evaluation process and FY 2001 funding proposals

DOT National Transportation Integrated Search

2000-04-01

Since the early 1970s, the federal government has provided a large share of the nation's capital investment in urban mass transportation. Much of this investment has come through the Federal Transit Administration's (FTA) New Starts program, which he...

Pressure ulcer prevention program: a journey.

PubMed

Delmore, Barbara; Lebovits, Sarah; Baldock, Philip; Suggs, Barbara; Ayello, Elizabeth A

2011-01-01

The Centers for Medicare & Medicaid Services' regulations regarding nonpayment for hospital-acquired conditions such as pressure ulcers have prompted a marked increase in focus on preventive care. Our hospital also used this change in payment policy as an opportunity to strengthen our pressure ulcer prevention practices. We used an 8-spoke prevention wheel to develop and implement practice changes that reduced pressure ulcer incidence from 7.3% to 1.3% in 3 years. Because it is about the journey, we will describe the mechanisms we designed and implemented, and identify strategies that worked or did not work as we promulgated a quality improvement process for pressure ulcer prevention in our large urban hospital center.

Oversight Hearing on Head Start. Hearing before the Subcommittee on Human Resources of the Committee on Education and Labor. House of Representatives, Ninety-Ninth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Education and Labor.

This hearing was held to gather information, identify concerns relevant to reauthorization of Project Head Start, and collect program directors' input on some of the immediate day-to-day problems of program implementation, such as insurance and salaries. Witnesses affirmed the current administration's support for Head Start, mentioned some program…

Impacts of Social-Emotional Curricula on Three-Year-Olds: Exploratory Findings from the Head Start CARES Demonstration. Research Snapshot. OPRE Report 2014-78

ERIC Educational Resources Information Center

Hsueh, JoAnn; Lowenstein, Amy E.; Morris, Pamela; Mattera, Shira K.; Bangser, Michael

2014-01-01

This report presents exploratory impact findings for 3-year-olds from the Head Start CARES demonstration, a large-scale randomized controlled trial implemented in Head Start centers for one academic year across the country. The study was designed primarily to test the effects of the enhancements on 4-year-olds, but it also provides an opportunity…

The application of structure-based assessment to support safety and chemistry diligence to manage genotoxic impurities in active pharmaceutical ingredients during drug development.

PubMed

Dobo, Krista L; Greene, Nigel; Cyr, Michelle O; Caron, Stéphane; Ku, Warren W

2006-04-01

Starting materials and intermediates used to synthesize pharmaceuticals are reactive in nature and may be present as impurities in the active pharmaceutical ingredient (API) used for preclinical safety studies and clinical trials. Furthermore, starting materials and intermediates may be known or suspected mutagens and/or carcinogens. Therefore, during drug development due diligence need be applied from two perspectives (1) to understand potential mutagenic and carcinogenic risks associated with compounds used for synthesis and (2) to understand the capability of synthetic processes to control genotoxic impurities in the API. Recently, a task force comprised of experts from pharmaceutical industry proposed guidance, with recommendations for classification, testing, qualification and assessing risk of genotoxic impurities. In our experience the proposed structure-based classification, has differentiated 75% of starting materials and intermediates as mutagenic and non-mutagenic with high concordance (92%) when compared with Ames results. Structure-based assessment has been used to identify genotoxic hazards, and prompted evaluation of fate of genotoxic impurities in API. These two assessments (safety and chemistry) culminate in identification of genotoxic impurities known or suspected to exceed acceptable levels in API, thereby triggering actions needed to assure appropriate control and measurement methods are in place. Hypothetical case studies are presented demonstrating this multi-disciplinary approach.

Water masers in the Kronian system

NASA Astrophysics Data System (ADS)

Pogrebenko, Sergei V.; Gurvits, Leonid I.; Elitzur, Moshe; Cosmovici, Cristiano B.; Avruch, Ian M.; Pluchino, Salvatore; Montebugnoli, Stelio; Salerno, Emma; Maccaferri, Giuseppe; Mujunen, Ari; Ritakari, Jouko; Molera, Guifre; Wagner, Jan; Uunila, Minttu; Cimo, Giuseppe; Schilliro, Francesco; Bartolini, Marco

The presence of water has been considered for a long time as a key condition for life in planetary environments. The Cassini mission discovered water vapour in the Kronian system by detecting absorption of UV emission from a background star (Hansen et al. 2006). Prompted by this discovery, we started an observational campaign for search of another manifestation of the water vapour in the Kronian system, its maser emission at the frequency of 22 GHz (1.35 cm wavelength). Observations with the 32 m Medicina radio telescope (INAF-IRA, Italy) started in 2006 using Mk5A data recording and the JIVE-Huygens software correlator. Later on, an on-line spectrometer was used at Medicina. The 14 m Metsähovi radio telescope (TKK-MRO, Finland) joined the observational campaign in 2008 using a locally developed data capture unit and software spectrometer. More than 300 hours of observations were collected in 2006-2008 campaign with the two radio telescopes. The data were analysed at JIVE using the Doppler tracking technique to compensate the observed spectra for the radial Doppler shift for various bodies in the Kronian system (Pogrebenko et al. 2009). Here we report the observational results for Hyperion, Titan, Enceladus and Atlas, and their physical interpretation. Encouraged by these results we started a campaign of follow up observations including other radio telescopes.

Four-year follow-up of pregnancy-associated osteoporosis: a case report.

PubMed

Takahashi, Naoto; Arai, Itaru; Kayama, Satoru; Ichiji, Kenji; Fukuda, Hironari; Handa, Jun-Ichi; Konno, Shin-Ichi

2014-01-01

A 22-year-old woman presented with complaints of severe pain in a wide region of the thoracolumbar spine. She developed severe pain in the thoracolumbar spine region 2 months after her first delivery and was referred 1 month later. A lateral thoracic X-ray showed depressed degenerative vertebrae (T7, T9). One month after the initial examination, thoracic sagittal magnetic resonance imaging showed low intensity areas on T1-weighted imaging and iso-high intensity areas on T2-weighted imaging at T5, 7, 8, 9 and 11. Bone mineral density measured by ultrasound was low (%YAM 76%). The bone metabolic markers were high, suggesting accelerated osteoclast activity. These findings prompted a diagnosis of pregnancy-associated osteoporosis. She was asked to stop breastfeeding and to wear a lumbar brace, and treatment with nutritional calcium, activated vitamin D3, and risedronate sodium was started. Her low back pain almost disappeared after treatment. Bone metabolic markers showed normalization 8 months after the initial examination. Risedronate sodium was stopped 2 years and 2 months after the initial examination. Teriparatide treatment was started because her bone mineral density remained low; however, the osteoblast marker P1NP was not increased 5 months after the start of teriparatide treatment.

Prompting technologies: A comparison of time-based and context-aware transition-based prompting

PubMed Central

Robertson, Kayela; Rosasco, Cody; Feuz, Kyle; Schmitter-Edgecombe, Maureen; Cook, Diane

2016-01-01

BACKGROUND While advancements in technology have encouraged the development of novel prompting systems to support cognitive interventions, little research has evaluated the best time to deliver prompts, which may impact the effectiveness of these interventions. OBJECTIVE This study examined whether transition-based context prompting (prompting an individual during task transitions) is more effective than traditional fixed time-based prompting. METHODS Participants were 42 healthy adults who completed 12 different everyday activities, each lasting 1–7 minutes, in an experimental smart home testbed and received prompts to record the completed activities from an electronic memory notebook. Half of the participants were delivered prompts during activity transitions, while the other half received prompts every 5 minutes. Participants also completed Likert-scale ratings regarding their perceptions of the prompting system. RESULTS Results revealed that participants in the transition-based context prompting condition responded to the first prompt more frequently and rated the system as more convenient, natural, and appropriate compared to participants in the time-based condition. CONCLUSIONS Our findings suggest that prompting during activity transitions produces higher adherence to the first prompt and more positive perceptions of the prompting system. This is an important finding given the benefits of prompting technology and the possibility of improving cognitive interventions by using context-aware transition prompting. PMID:26409520

AASHTO transportation asset management guide : a focus on implementation executive summary.

DOT National Transportation Integrated Search

2013-06-01

This AASHTO Transportation Asset Management Executive Summary serves as a companion to the AASHTO Transportation : Asset Management GuideA Focus on Implementation, which takes as a starting point the Transportation : Asset Management Guide publish...

Jump-Starting Educational Reform. Implementing British Columbia's Comprehensive School Act.

ERIC Educational Resources Information Center

Goldman, Paul

An educational reform effort to implement a comprehensive school act in British Columbia (Canada) is analyzed with a focus on some sociotechnical and political aspects. An overview of the content, background, and implementation of the reform effort is followed by identification of seven contradictions inherent in the plan. Contradictions are as…

Leadership: The Key to Successful Implementation of Total Quality Management

DTIC Science & Technology

1990-05-01

the implementation of the initiative called Total Quality Management as the philosophy and guiding principles to improve organizational efficiency...where and how to start. This paper presents the critical elements, their interrelationships, and how they can be used to achieve the cultural change necessary for successful implementation of Total Quality Management .

To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis.

PubMed

Glidewell, Liz; Willis, Thomas A; Petty, Duncan; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Davies, Andrew; Jamieson, Tony; Hunter, Cheryl; Hartley, Suzanne; Gray-Burrows, Kara; Clamp, Susan; Carder, Paul; Alderson, Sarah; Farrin, Amanda J; Foy, Robbie

2018-02-17

Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms-mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. 'graded tasks' and 'problem solving' for educational outreach). BCTs addressing the determinants 'environmental context' and 'social and professional roles' (e.g. 'restructuring the social and 'physical environment' and 'adding objects to the environment') were indicator specific. We found it challenging to operationalise BCTs targeting 'environmental context', 'social influences' and 'social and professional roles' within our chosen delivery mechanisms. We have demonstrated a transparent process for selecting, operationalising and verifying the BCT content in implementation packages adapted to target four quality indicators in primary care. There was considerable overlap in BCTs identified across the four indicators suggesting core BCTs can be embedded and verified within delivery mechanisms commonly available to primary care. Whilst feedback reports can include a wide range of BCTs, computerised prompts can deliver BCTs at the time of decision making, and educational outreach can allow for flexibility and individual tailoring in delivery.

Nutriendo la Promesa: Materiales Para la Aplicacion de las Normas de Ejecucion del Programa Head Start. Guia Para la Utilizacion de los Materiales [y] Transparencias (Nurturing the Promise: Set of Training Materials on the Head Start Program Performance Standards. User's Guide [and] Set of Transparencies).

ERIC Educational Resources Information Center

Educational Services, Inc., Washington, DC.

Since 1975, the Head Start Program Performance Standards have defined the services that local programs are required to provide to enrolled children and families. With revisions effective in 1998, the Program Performance Standards translate the Head Start vision into quality practices implemented at the local level. This document is comprised of a…

Provider Communication, Prompts, and Feedback to Improve HPV Vaccination Rates in Resident Clinics.

PubMed

Rand, Cynthia M; Schaffer, Stanley J; Dhepyasuwan, Nui; Blumkin, Aaron; Albertin, Christina; Serwint, Janet R; Darden, Paul M; Humiston, Sharon G; Mann, Keith J; Stratbucker, William; Szilagyi, Peter G

2018-04-01

Human papillomavirus (HPV) vaccination rates lag behind vaccination rates for other adolescent vaccines; a bundled intervention may improve HPV vaccination rates. Our objective is to evaluate the impact of quality improvement (QI) training plus a bundled practice-based intervention (provider prompts plus communication skills training plus performance feedback) on improving HPV vaccinations in pediatric resident continuity clinics. Staff and providers in 8 resident clinics participated in a 12-month QI study. The intervention included training to strengthen provider communication about the HPV vaccine. Clinics also implemented provider prompts, received monthly performance feedback, and participated in learning collaborative calls. The primary outcome measure was eligible visits with vaccination divided by vaccine-eligible visits (captured HPV vaccination opportunities). Practices performed chart audits that were fed into monthly performance feedback on captured HPV vaccination opportunities. We used conditional logistic regression (conditioning on practice) to assess captured vaccination opportunities, with the time period of the study (before and after the QI intervention) as the independent variable. Overall, captured opportunities for HPV vaccination increased by 16.4 percentage points, from 46.9% to 63.3%. Special cause was demonstrated by centerline shift, with 8 consecutive points above the preintervention mean. On adjusted analyses, patients were more likely to receive a vaccine during, versus before, the intervention (odds ratio: 1.87; 95% confidence interval: 1.54-2.28). Captured HPV vaccination rates improved at both well-child and other visits (by 11.7 and 13.0 percentage points, respectively). A bundled intervention of provider prompts and training in communication skills plus performance feedback increased captured opportunities for HPV vaccination. Copyright © 2018 by the American Academy of Pediatrics.

Visual prompt poster for promoting patient-physician conversations on weight loss.

PubMed

Stephens, Gillian S; Blanken, Stephanie E; Greiner, K Allen; Chumley, Heidi S

2008-01-01

This study investigated the effect of a simple visual prompt in the form of a poster on the occurrence of patient-physician weight loss conversations during routine office encounters in a primary care outpatient clinic. We conducted a 2-phase study in a family medicine residency program outpatient clinic in August and September 2006. During the first phase, lasting 5 days, we surveyed all nonpregnant adult patients (preintervention group) about weight loss. We then implemented a visual prompt in the form of a colorful poster (11 x 17 inches) in both English and Spanish. The poster read "Do you want to lose weight? Ask your doctor today!" and included a picture of a bathroom scale. During the second phase, also lasting 5 days, we again surveyed all nonpregnant adult patients (postintervention group). Analyses were based on 283 patients in the preintervention group and 386 patients in the postintervention group. The mean body mass index, obtained from medical records, did not differ significantly between groups (31 vs 32 kg/m2, respectively). Fully 60% of patients in the postintervention group recalled seeing the poster during their visit; however, the percentage of patients who reported discussing weight loss with their physician did not differ between the preintervention and postintervention groups overall (29% vs 27%), among the two-thirds of patients who wanted to lose weight (26% vs 23%), or when only postintervention patients who saw the poster were included in the comparison (29% vs 29%). The large majority of patients in both groups who had such discussions--82% and 77%--indicated that they found them useful; the difference between groups was not significant. A simple visual prompt in the form of a poster directed at patients did not increase the occurrence of conversations between patients and their physicians about weight loss.

Management Training for Directors.

ERIC Educational Resources Information Center

Yaptinchay, Karen

1998-01-01

Describes a management program for Head Start directors called the Head Start-Johnson & Johnson Management Fellows program that focuses on issues and problems encountered by directors in implementing and operating programs at the local level. Notes that the management program represents a response to increasing need for cost-effective and…

Parents' Perceptions of the First-Year Implementation of a One-to-One Laptop Initiative in a Midwestern High School

ERIC Educational Resources Information Center

Jin, Yi; Schmidt-Crawford, Denise A.

2017-01-01

With the widespread use and implementation of technology into PK-20 education, one-to-one laptop programs are becoming popular approaches and have been implemented all over the world in PK-20 classrooms. With the enthusiastic implementation of this kind of program, educators and researchers have started to pay attention to evaluating their…

[Ten years of the WHO Framework Convention on Tobacco Control: progress in the Americas].

PubMed

Blanco, Adriana; Sandoval, Rosa Carolina; Martínez-López, Leticia; Caixeta, Roberta de Betânia

2017-01-01

The objective of this article is to analyze the progress made in the Americas in the implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC) after its tenth anniversary of entry into force. At the time of the analysis, 30 of the 35 countries of the Americas are Parties to the FCTC. While progress has been made in implementing the measures contained in the FCTC, the level of implementation has not been homogeneous either across mandates or across countries. Forty percent of Parties to the Convention in the Americas are yet to implement any of the measures at their highest level of implementation according to the WHO classification. It is crucial that the countries of the Americas continue to progress towards the full implementation of the FCTC progressively. In these efforts, it is important to take into account that FCTC measures such as those related to smoke-free environments and adoption of effective health warnings are basic public health measures, which are almost entirely within the competence of health authorities and therefore susceptible to be implemented in a prompt fashion in all countries of the region.

Protecting the Health and Safety of Cell and Tissue Donors.

PubMed

Stroncek, David F; England, Lee

2015-04-01

Centers involved with collecting the starting material for cell and tissue therapies are obligated to protect the recipient's and donor's health and safety. All donors face risks during and after the collection which can be minimized by prescreening donors and excluding those that the collection would place at increased risk of physical harm. Another important part of protecting donors is the use of appropriate collection facilities. Donor risk can also be reduced by using specially designed collection devices and ancillary equipment, using only trained collection staff and limiting the volume or quantity of biologic material collected. Donors should be monitored during and after the collection for adverse events, and should adverse events occur, they should be promptly and appropriately treated. Protecting the safety of cell, gene and tissue donors is particularly difficult because of the wide variety in the types of donors and material collected. Biological material used to manufacture cell and tissue therapies is collected from healthy volunteers, matched-related, matched-unrelated and autologous donors. Precautions should be taken to ensure that the team of medical professionals evaluating related donors is not the same as the team caring for the transplant recipient in order to be sure that the donor evaluation is not biased and the donor is not coerced into donating. In conclusion, protecting cell and tissue donors requires the use of the practices developed to protect blood donors and the implementation of many other measures.

Protecting the Health and Safety of Cell and Tissue Donors

PubMed Central

Stroncek, David F.; England, Lee

2014-01-01

Centers involved with collecting the starting material for cell and tissue therapies are obligated to protect the recipient’s and donor’s health and safety. All donors face risks during and after the collection which can be minimized by prescreening donors and excluding those that the collection would place at increased risk of physical harm. Another important part of protecting donors is the use of appropriate collection facilities. Donor risk can also be reduced by using specially designed collection devices and ancillary equipment, using only trained collection staff and limiting the volume or quantity of biologic material collected. Donors should be monitored during and after the collection for adverse events, and should adverse events occur, they should be promptly and appropriately treated. Protecting the safety of cell, gene and tissue donors is particularly difficult because of the wide variety in the types of donors and material collected. Biological material used to manufacture cell and tissue therapies is collected from healthy volunteers, matched-related, matched-unrelated and autologous donors. Precautions should be taken to ensure that the team of medical professionals evaluating related donors is not the same as the team caring for the transplant recipient in order to be sure that the donor evaluation is not biased and the donor is not coerced into donating. In conclusion, protecting cell and tissue donors requires the use of the practices developed to protect blood donors and the implementation of many other measures. PMID:25937830

A method to improve the nutritional quality of foods and beverages based on dietary recommendations.

PubMed

Nijman, C A J; Zijp, I M; Sierksma, A; Roodenburg, A J C; Leenen, R; van den Kerkhoff, C; Weststrate, J A; Meijer, G W

2007-04-01

The increasing consumer interest in health prompted Unilever to develop a globally applicable method (Nutrition Score) to evaluate and improve the nutritional composition of its foods and beverages portfolio. Based on (inter)national dietary recommendations, generic benchmarks were developed to evaluate foods and beverages on their content of trans fatty acids, saturated fatty acids, sodium and sugars. High intakes of these key nutrients are associated with undesirable health effects. In principle, the developed generic benchmarks can be applied globally for any food and beverage product. Product category-specific benchmarks were developed when it was not feasible to meet generic benchmarks because of technological and/or taste factors. The whole Unilever global foods and beverages portfolio has been evaluated and actions have been taken to improve the nutritional quality. The advantages of this method over other initiatives to assess the nutritional quality of foods are that it is based on the latest nutritional scientific insights and its global applicability. The Nutrition Score is the first simple, transparent and straightforward method that can be applied globally and across all food and beverage categories to evaluate the nutritional composition. It can help food manufacturers to improve the nutritional value of their products. In addition, the Nutrition Score can be a starting point for a powerful health indicator front-of-pack. This can have a significant positive impact on public health, especially when implemented by all food manufacturers.

Future aeromedical assessment in general aviation: a contribution to the actual discussion

PubMed Central

Siedenburg, J

2008-01-01

The past years saw a transition of competencies from the Joint Aviation Authorities (JAA) to the European Aviation Safety Agency (EASA), which was founded in 2003, based on EU Regulation 1592/02. EASA started its work in the fields of Airworthiness and will soon its competencies inter alia to Flight Operations and Flight Crew Licensing, the latter including the requirements for aeromedical assessment. The appropriate new EU Regulation will most probably be published in April. It includes the Essential Requirements for Licensing and aeromedical certification. A proposal for a new Commission Regulation promulgates the Implementing Rules for Personnel Licensing, detailing – inter alia – the Medical Requirements (Annex II to the Regulation). The specific rules, numeric standards are published as Acceptable Means of Compliance (AMC) and Guidance Material (GM). The provisions are based on JAR-FCL 3 and have been transposed to the format choosen by EASA by a small working group of aeromedical experts (FCL.001). Comments received by the European Aviation Safety Agency (EASA) prompted the agencys statement that the JAR-FCL 3 requirements for private pilots were excessive and too demanding and that a better regulation in General Aviation had to be developed. Another working group (MDM.032), including one aeromedical specialist, was tasked to draft a set of lighter requirements for non-complex aircraft used in non-commercial operations. In this context a much lighter form of aeromedical assessment - involving self-declaration by the pilot and general practitioners as asessors – has been proposed. PMID:19048096

Post-disaster health effects: strategies for investigation and data collection. Experiences from the Enschede firework disaster.

PubMed

Roorda, J; van Stiphout, W A H J; Huijsman-Rubingh, R R R

2004-12-01

Public health policy is increasingly concerned with the care for victims of a disaster. This article describes the design and implementation of an epidemiological study, which seeks to match care services to the specific problems of persons affected by a large scale incident. The study was prompted by the explosion of a firework depot in Enschede, the Netherlands. All those directly affected by this incident (residents, emergency services personnel, and people who happened to be in the area at the time), some of whom suffered personal loss or injury. The project investigates both the physical and psychological effects of the disaster, as well as the target group's subsequent call on healthcare services. A questionnaire based follow up survey of those directly affected and an ongoing monitoring of health problems relying on reports from healthcare professionals. The follow up survey started three weeks after the incident and was repeated 18 months and almost four years after the incident. The monitoring is conducted over a four year period by general practitioners, the local mental health services department, occupational health services, and the youth healthcare services department. It provides ongoing information. The results of the study are regularly discussed with healthcare professionals and policy makers, and are made known to the research participants. The paper also explains the considerations that were made in designing the study to help others making up their research plans when confronted with possible health effects of a disaster.

Comparing the Effects of Echoic Prompts and Echoic Prompts Plus Modeled Prompts on Intraverbal Behavior

ERIC Educational Resources Information Center

Valentino, Amber L.; Shillingsburg, M. Alice; Call, Nathan A.

2012-01-01

We compared strategies to teach vocal intraverbal responses to an adolescent diagnosed with autism and Down syndrome. One strategy involved echoic prompts only. The second strategy involved an echoic prompt paired with a modeled prompt in the form of sign language. Presenting the modeled prompt with the echoic prompt resulted in faster acquisition…

Intermediate Outcomes, Strategies, and Challenges of Eight Healthy Start Projects

PubMed Central

Walker, Deborah Klein; Hargreaves, Margaret; Rosenbach, Margo

2008-01-01

Site visits were conducted for the evaluation of the national Healthy Start program to gain an understanding of how projects design and implement five service components (outreach, case management, health education, depression screening and interconceptional care) and four system components (consortium, coordination/collaboration, local health system action plan and sustainability) as well as program staff’s perceptions of these components’ influence on intermediate outcomes. Interviews with project directors, case managers, local evaluators, clinicians, consortium members, outreach/lay workers and other stakeholders were conducted during 3-day in-depth site visits with eight Healthy Start grantees. Grantees reported that both services and systems components were related to self-reported service achievements (e.g. earlier entry into prenatal care) and systems achievements (e.g. consumer involvement). Outreach, case management, and health education were perceived as the service components that contributed most to their achievements while consortia was perceived as the most influential systems component in reaching their goals. Furthermore, cultural competence and community voice were overarching project components that addressed racial/ethnic disparities. Finally, there was great variability across sites regarding the challenges they faced, with poor service availability and limited funding the two most frequently reported. Service provision and systems development are both critical for successful Healthy Start projects to achieve intermediate program outcomes. Unique contextual and community issues influence Healthy Start project design, implementation and reported accomplishments. All eight projects implement the required program components yet outreach, case management, and health education are cited most frequently for contributing to their perceived achievements. PMID:19011959

Electronic Health Records: DOD and VA Should Remove Barriers and Improve Efforts to Meet Their Common System Needs

DTIC Science & Technology

2011-02-01

and develop joint information technology (IT) capabilities for the James A. Lovell Federal Health Care Center ( FHCC ). In light of these efforts...Center to form the James A. Lovell Federal Health Care Center ( FHCC ) has prompted the departments to work toward implementing electronic health...information needs for the FHCC . To do this, GAO analyzed departmental reviews and other documentation and interviewed DOD and VA officials. What

Implementing an Intrusion Detection System in the Mysea Architecture

DTIC Science & Technology

2008-06-01

password for each user passwd <username> then follow the prompts 2. PostgreSQL 7.4.18 Installation Perform the following steps as root: 1. Copy...password changed Repeat for user snort. exit After making the groups and users the group and passwd file needs to be updated. Set security and...untrusted/bin/xtsmkgroup > /etc/group chmod 644 /etc/group /xts/untrusted/bin/xtsmkpasswd > /etc/ passwd chmod 644 /etc/ passwd 3. PostgreSQL 7.4.18

The Major Causes of Cost Growth in Defense Acquisition, Volume II: Main Body

DTIC Science & Technology

2009-12-01

confidence, it presents prima facie evidence not only of weaknesses in management oversight, including lax implementation of policies, but also in...responsibility to prepare independent estimates, and prompted a substantial increase in its staff.22 In the mid 1990s, OSD adopted the commercial business ...law, the authority to obligate funds for the program lapses if no certification is provided. In the case of one of the programs we studied, the Armed

Implementation of the Agitated Behavior Scale in the Electronic Health Record.

PubMed

Wilson, Helen John; Dasgupta, Kritis; Michael, Kathleen

The purpose of the study was to implement an Agitated Behavior Scale through an electronic health record and to evaluate the usability of the scale in a brain injury unit at a rehabilitation hospital. A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants using convenience sampling. The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale. The Agitated Behavior Scale was found to be usable, and there was 92.2% compliance with the use of the electronic Electronic Agitated Behavior Scale. The Agitated Behavior Scale was effectively implemented in the electronic health record and was found to be usable in the assessment of agitation. Utilization of the scale through the electronic health record on a daily basis will allow for an early identification of agitation in patients with traumatic brain injury and enable prompt interventions to manage agitation.

Effects of written action plan adherence on COPD exacerbation recovery.

PubMed

Bischoff, Erik W M A; Hamd, Dina H; Sedeno, Maria; Benedetti, Andrea; Schermer, Tjard R J; Bernard, Sarah; Maltais, François; Bourbeau, Jean

2011-01-01

The effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence. This was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan. From the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (-5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV(1) as percentage predicted. This study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.

Modes of Ignition of Powder Layers of Nanocomposite Thermites by Electrostatic Discharge

NASA Astrophysics Data System (ADS)

Monk, I.; Schoenitz, M.; Dreizin, E. L.

2017-01-01

Nanocomposite powders with aluminum as a fuel and oxides of molybdenum, copper, bismuth, and iron as oxidizers were prepared by arrested reactive milling. The powders were placed in 0.5-mm-thick layers and ignited by electrostatic discharge (ESD) in air. In different tests, time-resolved light emission was recorded at 568 nm or in the range of 373-641 nm. The amount of material consumed was recorded as well. Time-resolved temperatures were determined. Two distinct ignition regimes were observed. Prompt ignition occurred within 10 µs of the electric discharge, comparable to what had previously been observed for corresponding powder monolayers. This ignition mode was observed for composites with Bi2O3 and Fe2O3 ignited with a 12-kV discharge, whereas it only occurred at higher spark voltage (20 kV) and energy for CuO and MoO3 composites. Delayed ignition, occurring after 0.1-1 ms following the discharge, was observed for all composites with consistently stronger light emission. Analysis of quenched, partially burned particles showed that the original nanostructure was preserved after prompt ignition but not after delayed ignition. It is proposed that prompt ignition represents direct ESD initiation of composite particles rapidly and adiabatically preheated to high temperatures while keeping the nanostructure intact, resulting in a heterogeneous reaction consuming most of the aluminum. Delayed ignition occurs when particles preheated to lower temperatures start oxidizing at much lower rates, leading to cloud combustion, in which thermal interaction between individual aerosolized burning particles is substantial. During this process, the nanostructure may be lost. Temperature measurements show that nanocomposites with CuO and MoO3 burned superadiabatically with flame temperatures exceeding thermodynamic predictions.

Implementation Quality: Lessons Learned in the Context of the Head Start REDI Trial

ERIC Educational Resources Information Center

Domitrovich, Celene E.; Gest, Scott D.; Jones, Damon; Gill, Sukhdeep; Sanford DeRousie, Rebecca M.

2010-01-01

This study uses data collected in the intervention classrooms (N = 22) of Head Start REDI (Research-based, Developmentally Informed), a randomized clinical trial testing the efficacy of a comprehensive preschool curriculum targeting children's social-emotional competence, language, and emergent literacy skills delivered by teachers who received…

Rigor Made Easy: Getting Started

ERIC Educational Resources Information Center

Blackburn, Barbara R.

2012-01-01

Bestselling author and noted rigor expert Barbara Blackburn shares the secrets to getting started, maintaining momentum, and reaching your goals. Learn what rigor looks like in the classroom, understand what it means for your students, and get the keys to successful implementation. Learn how to use rigor to raise expectations, provide appropriate…

Home-Start between Childhood and Maturity: A Programme Evaluation.

ERIC Educational Resources Information Center

Terpstra, Linda; van Dijke, Anke

A crucial question for evaluating nationally or internationally implemented programs is whether local adaptations detract from program quality and effectiveness. An evaluation examined the program successes and challenges encountered in the first 5 years of Home-Start in the Netherlands, a home-based family support program for families with young…

Helping Anxious Students Move Forward

ERIC Educational Resources Information Center

Minahan, Jessica

2018-01-01

Students with anxiety are prone to giving up a difficult work assignment before they even start it. So how can teachers help these students develop skills to successfully start and finish assignments and succeed in school? Behavioral analyst Jessica Minahan offers some practical solutions that teachers can implement in the classroom to motivate…

Impact of prospective verification of intravenous antibiotics in an ED.

PubMed

Hunt, Allyson; Nakajima, Steven; Hall Zimmerman, Lisa; Patel, Manav

2016-12-01

Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED. This retrospective, institutional review board-approved preimplementation vs postimplementation study evaluated patients 18years or older who were started on IV antibiotics in the ED. Patients were excluded if pregnant, if the patient is a prisoner, if no cultures were drawn, or if the patient was transferred from an outside facility. Appropriate antibiotic therapy was based on empiric source-specific evidence-based guidelines, appropriate pharmacokinetic and pharmacodynamic properties, and microbiologic data. The primary end point was the time from ED arrival to administration of appropriate antibiotic therapy. Of the 1628 evaluated, 128 patients met the inclusion criteria (64 pre vs 64 post). Patients were aged 65.2±17.0years, with most of infections being pneumonia (44%) and urinary tract infections (18%) and most patients being noncritically ill. Time to appropriate antibiotic therapy was reduced in the postgroup vs pregroup (8.1±8.6 vs 15.2±22.8hours, respectively, P=.03). In addition, appropriate empiric antibiotics were initiated more frequently after the implementation (92% post vs 66% pre; P=.0001). There was no difference in mortality or length of stay between the 2 groups. Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of antibiotics by pharmacists led to significant improvement on both empiric selection of and time to appropriate antibiotic therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Estimating energy intensity and CO{sub 2} emission reduction potentials in the manufacturing sectors in Thailand

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

Wangskarn, P.; Khummongkol, P.; Schrattenholzer, L.

The final energy consumption in Thailand increased at about ten percent annually within the last 10 years. To slow the energy demand growth rate while maintaining the country`s economic advance and environmental sustainability, the Energy Conservation Promotion Act (ECPA) was adopted in 1992. With this Act, a comprehensive Energy Conservation Program (ENCON) was initiated. ENCON commits the government to promoting energy conservation, to developing appropriate regulations, and to providing financial and organizational resources for program implementation. Due to this existing ENCON program a great benefit is expected not only to reducing energy consumption, but also to decreasing GHGs emissions substantially.more » This study is a part of the ENCON research program which was supported by the German Federal Government under the program called Prompt-Start Measures to Implement the U.N. Framework Convention on Climate Change (FCCC). The basic activities carried out during the project included (1) An assessment of Thailand`s total and specific energy consumption in the industrial sectors and commercial buildings; (2) Identification of existing and candidate technologies for GHG emission reduction and energy efficiency improvements in specific factories and commercial buildings; and (3) Identification of individual factories and commercial buildings as candidates for detailed further study. Although the energy assessment had been carried out for the commercial buildings also, this paper will cover only the work on the manufacturing sector. On the basis of these steps, 14 factories were visited by the project team and preliminary energy audits were performed. As a result, concrete measures and investments were proposed and classified into two groups according to their economic characteristics. Those investments with a payback time of less than four years were considered together in a Moderate scenario, and those with longer payback times in an Intensive scenario.« less

Implementation of automated external defibrillators on merchant ships.

PubMed

Oldenburg, Marcus; Baur, Xaver; Schlaich, Clara

2011-01-01

In contrast to cruise ships, ferries and merchant ships are rarely equipped with automated external defibrillators (AEDs). Germany is the first flag state worldwide that legally requires to carry AEDs on seagoing merchant vessels by September 2012 at the latest. The aim of this study was to investigate the effect of training ship officers in the handling of AEDs and to explore their perceptions concerning the user-friendliness of currently available defibrillators. Using four different AEDs, 130 nautical officers performed a total of 400 resuscitation drills. One group (n = 60) used only one device before and after resuscitation training; the other group (n = 70) used all four AEDs in comparison after training. The officers' performances were timed and they were asked by questionnaire about the user-friendliness of each AED. Without resuscitation training, 81.7% of the first mentioned group delivered an effective defibrillation shock. After a 7-hour resuscitation training with special regard to defibrillation, all ship officers (n = 130) used the AED correctly. Among all AEDs, the mean time until start of analysis decreased from 72.4 seconds before to 60.4 seconds after resuscitation training (Wilcoxon test; p < 0.001). The results of the questionnaire and the differences in time to first shock indicated a different user-friendliness of the AEDs. The voice prompts and the screen messages of all AEDs were well understood by all participants. In the second mentioned group, 57.1% regarded feedback information related to depths and frequency of thorax compression as helpful. Nautical officers are able to use AEDs in a timely and effective way with proper training. However, to take advantage of all wanted features of the device (monitoring and resuscitation), the ship management has to observe practical questions of storage, maintenance, signing, training, data management, and transmission. Thus, implementation of the regulations requires proper instructions for the maritime industry by responsible bodies. © 2011 International Society of Travel Medicine.

One network metric datastore to track them all: the OSG network metric service

NASA Astrophysics Data System (ADS)

Quick, Robert; Babik, Marian; Fajardo, Edgar M.; Gross, Kyle; Hayashi, Soichi; Krenz, Marina; Lee, Thomas; McKee, Shawn; Pipes, Christopher; Teige, Scott

2017-10-01

The Open Science Grid (OSG) relies upon the network as a critical part of the distributed infrastructures it enables. In 2012, OSG added a new focus area in networking with a goal of becoming the primary source of network information for its members and collaborators. This includes gathering, organizing, and providing network metrics to guarantee effective network usage and prompt detection and resolution of any network issues, including connection failures, congestion, and traffic routing. In September of 2015, this service was deployed into the OSG production environment. We will report on the creation, implementation, testing, and deployment of the OSG Networking Service. Starting from organizing the deployment of perfSONAR toolkits within OSG and its partners, to the challenges of orchestrating regular testing between sites, to reliably gathering the resulting network metrics and making them available for users, virtual organizations, and higher level services, all aspects of implementation will be reviewed. In particular, several higher-level services were developed to bring the OSG network service to its full potential. These include a web-based mesh configuration system, which allows central scheduling and management of all the network tests performed by the instances; a set of probes to continually gather metrics from the remote instances and publish it to different sources; a central network datastore (esmond), which provides interfaces to access the network monitoring information in close to real time and historically (up to a year) giving the state of the tests; and a perfSONAR infrastructure monitor system, ensuring the current perfSONAR instances are correctly configured and operating as intended. We will also describe the challenges we encountered in ongoing operations of the network service and how we have evolved our procedures to address those challenges. Finally we will describe our plans for future extensions and improvements to the service.

A Story Approach to Create Online College Courses

ERIC Educational Resources Information Center

Romero, Liz

2016-01-01

The purpose of this article is to describe the implementation of a story approach to create online courses in a college environment. The article describes the components of the approach and the implementation process to create a nursing and a language course. The implementation starts with the identification of the need and follows by creating a…

Overview of the SVOM Gamma-Ray Burst mission under development with a focus on its Trigger system

NASA Astrophysics Data System (ADS)

Schanne, Stephane

2017-08-01

The SVOM mission (Space-based Variable Objects Monitor) is a Chinese-French satellite mission under development, devoted to collecting a complete sample of Gamma-Ray Bursts (GRBs) observed at multi-wavelengths with a high fraction of redshift determinations. In January 2017 the mission entered Phase C, starting officially construction, and the launch is foreseen in 2021. The SVOM satellite is equipped with 4 instruments, 2 of which cover the prompt GRB phase. The ECLAIRs coded-mask imager surveys a 2-sr large portion of the sky in the 4-150 keV energy range, well suited for the detection of X-ray rich and highly redshifted GRBs. The ECLAIRs trigger system continuously searches for GRBs using two algorithms, a count-rate trigger for short time scales and an image trigger for long time scales. In case of a localized new GRB candidate or a bright outburst of a known source, it promptly requests a satellite slew and sends an alert to ground. The onboard GRM (Gamma-Ray Monitor) extends the prompt energy coverage up to 5 MeV. After slew, 2 more onboard instruments study the GRB afterglow and refine the GRB localization: the MXT (Multi-pore optics X-ray Telescope) and the VT (Visible Telescope). Two types of ground telescopes are dedicated to SVOM. The GFTs (Ground Follow-up Telescopes) repoint autonomously to GRB alerts, refine their localization and provide photometric redshift. The SVOM observing strategy with roughly antisolar pointing combined with Galactic plane avoidance, ensures that most GRBs are quickly visible by the GFTs and large spectroscopic telescopes. The GWAC (Ground Wide Angle Camera) will observe the sky simultaneously with ECLAIRs to detect prompt optical GRB emissions. Today part of the GWAC is already operational. The SVOM GRB program is complemented by pre-planned target observations and ground-commanded targets of opportunity, e.g. to search for electromagnetic counterparts of gravity-wave events. On behalf of the SVOM and ECLAIRs teams, this paper presents an overview of SVOM with a focus on its GRB trigger system.

[Myxedema coma. A case reported].

PubMed

Rebollo-Gómez, Héctor

2010-01-01

Myxedema coma is a life-threatening condition; it is a complication of untreated hypothyroidism and an endocrine emergency. Most patients are elderly women with a previous history of long-standing hypothyroidism which presents during the winter. The myxedema coma has an insidious onset and it is very rare; its recognition can be quite difficult. Once suspected, treatment can be lifesaving and should be start promptly in anticipation of confirmation of the diagnosis by laboratory test. The mortality rate is high. I presented a case of an old woman with myxedema coma with an undiagnosed hypothyroidism, with altered mental status, normal temperature, pneumonia, hyponatremia and high level of creatine phosphokinase, who presented in the emergency room.

[Large vessels vasculopathy in systemic sclerosis].

PubMed

Tejera Segura, Beatriz; Ferraz-Amaro, Iván

2015-12-07

Vasculopathy in systemic sclerosis is a severe, in many cases irreversible, manifestation that can lead to amputation. While the classical clinical manifestations of the disease have to do with the involvement of microcirculation, proximal vessels of upper and lower limbs can also be affected. This involvement of large vessels may be related to systemic sclerosis, vasculitis or atherosclerotic, and the differential diagnosis is not easy. To conduct a proper and early diagnosis, it is essential to start prompt appropriate treatment. In this review, we examine the involvement of large vessels in scleroderma, an understudied manifestation with important prognostic and therapeutic implications. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Classification System and Information Services in the Library of SAO RAS

NASA Astrophysics Data System (ADS)

Shvedova, G. S.

The classification system used at SAO RAS is described. It includes both special determinants from UDC (Universal Decimal Classification) and newer tables with astronomical terms from the Library-Bibliographical Classification (LBC). The classification tables are continually modified, and new astronomical terms are introduced. At the present time the information services of the scientists is fulfilled with the help of the Abstract Journal Astronomy, Astronomy and Astrophysics Abstracts, catalogues and card indexes of the library. Based on our classification system and The Astronomy Thesaurus completed by R.M. Shobbrook and R.R. Shobbrook the development of a database for the library has been started, which allows prompt service of the observatory's staff members.

Chemical synthesis of 2',5'-oligoribonucleotides.

PubMed

Hirao, I; Nishino, S; Kamaike, K; Nishiyama, S; Ueda, S; Yamamoto, H; Ishido, Y

1983-01-01

Partial phenylcarbamoylation of ribonucleosides by metal carboxylates - phenyl isocyanate system was found to be induced at 2'-position with high regioselectivity in good yields, similar to that by amines - phenyl isocyanate system; these results prompted us to perform synthesis of oligoribonucleotides bearing 2'-5' phosphodiester linkage starting either from 5'-0-acetyl-2'-0-phenylcarbamoyl or from 2', 5'-bis(phenylcarbamo)yl derivatives through the sequence of reactions, i.e. tetrahydropyranylation at 3'-position, decarbamoylation and deacylation with sodium methoxide in methanol both at 2'- and 5'-positions, dimethoxytritylation at 5'-position, and phosphorylation at 2'-position with 5-chloro-8-quinolylphosphate/8-quinolinesulfonyl chloride, followed by the usual coupling procedures by Takaku et al).

One-pot synthesis of 2,5-dihydropyrroles from terminal alkynes, azides, and propargylic alcohols by relay actions of copper, rhodium, and gold.

PubMed

Miura, Tomoya; Tanaka, Takamasa; Matsumoto, Kohei; Murakami, Masahiro

2014-12-01

Relay actions of copper, rhodium, and gold formulate a one-pot multistep pathway, which directly gives 2,5-dihydropyrroles starting from terminal alkynes, sulfonyl azides, and propargylic alcohols. Initially, copper-catalyzed 1,3-dipolar cycloaddition of terminal alkynes with sulfonyl azides affords 1-sulfonyl-1,2,3-triazoles, which then react with propargylic alcohols under the catalysis of rhodium. The resulting alkenyl propargyl ethers subsequently undergo the thermal Claisen rearrangement to give α-allenyl-α-amino ketones. Finally, a gold catalyst prompts 5-endo cyclization to produce 2,5-dihydropyrroles. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Luminescent Organometallic Nanomaterials with Aggregation-Induced Emission.

PubMed

Shu, Tong; Wang, Jianxing; Su, Lei; Zhang, Xueji

2018-07-04

Recent researches in metal nanoclusters (NCs) have prompted their promising practical applications in biomedical fields as novel inorganic luminophores. More recently, to further improve the photoluminescence (PL) performance of NCs, the aggregation-induced emission (AIE) effect has been introduced to develop highly luminescent metal NCs and metal complex materials. In this review, we start our discussion from recent progresses on AIE materials developments. Then, we address our understandings on the PL properties of thiolated metal NCs. Subsequently, we link thiolated metal NCs with AIE effect. We also highlight some recent advances in synthesizing the AIE-type metal complex nanomaterials. We finally discuss visions and directions for future development of AIE-type metal complex nanomaterials.

Salicylaldehydes as privileged synthons in multicomponent reactions

NASA Astrophysics Data System (ADS)

Momahed Heravi, M.; Zadsirjan, V.; Mollaiye, M.; Heydari, M.; Taheri Kal Koshvandi, A.

2018-06-01

Salicylaldehyde (2-hydroxybenzaldehyde) bearing two different active functional groups, namely, a hydroxy group and an aldehyde group, finds wide application as a key chemical in a variety of industrial processes, especially in the large-scale production of pharmaceuticals. Salicylaldehyde and most of its derivatives are commercially available or readily accessible, and hence are ideal starting materials for multicomponent reactions (MCRs), mostly in pseudo-three and four-component ones, giving rise to a plethora of heterocyclic systems. The importance of salicylaldehyde and an impressive amount of studies concerning its applications in MCRs prompted us to highlight in this review the important role of this compound as a privileged synthon in the synthesis of heterocycles. The bibliography includes 276 references.

Reductions in invasive device use and care costs after institution of a daily safety checklist in a pediatric critical care unit.

PubMed

Tarrago, Rod; Nowak, Jeffrey E; Leonard, Christopher S; Payne, Nathaniel R

2014-06-01

In the critical care unit, complexity of care can contribute to both medical errors and increased costs, particularly when clinicians are forced to rely on memory. Checklists can be used to improve safety and reduce cost. A number of omission-related adverse events in 2010 prompted the development of a checklist to reduce the possibility of similar future events. The PICU Safety Checklist was implemented in the pediatric ICU (PICU) at Children's Hospitals and Clinics of Minnesota. During a 21-month period, the checklist was used to prompt the care team to address quality and safety items during rounds. The initial checklist was paper, with two subsequent versions being incorporated into the electronic medical record (EMR). The daily safety checklist was successfully implemented in the PICU. Work-flow improvements based on regular multidisciplinary feedback led to more consistent use of the checklist. Improvements on all quality and safety metrics were identified, including invasive device use, medication costs, antibiotic and laboratory test use, and compliance with standards of care. Staff satisfaction rates were > 80% for safety, communication, and collaboration. By using a daily safety checklist in the pediatric critical care unit, we improved quality and safety, as well as the collaborative culture among all clinicians. Incorporating the checklist into the EMR improved compliance and accountability, ensuring its application to all patients. Clinicians now often individually address many checklist items outside the formal rounding process, indicating that the checklist content has become part of their usual practice. A successful implementation showing tangible clinical improvements can lead to interest and adoption in other clinical areas within the institution.

Assessing Emotional Suffering in Palliative Care: Use of a Structured Note Template to Improve Documentation.

PubMed

Lamba, Sangeeta; Berlin, Ana; Goett, Rebecca; Ponce, Christopher B; Holland, Bart; Walther, Susanne

2016-07-01

Documentation of the emotional or psychological needs of seriously ill patients receiving specialty palliative care is endorsed by the "Measuring What Matters" project as a quality performance metric and recommended for use by hospice and palliative care programs for program improvement. The aim of this study was to increase the proportion of inpatient palliative care team encounters in which emotional or psychological needs of patients and family members were documented and to qualitatively enrich the nature of this documentation. This is a mixed-methods retrospective study of 200 patient charts reviewed before and after implementation of a structured note template (SmartPhrase) for palliative care encounters. Patterns of documentation of emotional needs pre- and post-implementation were assessed quantitatively and qualitatively using thematic analysis. A total of 158 of 200 pre-intervention charts and 185 of 200 post-intervention charts included at least one note from the palliative care team. Documentation of emotional assessment increased after SmartPhrase implementation (63.9% [101 of 158] vs. 74.6% [138 of 185]; P < 0.03). Qualitative analysis revealed a post-intervention reduction in the use of generic phrases ("emotional support provided") and an increase in the breadth and depth of emotion-related documentation. A structured note template with a prompt for emotional assessment increases the overall quantity and richness of documentation related to patient and family emotions. However, this documentation remains mostly descriptive. Additional prompting for documentation of recommendations to address identified emotional needs, and the use of screening tools for depression and anxiety, when appropriate, may be necessary for clinically meaningful quality improvements in patient care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program

PubMed Central

Jones, Stephen L.; Ashton, Carol M.; Kiehne, Lisa; Gigliotti, Elizabeth; Bell-Gordon, Charyl; Disbot, Maureen; Masud, Faisal; Shirkey, Beverly A.; Wray, Nelda P.

2016-01-01

Background Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it. Methods The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008–2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program. Results By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006–2008) to 21.1% after implementation (2009–2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care. Conclusion This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way. PMID:26484679

Deregulation of sale of over-the-counter drugs outside of pharmacies in the Republic of Korea: interrupted-time-series analysis of outpatient visits before and after the policy.

PubMed

Chun, Sung-Youn; Park, Hye-Ki; Han, Kyu-Tae; Kim, Woorim; Lee, Hyo-Jung; Park, Eun-Cheol

2017-07-12

We evaluated the effectiveness of a policy allowing for the sale of over-the-counter drugs outside of pharmacies by examining its effect on number of monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. We used medical claims data extracted from the Korean National Health Insurance Cohort Database from 2009 to 2013. The Korean National Health Insurance Cohort Database comprises a nationally representative sample of claims - about 2% of the entire population - obtained from the medical record data held by the Korean National Health Insurance Corporation (which has data on the entire nation). The analysis included26,284,706 person-months of 1,042,728 individuals. An interrupted-time series analysis was performed. Outcome measures were monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. To investigate the effect of the policy, we compared the number of monthly visits before and after the policy's implementation in 2012. For acute upper respiratory infections, monthly outpatient visits showed a decreasing trend before the policy (ß = -0.0003);after it, a prompt change and increasing trend in monthly outpatient visits were observed, but these were non-significant. For dyspepsia, the trend was increasing before implementation (ß = -0.0101), but this reversed after implementation(ß = -0.007). For migraine, an increasing trend was observed before the policy (ß = 0.0057). After it, we observed a significant prompt change (ß = -0.0314) but no significant trend. Deregulation of selling over-the-counter medication outside of pharmacies reduced monthly outpatient visits for dyspepsia and migraine symptoms, but not acute upper respiratory infections.

Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives

PubMed Central

2014-01-01

Background Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines possible factors that influence each domain, according to providers’ perspectives. Methods A retrospective, cross-sectional survey was done between August and December 2010 in Kaduna state, and 466 health care provider personnel were interviewed. Optimal-resource-use was defined in four domains: provider payment mechanism (capitation and fee-for-service payment methods), benefit package, administrative efficiency, and active monitoring mechanism. Logistic regression analysis was used to identify provider factors that may influence each domain. Results In the provider payment mechanism domain, capitation payment method (95%) performed better than fee-for-service payment method (62%). Benefit package domain performed strongly (97%), while active monitoring mechanism performed weakly (37%). In the administrative efficiency domain, both promptness of referral system (80%) and prompt arrival of funds (93%) performed well. At the individual level, providers with fewer enrolees encountered difficulties with reimbursement. Other factors significantly influenced each of the optimal-resource-use domains. Conclusions Fee-for-service payment method and claims review, in the provider payment and active monitoring mechanisms, respectively, performed weakly according to the providers’ (at individual-level) perspectives. A short-fall on the supply-side of health insurance could lead to a direct or indirect adverse effect on the demand-side of the scheme. Capitation payment per enrolees should be revised to conform to economic circumstances. Performance indicators and providers’ characteristics and experiences associated with resource use can assist policy makers to monitor and evaluate health insurance implementation. PMID:24628889

Recommendations for Clinical Decision Support Deployment: Synthesis of a Roundtable of Medical Directors of Information Systems

PubMed Central

Jenders, Robert A.; Osheroff, Jerome A.; Sittig, Dean F.; Pifer, Eric A.; Teich, Jonathan M

2007-01-01

Background: Ample evidence exists that clinical decision support (CDS) can improve clinician performance. Nevertheless, additional evidence demonstrates that clinicians still do not perform adequately in many instances. This suggests an ongoing need for implementation of CDS, in turn prompting development of a roadmap for national action regarding CDS. Objective: Develop practical advice to aid CDS implementation in order to improve clinician performance. Method: Structured group interview during a roundtable discussion by medical directors of information systems (N = 30), with subsequent review by participants and synthesis. Results: Participant consensus was that CDS should be comprehensive and should involve techniques such as order sets and facilitated documentation as well as alerts; should be subject to ongoing feedback; and should flow from and be governed by an organization’s clinical goals. Conclusion: A structured roundtable discussion of clinicians experienced in health information technology can yield practical, consensus advice for implementation of CDS. PMID:18693858

Implementation of critical care response team.

PubMed

Al Shimemeri, Abdullah

2014-04-01

Analyses of hospital deaths have indicated that a significant proportion of the reported deaths might have been prevented had the patients received intensive level care early enough. Over the past few decades the critical care response team has become an important means of preventing these deaths. As the proactive arm of intensive care delivery, the critical care response team places emphasis on early identification of signs of clinical deterioration, which then prompts the mobilization of intensive care brought right to the patient's bedside. However, the setting up of a critical care response team is a difficult undertaking involving different levels of cooperation between all service stakeholders, and a bringing together of professional expertise and experience in its operations. The implementation of a critical care response team often involves a high-level restructuring of a hospital's service orientation. In the present work, the various factors and different models to be considered in implementing a critical care response team are addressed.

PRESAGE: PRivacy-preserving gEnetic testing via SoftwAre Guard Extension.

PubMed

Chen, Feng; Wang, Chenghong; Dai, Wenrui; Jiang, Xiaoqian; Mohammed, Noman; Al Aziz, Md Momin; Sadat, Md Nazmus; Sahinalp, Cenk; Lauter, Kristin; Wang, Shuang

2017-07-26

Advances in DNA sequencing technologies have prompted a wide range of genomic applications to improve healthcare and facilitate biomedical research. However, privacy and security concerns have emerged as a challenge for utilizing cloud computing to handle sensitive genomic data. We present one of the first implementations of Software Guard Extension (SGX) based securely outsourced genetic testing framework, which leverages multiple cryptographic protocols and minimal perfect hash scheme to enable efficient and secure data storage and computation outsourcing. We compared the performance of the proposed PRESAGE framework with the state-of-the-art homomorphic encryption scheme, as well as the plaintext implementation. The experimental results demonstrated significant performance over the homomorphic encryption methods and a small computational overhead in comparison to plaintext implementation. The proposed PRESAGE provides an alternative solution for secure and efficient genomic data outsourcing in an untrusted cloud by using a hybrid framework that combines secure hardware and multiple crypto protocols.

An evaluation of the effectiveness of PROMPT therapy in improving speech production accuracy in six children with cerebral palsy.

PubMed

Ward, Roslyn; Leitão, Suze; Strauss, Geoff

2014-08-01

This study evaluates perceptual changes in speech production accuracy in six children (3-11 years) with moderate-to-severe speech impairment associated with cerebral palsy before, during, and after participation in a motor-speech intervention program (Prompts for Restructuring Oral Muscular Phonetic Targets). An A1BCA2 single subject research design was implemented. Subsequent to the baseline phase (phase A1), phase B targeted each participant's first intervention priority on the PROMPT motor-speech hierarchy. Phase C then targeted one level higher. Weekly speech probes were administered, containing trained and untrained words at the two levels of intervention, plus an additional level that served as a control goal. The speech probes were analysed for motor-speech-movement-parameters and perceptual accuracy. Analysis of the speech probe data showed all participants recorded a statistically significant change. Between phases A1-B and B-C 6/6 and 4/6 participants, respectively, recorded a statistically significant increase in performance level on the motor speech movement patterns targeted during the training of that intervention. The preliminary data presented in this study make a contribution to providing evidence that supports the use of a treatment approach aligned with dynamic systems theory to improve the motor-speech movement patterns and speech production accuracy in children with cerebral palsy.

The Olympus satellite and satellite direct broadcasting in Italy

NASA Astrophysics Data System (ADS)

Castelli, E.; Tirro, S.

Plans for the development of DBS-TV technology in Italy are discussed from the perspective of the Italian electronics industry, with an emphasis on experimental broadcasts using the Olympus satellite channel assigned to Italy by ESA. Consideration is given to the operating characteristics of PAL, MAC-C, MAC-D2, extended-MAC, and MUSE color-TV systems and their compatibility with DBS; the planned availability of TV channels on Olympus-type and Italsat-type satellites; individual, community, and CATV reception of DBS signals; the projected growth of the DBS audience in Italy, the UK, and the FRG by 1999; and the potential Italian market for satellite receivers and antennas. The need for prompt completion and evaluation of the Olympus experiments and antennas. The need for prompt completion and evaluation of the Olympus experiments (beginning in 1987) and selection of the systems to be implemented, so that the industry can supply the home equipment required on time, is stressed. Tables of numerical data and maps of the Olympus coverage areas are provided.

Evaluation of Swift Start TCP in Long-Delay Environment

NASA Technical Reports Server (NTRS)

Lawas-Grodek, Frances J.; Tran, Diepchi T.

2004-01-01

This report presents the test results of the Swift Start algorithm in single-flow and multiple-flow testbeds under the effects of high propagation delays, various slow bottlenecks, and small queue sizes. Although this algorithm estimates capacity and implements packet pacing, the findings were that in a heavily congested link, the Swift Start algorithm will not be applicable. The reason is that the bottleneck estimation is falsely influenced by timeouts induced by retransmissions and the expiration of delayed acknowledgment (ACK) timers, thus causing the modified Swift Start code to fall back to regular transmission control protocol (TCP).

[Thoughts on the Revue de Chirurgie Plastique (1931-34) and the Revue de Chirurgie Structive (1935-38)].

PubMed

Vrebos, J

2007-08-01

The history of modern plastic surgery starts when a young, restless ENT man, Dr M. Coelst, started a training in Plastic Surgery with Sebileau in Paris and Joseph in Berlin. This man of vision and far-sighted imagination realized that the separated efforts and publications of so many pioneers, scaterred all over the world, would be lost if not gathered in a scientific journal only devoted to plastic surgery for the benefit of all. This brought him to the idea of establishing, in 1931, at his own initiative, the first international Journal of Plastic Surgery ever published, the Revue de Chirurgie Plastique, fifteen years before the USA Journal Plastic and Reconstructive Surgery and sixteen years before the British Journal of Plastic Surgery. The name of the journal was changed in 1935 to the Revue de Chirurgie Structive. Coelst' Revue was promptly accepted as the leading Journal of Plastic Surgery and all the internationally known plastic Surgeons contributed to it by scientific papers of great value, even today.

[Quality of mental health services: a self audit in the South Verona mental health service].

PubMed

Allevi, Liliana; Salvi, Giovanni; Ruggeri, Mirella

2006-01-01

To start a process of Continuous Quality Improvement (CQI) in an Italian Community Mental Health Service by using a quality assurance questionnaire in a self audit exercise. The questionnaire was administered to 14 key workers and clinical managers with different roles and seniority. One senior manager's evaluation was used as a benchmark for all the others. Changes were introduced in the service practice according to what emerged from the evaluation. Meetings were scheduled to monitor those changes and renew the CQI process. There was a wide difference in the key workers' answers. Overall, the senior manager's evaluation was on the 60th percentile of the distribution of the other evaluations. Those areas that required prompt intervention were risk management, personnel development, and CQI. The CQI process was followed up for one year: some interventions were carried out to change the practice of the service. A self audit exercise in Community Mental Health Services was both feasible and useful. The CQI process was easier to start than to carry on over the long term.

Effect of mitoguazone on polyamine oxidase activity in rat liver.

PubMed

Ferioli, Maria Elena; Berselli, Debora; Caimi, Samuela

2004-12-01

Mitoguazone is a known inhibitor of polyamine biosynthesis through competitive inhibition of S-adenosylmethionine decarboxylase. A recent renewed interest in mitoguazone as an antineoplastic agent prompted us to investigate the effect of the drug on polyamine catabolism in rat liver, since the organ plays an important role in detoxification mechanisms. Thus, the purpose of this work was to evaluate the effect of in vivo mitoguazone administration on polyamine catabolic enzymes. In particular, our interest was directed to the changes in polyamine oxidase activity, since this enzyme has been recently confirmed to exert important functions that until now were underestimated. Mitoguazone administration induced hepatic polyamine oxidase activity starting at 4 h after administration, and the enzyme returned to basal levels 96 h after treatment. The changes in enzyme activity were accompanied by changes in putrescine concentrations, which increased starting at 4 h until 72 h after treatment. We also evaluated the activity of the newly identified spermine oxidase, which was not significantly changed by mitoguazone treatment. Therefore, we hypothesized that the enzyme involved in mitoguazone response of the liver is the polyamine oxidase, which acts on acetylated polyamines as substrate.

The Effects of Course-Related Service Projects in a Child Development Course

ERIC Educational Resources Information Center

Conner, David B.

2004-01-01

A Head Start volunteer project was designed for a college-level child development course and implemented in three different sections of the class across two semesters. Overall, 70 students participated (65 females and 5 males) with assessment data collected from student volunteers and Head Start teachers and administrators. Students reported a…

Integrating Districts in Comprehensive School Reform in the Middle-Grades: Lessons from Middle Start CSR

ERIC Educational Resources Information Center

Gopalan, Pritha

2004-01-01

This report compares district leaders' perspectives on changes in school capacity, student outcomes and district policy over three years of implementation of Middle Start (MS), a comprehensive school reform program to demonstrate the potential for improving the effectiveness and sustainability of CSR at the school level through integrating…

"I Am Much More than Just a Mum". Social Capital, Empowerment and Sure Start

ERIC Educational Resources Information Center

Bagley, Carl; Ackerley, Clare L.

2006-01-01

An earlier article published in this journal sought to recover the views of professionals concerned with the delivery and implementation of a "Third Way" multiagency programme tackling the social exclusion of young children and their families known as Sure Start. The tentative findings suggested a "bottom-up" partnership…

Measuring Data Use Beliefs and Practices in Early Education Settings

ERIC Educational Resources Information Center

Stein, Amanda; Connors, Maia C.

2016-01-01

Educare is a network of enhanced Early Head Start (EHS)/Head Start (HS) (birth to age 5) programs that implement innovative Research-Program Partnerships (RPPs) to engage researchers, program leaders, staff, and at times, other stakeholders in a collaborative approach to supporting data use practices for decision-making and continuous quality…

45 CFR 1306.33 - Home-based program option.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 4 2013-10-01 2013-10-01 false Home-based program option. 1306.33 Section 1306.33... PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.33 Home-based program option. (a) Grantees implementing a home-based program option must: (1) Provide one home...

45 CFR 1306.33 - Home-based program option.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Home-based program option. 1306.33 Section 1306.33... PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.33 Home-based program option. (a) Grantees implementing a home-based program option must: (1) Provide one home...

45 CFR 1306.33 - Home-based program option.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Home-based program option. 1306.33 Section 1306.33... PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.33 Home-based program option. (a) Grantees implementing a home-based program option must: (1) Provide one home...

Attitudes of Suburban Chicago Teachers Toward Applied Biological and Agricultural Occupations Programs.

ERIC Educational Resources Information Center

Thomas, Hollie B.; Jackson, Franklin D. R.

The attitudes of teachers in a metropolitan area toward starting programs in applied biological and agricultural occupations and other vocational areas were studied in order to establish a base line of attitudes with which program implementation must start. Specific objectives were to: (1) determine the attitude of teachers toward offering such…

Roadmap to Implementing Green Cleaning in Districts and Schools

ERIC Educational Resources Information Center

Davis, Rochelle, Ed.

2012-01-01

Bill Thompson, Director of Facilities for Lockport Township High School in Illinois, first considered starting a green cleaning program after his janitors became dizzy when using a traditional chemical floor stripper. Thompson started introducing green products gradually at Lockport Township High, and now almost all of the cleaning agents used at…

Implementation of the Early Start Denver Model in an Italian Community

ERIC Educational Resources Information Center

Colombi, Costanza; Narzisi, Antonio; Ruta, Liliana; Cigala, Virginia; Gagliano, Antonella; Pioggia, Giovanni; Siracusano, Rosamaria; Rogers, Sally J.; Muratori, Filippo

2018-01-01

Identifying effective, community-based specialized interventions for young children with autism spectrum disorder is an international clinical and research priority. We evaluated the effectiveness of the Early Start Denver Model intervention in a group of young children with autism spectrum disorder living in an Italian community compared to a…

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care.

PubMed

Hoekstra, Femke; van Offenbeek, Marjolein A G; Dekker, Rienk; Hettinga, Florentina J; Hoekstra, Trynke; van der Woude, Lucas H V; van der Schans, Cees P

2017-12-01

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior. This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes. Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303). Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances. The Netherlands National Trial Register NTR3961 . Registered 18 April 2013.

Estuary ecosystem restoration: implementing and institutionalizing adaptive management: Institutionalizing adaptive management

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

Ebberts, Blaine D.; Zelinsky, Ben D.; Karnezis, Jason P.

We successfully implemented and institutionalized an adaptive management (AM) process for the Columbia Estuary Ecosystem Restoration Program, which is a large-scale restoration program focused on improving ecosystem conditions in the 234-km lower Columbia River and estuary. For our purpose, “institutionalized” means the AM process and restoration program are embedded in the work flow of the implementing agencies and affected parties. While plans outlining frameworks, processes, or approaches to AM of ecosystem restoration programs are commonplace, establishment for the long term is not. This paper presents the basic AM framework and explains how AM was implemented and institutionalized. Starting with amore » common goal, we pursued included a well-understood governance and decision-making structure, routine coordination and communication activities, data and information sharing, commitment from partners and upper agency management to the AM process, and meaningful cooperation among program managers and partners. The overall approach and steps to implement and institutionalize AM for ecosystem restoration explained here are applicable to situations where it has been less than successful or, as in our case, the restoration program is just getting started.« less

Implementing a self-structuring data learning algorithm

NASA Astrophysics Data System (ADS)

Graham, James; Carson, Daniel; Ternovskiy, Igor

2016-05-01

In this paper, we elaborate on what we did to implement our self-structuring data learning algorithm. To recap, we are working to develop a data learning algorithm that will eventually be capable of goal driven pattern learning and extrapolation of more complex patterns from less complex ones. At this point we have developed a conceptual framework for the algorithm, but have yet to discuss our actual implementation and the consideration and shortcuts we needed to take to create said implementation. We will elaborate on our initial setup of the algorithm and the scenarios we used to test our early stage algorithm. While we want this to be a general algorithm, it is necessary to start with a simple scenario or two to provide a viable development and testing environment. To that end, our discussion will be geared toward what we include in our initial implementation and why, as well as what concerns we may have. In the future, we expect to be able to apply our algorithm to a more general approach, but to do so within a reasonable time, we needed to pick a place to start.

Normative prompts reduce consumer food waste in restaurants.

PubMed

Stöckli, Sabrina; Dorn, Michael; Liechti, Stefan

2018-05-03

This field study demonstrates that prompts reduce food waste in a restaurant. Based on the behavioral change literature, it was hypothesized that (1) informational prompts encourage consumers to reduce food waste, and that (2) an informational prompt with a normative message is more effective than a prompt with only an informative message. The results were mixed. As expected, diners who were exposed to prompts asked to take away their leftovers more frequently than diners who were exposed to no prompts. However, prompts with an informative and normative message were no more powerful than prompts with only an informative message. Copyright © 2018 Elsevier Ltd. All rights reserved.

Open SHMEM Reference Implementation

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

Pritchard, Howard; Curtis, Anthony; Welch, Aaron

2016-05-12

OpenSHMEM is an effort to create a specification for a standardized API for parallel programming in the Partitioned Global Address Space. Along with the specification the project is also creating a reference implementation of the API. This implementation attempts to be portable, to allow it to be deployed in multiple environments, and to be a starting point for implementations targeted to particular hardware platforms. It will also serve as a springboard for future development of the API.

Rapid Geriatric Assessment of Hip Fracture.

PubMed

Zanker, Jesse; Duque, Gustavo

2017-08-01

A comprehensive geriatric assessment, combined with a battery of imaging and blood tests, should be able to identify those hip fracture patients who are at higher risk of short- and long-term complications. This comprehensive assessment should be followed by the implementation of a comprehensive multidimensional care plan aimed to prevent negative outcomes in the postoperative period (short and long term), thus assuring a safe and prompt functional recovery while also preventing future falls and fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

Identifying Patients Who Need a Change in Depression Treatment and Implementing That Change.

PubMed

Papakostas, George I

2016-08-01

For patients whose depression is difficult to treat or treatment-resistant, physicians must make an educated choice to switch, augment, or combine therapies to help patients adequately respond after initial treatment selections fail. Uncover some of the complexities of this challenging diagnosis by following the case of Robert, a 55-year-old accountant whose inadequate response to treatment by his primary care doctor has prompted a referral to a specialist. © Copyright 2016 Physicians Postgraduate Press, Inc.

Chronic eosinophilic pneumonia presenting with ipsilateral pleural effusion: a case report.

PubMed

Sriratanaviriyakul, Narin; La, Hanh H; Albertson, Timothy E

2016-08-12

Chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. The nearly pathognomonic radiographic finding is the peripheral distribution of alveolar opacities. Pleural effusions are rarely seen. We report a case of chronic eosinophilic pneumonia with transudative eosinophilic pleural effusion. A 57-year-old Hispanic woman, a nonsmoker with a history of controlled asthma, presented to the hospital with unresolving pneumonia despite three rounds of antibiotics over a 2-month period. She was later diagnosed with chronic eosinophilic pneumonia based on the presence of peripheral blood eosinophilia, the peripheral distribution of alveolar infiltrates on chest radiograph, and a lung parenchymal biopsy with infiltrates of eosinophils. Upon presentation, our patient had a right-sided moderate-sized pleural effusion. The pleural fluid profile was consistent with a transudative effusion with eosinophil predominance. Our patient responded promptly to oral corticosteroid treatment in a few days. The pulmonary infiltrates and pleural effusion subsided on a 1-month follow-up chest radiograph after starting corticosteroid treatment. We report the first case of chronic eosinophilic pneumonia presenting with pneumonia with ipsilateral transudative eosinophilic pleural effusion. Like other cases of chronic eosinophilic pneumonia, early recognition and diagnosis is essential and prompt treatment with corticosteroids is the mainstay of therapy. Pleural effusion resolved without the further need for therapeutic thoracentesis.

Prompt gamma neutron activation analysis of toxic elements in radioactive waste packages.

PubMed

Ma, J-L; Carasco, C; Perot, B; Mauerhofer, E; Kettler, J; Havenith, A

2012-07-01

The French Alternative Energies and Atomic Energy Commission (CEA) and National Radioactive Waste Management Agency (ANDRA) are conducting an R&D program to improve the characterization of long-lived and medium activity (LL-MA) radioactive waste packages. In particular, the amount of toxic elements present in radioactive waste packages must be assessed before they can be accepted in repository facilities in order to avoid pollution of underground water reserves. To this aim, the Nuclear Measurement Laboratory of CEA-Cadarache has started to study the performances of Prompt Gamma Neutron Activation Analysis (PGNAA) for elements showing large capture cross sections such as mercury, cadmium, boron, and chromium. This paper reports a comparison between Monte Carlo calculations performed with the MCNPX computer code using the ENDF/B-VII.0 library and experimental gamma rays measured in the REGAIN PGNAA cell with small samples of nickel, lead, cadmium, arsenic, antimony, chromium, magnesium, zinc, boron, and lithium to verify the validity of a numerical model and gamma-ray production data. The measurement of a ∼20kg test sample of concrete containing toxic elements has also been performed, in collaboration with Forschungszentrum Jülich, to validate the model in view of future performance studies for dense and large LL-MA waste packages. Copyright © 2012 Elsevier Ltd. All rights reserved.

Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention.

PubMed

Mount, Hillary R; Boyle, Sean D

2017-09-01

The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity. Bacterial meningitis is a medical emergency that requires prompt recognition and treatment. Mortality remains high despite the introduction of vaccinations for common pathogens that have reduced the incidence of meningitis worldwide. Aseptic meningitis is the most common form of meningitis with an annual incidence of 7.6 per 100,000 adults. Most cases of aseptic meningitis are viral and require supportive care. Viral meningitis is generally self-limited with a good prognosis. Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis because of variable sensitivity and specificity. Because clinical findings are also unreliable, the diagnosis relies on the examination of cerebrospinal fluid obtained from lumbar puncture. Delayed initiation of antibiotics can worsen mortality. Treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis. Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors. Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics. Vaccination against the most common pathogens that cause bacterial meningitis is recommended. Chemoprophylaxis of close contacts is helpful in preventing additional infections.

Learning from instructional explanations: effects of prompts based on the active-constructive-interactive framework.

PubMed

Roelle, Julian; Müller, Claudia; Roelle, Detlev; Berthold, Kirsten

2015-01-01

Although instructional explanations are commonly provided when learners are introduced to new content, they often fail because they are not integrated into effective learning activities. The recently introduced active-constructive-interactive framework posits an effectiveness hierarchy in which interactive learning activities are at the top; these are then followed by constructive and active learning activities, respectively. Against this background, we combined instructional explanations with different types of prompts that were designed to elicit these learning activities and tested the central predictions of the active-constructive-interactive framework. In Experiment 1, N = 83 students were randomly assigned to one of four combinations of instructional explanations and prompts. To test the active < constructive learning hypothesis, the learners received either (1) complete explanations and engaging prompts designed to elicit active activities or (2) explanations that were reduced by inferences and inference prompts designed to engage learners in constructing the withheld information. Furthermore, in order to explore how interactive learning activities can be elicited, we gave the learners who had difficulties in constructing the prompted inferences adapted remedial explanations with either (3) unspecific engaging prompts or (4) revision prompts. In support of the active < constructive learning hypothesis, we found that the learners who received reduced explanations and inference prompts outperformed the learners who received complete explanations and engaging prompts. Moreover, revision prompts were more effective in eliciting interactive learning activities than engaging prompts. In Experiment 2, N = 40 students were randomly assigned to either (1) a reduced explanations and inference prompts or (2) a reduced explanations and inference prompts plus adapted remedial explanations and revision prompts condition. In support of the constructive < interactive learning hypothesis, the learners who received adapted remedial explanations and revision prompts as add-ons to reduced explanations and inference prompts acquired more conceptual knowledge.

Learning from Instructional Explanations: Effects of Prompts Based on the Active-Constructive-Interactive Framework

PubMed Central

Roelle, Julian; Müller, Claudia; Roelle, Detlev; Berthold, Kirsten

2015-01-01

Although instructional explanations are commonly provided when learners are introduced to new content, they often fail because they are not integrated into effective learning activities. The recently introduced active-constructive-interactive framework posits an effectiveness hierarchy in which interactive learning activities are at the top; these are then followed by constructive and active learning activities, respectively. Against this background, we combined instructional explanations with different types of prompts that were designed to elicit these learning activities and tested the central predictions of the active-constructive-interactive framework. In Experiment 1, N = 83 students were randomly assigned to one of four combinations of instructional explanations and prompts. To test the active < constructive learning hypothesis, the learners received either (1) complete explanations and engaging prompts designed to elicit active activities or (2) explanations that were reduced by inferences and inference prompts designed to engage learners in constructing the withheld information. Furthermore, in order to explore how interactive learning activities can be elicited, we gave the learners who had difficulties in constructing the prompted inferences adapted remedial explanations with either (3) unspecific engaging prompts or (4) revision prompts. In support of the active < constructive learning hypothesis, we found that the learners who received reduced explanations and inference prompts outperformed the learners who received complete explanations and engaging prompts. Moreover, revision prompts were more effective in eliciting interactive learning activities than engaging prompts. In Experiment 2, N = 40 students were randomly assigned to either (1) a reduced explanations and inference prompts or (2) a reduced explanations and inference prompts plus adapted remedial explanations and revision prompts condition. In support of the constructive < interactive learning hypothesis, the learners who received adapted remedial explanations and revision prompts as add-ons to reduced explanations and inference prompts acquired more conceptual knowledge. PMID:25853629

Tips for Implementing a Wireless Network

ERIC Educational Resources Information Center

Walery, Darrell

2005-01-01

This article provides a quick start guide to provide educators with the basic points to consider before installing a wireless network in the school. Since many school districts have already implemented wireless networks, there is a lot of information available online to assist in the process.

Variation in community intervention programmes and consequences for children and families: the example of Sure Start Local Programmes.

PubMed

Melhuish, Edward; Belsky, Jay; Anning, Angela; Ball, Mog; Barnes, Jacqueline; Romaniuk, Helena; Leyland, Alastair

2007-06-01

An area-based initiative, Sure Start Local Programmes (SSLPs), was established by the UK government to reduce social exclusion through improving the well-being of children aged 0-3 years and their families in disadvantaged communities; a true community intervention in that all children under four and their families in specified areas served as targets of universal services. A national evaluation examined the links between variation in programme implementation and effectiveness. Data gathered from multiple sources produced measures of implementation in terms of proficiency, services and staffing. Measures of programme impact on child/parenting outcomes derived from multilevel models, controlling for child, family and area characteristics, were identified to demonstrate programme effectiveness. Some modest linkage between programme implementation (e.g., proficiency, empowerment of parents and staff, identification of users) and effectiveness for child and parenting outcomes. Overall proficiency and specific aspects of implementation may influence effectiveness, which should guide the design of other child, family and community services.

Evaluation of free to grow: head start partnerships to promote substance-free communities.

PubMed

Wolfson, Mark; Champion, Heather; Rogers, Todd; Neiberg, Rebecca H; Barker, Dianne C; Talton, Jennifer W; Ip, Edward H; D'Agostino, Ralph B; Parries, Maria T; Easterling, Doug

2011-04-01

Free to Grow: Head Start Partnerships to Promote Substance-free Communities (FTG) was a national initiative in which local Head Start (HS) agencies, in partnership with other community organizations, implemented a mix of evidence-based family-strengthening and community-strengthening strategies. The evaluation of FTG used a quasi-experimental design to compare 14 communities that participated in the FTG intervention with 14 matched comparison communities. Telephone surveys were conducted with two cohorts of the primary caregivers of children in HS at baseline and then annually for 2 years. The survey was also administered to repeated cross-sectional samples of primary caregivers of young children who were not enrolled in HS. No consistent evidence was found in changes in family functioning or neighborhood conditions when the 14 FTG sites were compared to 14 matched sites. However, caregivers of young children who were not in HS in three high-implementing FTG sites showed evidence of improvements in neighborhood organization, neighborhood norms against substance abuse, and child disciplinary practices. Results provide highly limited support for the concept that family and neighborhood conditions that are likely to affect child development and well-being can be changed through organized efforts implemented by local HS programs.

Improving operating room first start efficiency - value of both checklist and a pre-operative facilitator.

PubMed

Panni, M K; Shah, S J; Chavarro, C; Rawl, M; Wojnarwsky, P K; Panni, J K

2013-10-01

There are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process. An orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18-month period. Initially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (-49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as 'other reasons' (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion. While we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet - pre-operative checklist in addition to a dedicated pre-operative facilitator; allowed us to make a substantial improvement in our first start on time starts. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Anterior ischaemic optic neuropathy in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): a case report and review of the literature.

PubMed

Padovano, Ilaria; Pazzola, Giulia; Pipitone, Nicolò; Cimino, Luca; Salvarani, Carlo

2014-01-01

We report a 62-year-old man with mild fever, headache and acute visual loss in his right eye due to anterior ischaemic optic neuropathy (AION), followed a few days later by pain in the legs and left arm associated with numbness and weakness. Giant cell arteritis complicated by AION was suspected at the beginning and high-dose oral glucocorticoids were started. However, on the basis of the past medical history of nasal polyposis, asthma, and hypereosynophilia as well as of further investigations (biopsy of the nasal mucosa showing granulomatous inflammation with a rich eosinophilic infiltrate, electromyography demonstrating, mononeuritis multiplex and positive p-ANCA), eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss syndrome, was diagnosed. Because visual acuity in the right eye deteriorated despite glucocorticoid therapy, pulse intravenous cyclophosphamide was started, subsequently replaced by oral azathioprine, while prednisone was slowly tapered. This treatment led to gradual improvement of the neurological symptoms, whereas the right visual impairment remained unchanged. EGPA-related AION is an uncommon lesion that is probably due to vasculitic involvement of posterior ciliary and/or chorioretinal arteries. The prognosis of established AION is poor for the affected eye, even when glucocorticoid treatment is started immediately. However, early recognition of AION and prompt aggressive treatment with high-dose glucocorticoids plus cyclophosphamide can prevent visual loss in the unaffected eye.

The Relationship between Stimulus and Response Prompts under Two Types of Programmed Presentations.

ERIC Educational Resources Information Center

Young, Jon I.; And Others

Prompts in concept classification normally occur on the stimulus, while in memorization tasks prompts customarily are given on the response. Opposite results have been obtained for these two tasks with excessive prompting. This study used English-Russian word pairs to compare stimulus prompts (underlining the English word) with response prompts in…

Secure and Resilient Functional Modeling for Navy Cyber-Physical Systems

DTIC Science & Technology

2017-05-24

Functional Modeling Compiler (SCCT) FM Compiler and Key Performance Indicators (KPI) May 2018 Pending. Model Management Backbone (SCCT) MMB Demonstration...implement the agent- based distributed runtime. - KPIs for single/multicore controllers and temporal/spatial domains. - Integration of the model management ...Distributed Runtime (UCI) Not started. Model Management Backbone (SCCT) Not started. Siemens Corporation Corporate Technology Unrestricted

Social and Emotional Learning in the Kindergarten Classroom: Evaluation of the "Strong Start" Curriculum

ERIC Educational Resources Information Center

Kramer, Thomas J.; Caldarella, Paul; Christensen, Lynnette; Shatzer, Ryan H.

2010-01-01

There has been increasing interest in the promotion of social and emotional learning in schools, and research has shown positive outcomes. However, relatively few studies have been conducted in kindergarten classrooms or considered the feasibility of kindergarten implementation. This study examined the effects of "Strong Start" on the social and…

Enhancing Children's Growth and Development. Training Guides for the Head Start Learning Community.

ERIC Educational Resources Information Center

Aspen Systems Corp., Rockville, MD.

This training guide is designed to enhance the skills of Head Start education staff in applying knowledge of how children grow and develop to planning, implementing, and evaluating activities and experiences in the center, at home, and during group socialization sessions. Each of the guide's modules details module outcomes, key concepts, and…

Implementing a Nutrition and Physical Activity Curriculum in Head Start through an Academic-community Partnership

ERIC Educational Resources Information Center

Zahnd, Whitney E.; Smith, Tracey; Ryherd, Susan J.; Cleer, Melissa; Rogers, Valerie; Steward, David E.

2017-01-01

Background: Schools may be an effective avenue for interventions that prevent childhood obesity. "I am Moving I am Learning/Choosy Kids"© (IMIL/CK) is a curriculum recommended by Head Start (HS) for education in nutrition, physical activity, and healthy lifestyle habits. Methods: We formed an academic-community partnership (ACP), the…

Leading the Way: Disabilities Services and the Management Team. Training Guides for the Head Start Learning Community.

ERIC Educational Resources Information Center

Education Development Center, Inc., Newton, MA.

This guide is designed to provide Head Start managers with the skills and knowledge needed to plan and implement integrated services for children with disabilities and their families. Module 1, "Identifying Shared Responsibilities," assists participants in identifying how current roles and collaboration practices as a team affect…

The Early Start Denver Model: A Case Study of an Innovative Practice

ERIC Educational Resources Information Center

Vismara, Laurie A.; Rogers, Sally J.

2008-01-01

Intervention was implemented with an infant identified at 9 months of age with a behavioral profile consistent with autistic spectrum disorder. The intervention approach, the Early Start Denver model, consisted of a 12-week, 1.5-hr-per-week individualized parent-child education program. Results of this case study demonstrated that the parent…

CHILE: An Evidence-Based Preschool Intervention for Obesity Prevention in Head Start

ERIC Educational Resources Information Center

Davis, Sally M.; Sanders, Sarah G.; FitzGerald, Courtney A.; Keane, Patricia C.; Canaca, Glenda F.; Volker-Rector, Renee

2013-01-01

Background: Obesity is a major concern among American Indians and Hispanics. The Child Health Initiative for Lifelong Eating and Exercise (CHILE) is an evidence-based intervention to prevent obesity in children enrolled in 16 Head Start (HS) Centers in rural communities. The design and implementation of CHILE are described. Methods: CHILE uses a…

Three Approaches to Preschoolers' Social and Emotional Competence: A Summary of Impact and Implementation Findings from Head Start CARES

ERIC Educational Resources Information Center

MDRC, 2015

2015-01-01

This summary describes the Head Start CARES research project, which evaluated three classroom-based approaches to enhancing children's social-emotional development: (1) The Incredible Years Teacher Training Program; (2) Preschool PATHS (Promoting Alternative Thinking Strategies); and (3) Tools of the Mind--Play. The three social-emotional…

Training Head Start Teachers to Conduct Trial-Based Functional Analysis of Challenging Behavior

ERIC Educational Resources Information Center

Rispoli, Mandy; Burke, Mack D.; Hatton, Heather; Ninci, Jennifer; Zaini, Samar; Sanchez, Lisa

2015-01-01

Trial-based functional analysis (TBFA) is a procedure for experimentally identifying the function of challenging behavior within applied settings. The purpose of this study was to examine the effects of a TBFA teacher-training package in the context of two Head Start centers implementing programwide positive behavior support (PWPBS). Four Head…

Acceleration through a Holistic Support Model: An Implementation and Outcomes Analysis of FastStart@CCD

ERIC Educational Resources Information Center

Edgecombe, Nikki; Jaggars, Shanna Smith; Baker, Elaine DeLott; Bailey, Thomas

2013-01-01

Originally designed for students who test into at least two levels of developmental education in a particular subject area, FastStart is a compressed course program model launched in 2005 at the Community College of Denver (CCD). The program combines multiple semester-length courses into a single intensive semester, while providing case…

Examining the Use of Curriculum to Support Early Literacy Instruction: A Multiple Case Study of Head Start Teachers

ERIC Educational Resources Information Center

Mihai, Alina; Butera, Gretchen; Friesen, Amber

2017-01-01

Research Findings: This qualitative study examined how Head Start teachers thought about children's early literacy and how they enacted their thinking in a year-long curriculum reform effort. Data collected included interviews, observations, questionnaires, concept maps, and teachers' reflections on implementation. The results indicated that as…

Evaluation of the Preschool Life Skills Program in Head Start Classrooms: A Systematic Replication

ERIC Educational Resources Information Center

Hanley, Gregory P.; Fahmie, Tara A.; Heal, Nicole A.

2014-01-01

In an attempt to address risk factors associated with extensive nonfamilial child care, we implemented the preschool life skills (PLS) program (Hanley, Heal, Tiger, & Ingvarsson, 2007) in two community-based Head Start classrooms. A multiple baseline design across classrooms, repeated across skills, showed that the program resulted in a 5-fold…

iSTART Therefore I Understand: But Metacognitive Supports Did Not Enhance Comprehension Gains

ERIC Educational Resources Information Center

McCarthy, Kathryn S.; Jacovina, Matthew E.; Snow, Erica L.; Guerrero, Tricia A.; McNamara, Danielle S.

2017-01-01

iSTART is an intelligent tutoring system designed to provide self-explanation instruction and practice to improve students' comprehension of complex, challenging text. This study examined the effects of extended game-based practice within the system as well as the effects of two metacognitive supports implemented within this practice. High school…

Warhead Confirmation: A Follow-on to New START

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

MacArthur, Duncan W.

This presentation's slides are comprised of the following: Warhead Confirmation: A Follow-on to New START; What May Change?; Generic Arms Reduction Treaty; Challenges; Dismantlement and Warhead Confirmation; Confirmation Approaches; Certification; Information Barriers (IBs); The Fissile Material Transparency Technology Demonstration (FMTTD); More Recent Implementations; The Monitor’s View; Authentication; Authentication Options; Authentication in Phases; and Future Treaties.

Periodic Email Prompts to Re-Use an Internet-Delivered Computer-Tailored Lifestyle Program: Influence of Prompt Content and Timing

PubMed Central

de Vries, Hein; Candel, Math; van de Kar, Angelique; van Osch, Liesbeth

2013-01-01

Background Adherence to Internet-delivered lifestyle interventions using multiple tailoring is suboptimal. Therefore, it is essential to invest in proactive strategies, such as periodic email prompts, to boost re-use of the intervention. Objective This study investigated the influence of content and timing of a single email prompt on re-use of an Internet-delivered computer-tailored (CT) lifestyle program. Methods A sample of municipality employees was invited to participate in the program. All participants who decided to use the program received an email prompting them to revisit the program. A 2×3 (content × timing) design was used to test manipulations of prompt content and timing. Depending on the study group participants were randomly assigned to, they received either a prompt containing standard content (an invitation to revisit the program), or standard content plus a preview of new content placed on the program website. Participants received this prompt after 2, 4, or 6 weeks. In addition to these 6 experimental conditions, a control condition was included consisting of participants who did not receive an additional email prompt. Clicks on the uniform resource locator (URL) provided in the prompt and log-ins to the CT program were objectively monitored. Logistic regression analyses were conducted to determine whether prompt content and/or prompt timing predicted clicking on the URL and logging in to the CT program. Results Of all program users (N=240), 206 participants received a subsequent email prompting them to revisit the program. A total of 53 participants (25.7%) who received a prompt reacted to this prompt by clicking on the URL, and 25 participants (12.1%) actually logged in to the program. There was a main effect of prompt timing; participants receiving an email prompt 2 weeks after their first visit clicked on the URL significantly more often compared with participants that received the prompt after 4 weeks (odds ratio [OR] 3.069, 95% CI 1.392-6.765, P=.005) and after 6 weeks (OR 4.471, 95% CI 1.909-10.471, P=.001). Furthermore, participants who received an email prompt 2 weeks after their first visit logged in to the program significantly more often compared to participants receiving the prompt after 6 weeks (OR 16.356, 95% CI 2.071-129.196, P=.008). A trend was observed with regard to prompt content. Participants receiving a prompt with additional content were more likely to log in to the program compared to participants who received a standard prompt. However, this result was not statistically significant (OR 2.286, 95% CI 0.892-5.856, P=.09). Conclusions The key findings suggest that boosting revisits to a CT program benefits most from relatively short prompt timing. Furthermore, a preview of new website content may be added to a standard prompt to further increase its effectiveness in persuading people to log in to the program. PMID:23363466

Periodic email prompts to re-use an internet-delivered computer-tailored lifestyle program: influence of prompt content and timing.

PubMed

Schneider, Francine; de Vries, Hein; Candel, Math; van de Kar, Angelique; van Osch, Liesbeth

2013-01-31

Adherence to Internet-delivered lifestyle interventions using multiple tailoring is suboptimal. Therefore, it is essential to invest in proactive strategies, such as periodic email prompts, to boost re-use of the intervention. This study investigated the influence of content and timing of a single email prompt on re-use of an Internet-delivered computer-tailored (CT) lifestyle program. A sample of municipality employees was invited to participate in the program. All participants who decided to use the program received an email prompting them to revisit the program. A 2×3 (content × timing) design was used to test manipulations of prompt content and timing. Depending on the study group participants were randomly assigned to, they received either a prompt containing standard content (an invitation to revisit the program), or standard content plus a preview of new content placed on the program website. Participants received this prompt after 2, 4, or 6 weeks. In addition to these 6 experimental conditions, a control condition was included consisting of participants who did not receive an additional email prompt. Clicks on the uniform resource locator (URL) provided in the prompt and log-ins to the CT program were objectively monitored. Logistic regression analyses were conducted to determine whether prompt content and/or prompt timing predicted clicking on the URL and logging in to the CT program. Of all program users (N=240), 206 participants received a subsequent email prompting them to revisit the program. A total of 53 participants (25.7%) who received a prompt reacted to this prompt by clicking on the URL, and 25 participants (12.1%) actually logged in to the program. There was a main effect of prompt timing; participants receiving an email prompt 2 weeks after their first visit clicked on the URL significantly more often compared with participants that received the prompt after 4 weeks (odds ratio [OR] 3.069, 95% CI 1.392-6.765, P=.005) and after 6 weeks (OR 4.471, 95% CI 1.909-10.471, P=.001). Furthermore, participants who received an email prompt 2 weeks after their first visit logged in to the program significantly more often compared to participants receiving the prompt after 6 weeks (OR 16.356, 95% CI 2.071-129.196, P=.008). A trend was observed with regard to prompt content. Participants receiving a prompt with additional content were more likely to log in to the program compared to participants who received a standard prompt. However, this result was not statistically significant (OR 2.286, 95% CI 0.892-5.856, P=.09). The key findings suggest that boosting revisits to a CT program benefits most from relatively short prompt timing. Furthermore, a preview of new website content may be added to a standard prompt to further increase its effectiveness in persuading people to log in to the program.

Creating Tesselations with Pavement Chalk: Implementing Best Practices in Mathematics

ERIC Educational Resources Information Center

Furner, Joseph M.; Goodman, Barbara; Meeks, Shirley

2004-01-01

Implementing best practices like cooperative learning, using concrete manipulatives, problem solving, technology, active learning, multi-age grouping, and team teaching have shown benefits for students when learning mathematics concepts within the curriculum (Zemelman, Daniels & Hyde, 1998; NCTM, 2000). What started as a professional development…

State and Federal project development procedures for bus rapid transit : managing differences and reducing implementation delays

DOT National Transportation Integrated Search

2011-08-01

This report documents an investigation into the transportation project development process in the : context of the implementation of bus rapid transit systems on the State Highway System as well as such : systems being part of the Federal New Starts ...

The use of picture prompts and prompt delay to teach receptive labeling.

PubMed

Vedora, Joseph; Barry, Tiffany

2016-12-01

The current study extended research on picture prompts by using them with a progressive prompt delay to teach receptive labeling of pictures to 2 teenagers with autism. The procedure differed from prior research because the auditory stimulus was not presented or was presented only once during the picture-prompt condition. The results indicated that the combination of picture prompts and prompt delay was effective, although 1 participant required a procedural modification. © 2016 Society for the Experimental Analysis of Behavior.

Evaluation of the isoniazid preventive therapy (IPT) program in Shurugwi District, Midlands Province, Zimbabwe, January 2013 to August 2014.

PubMed

Makoni, Annamercy; Chemhuru, Milton; Tshimanga, Mufuta; Gombe, Notion Tafara; Mungati, More; Bangure, Donewell

2015-09-25

Midlands Province started implementing the Isoniazid (INH) preventive therapy (IPT) program in January 2013. Shurugwi and Gokwe North were the piloting district hospitals. In May 2014, four more districts hospitals (Gokwe South, Gweru, Kwekwe and Zvishavane) started implementing IPT. Shurugwi District decentralized the program to its rural health facilities in January 2014. A review of the Shurugwi IPT program, 2013 data, indicated that the majority of eligible clients were not started on IPT. None out of the 400 eligible clients were started on IPT in November against the 100% target according to the World Health Organization and the National Tuberculosis (TB) Program. We conducted a study to evaluate the IPT program in Shurugwi District from January 2013 to August 2014. The logical framework approach was used to evaluate inputs, processes, outputs and outcomes of the IPT program. An interviewer administered questionnaire was used to collect data from key informants. Checklists were used to collect data from IPT program records. Sixteen health facilities were implementing IPT in Shurugwi District. All the facilities had TB screening tools and three did not have TB screening algorithms. The district experienced medicine stock outs in 2013. One formal training at district level and on job trainings in implementing health facilities were done. From January 2013 to August 2014, Shurugwi District screened 6794 antiretroviral (ART) clients for TB. Out of those screened, 5255 were eligible for IPT and 2831 (54%) were started on IPT. A total of 700 clients had completed the IPT 6 month's course by August 2014. The dropout rate due to INH toxicity and TB was 0.6% (n = 18) and 0.3% (n = 8) respectively. Fifty-three advocacy and community sensitization meetings were done. The program had no Information Education and Communication (IEC) materials. The IPT program in Shurugwi District achieved half its target. This could be due to inadequate formally trained staff, lack of IEC materials, inadequate advocacy and community sensitization, non-availability of the INH 300 mg single dose and inadequate INH 100 mg dose tablets in 2013. To improve the IPT program, there is need for routine advocacy, communication and social mobilization.

[Myxoid liposarcoma of the anterior mediastinum. A case report and bibliography review].

PubMed

Luna-Martínez, Javier; Molina-Ramírez, Daniel; Mata-Quintero, Carlos Javier; García-Arrona, Luis Roberto; Peña-Rosas, Diana Pérez; Mondragón-Pinzón, Erwin Eduardo

2014-01-01

Five cases per year. Of those cases 50% are located in the extremities and 40% are located in the trunk and retroperitoneum. Primary mediastinal liposarcomas represent less than 1% of mediastinal tumors. A 53 year old female, native and resident of Tabasco, with a history of anterior mediastinal tumor was treated with resection at the National Institute of Cancerology about 16 years ago with histopathological diagnosis of pleomorphic liposarcoma. She started her condition with chest pain, cough and hyaline expectoration, managed as pneumonia in her unit. Other symptoms occurred, moderate exertion dyspnea and edema of lower limbs, chest computed tomography prompted for documenting mediastinal tumor measured to be 9 × 9 cm and sent to our unit which is managed with resection.

Current Results of NEUTRINO-4 Experiment

NASA Astrophysics Data System (ADS)

Serebrov, A.; Ivochkin, V.; Samoilov, R.; Fomin, A.; Polyushkin, A.; Zinoviev, V.; Neustroev, P.; Golovtsov, V.; Chernyj, A.; Zherebtsov, O.; Martemyanov, V.; Tarasenkov, V.; Aleshin, V.; Petelin, A.; Izhutov, A.; Tuzov, A.; Sazontov, S.; Ryazanov, D.; Gromov, M.; Afanasiev, V.; Zaytsev, M.; Chaikovskii, M.

2017-12-01

The main goal of experiment “Neutrino-4” is to search for the oscillation of reactor antineutrino to a sterile state. Experiment is conducted on SM-3 research reactor (Dimitrovgrad, Russia). Data collection with full-scale detector with liquid scintillator volume of 3m3 was started in June 2016. We present the results of measurements of reactor antineutrino flux dependence on the distance in range 6- 12 meters from the center of the reactor. At that distance range, the fit of experimental dependence has good agreement with the law 1/L2. Which means, at achieved during the data collecting accuracy level oscillations to sterile state are not observed. In addition, the spectrum of prompt signals of neutrino-like events at different distances have been presented.

Accelerator boom hones China's engineering expertise

NASA Astrophysics Data System (ADS)

Normile, Dennis

2018-02-01

In raising the curtain on the China Spallation Neutron Source, China has joined just four other nations in having mastered the technology of accelerating and controlling beams of protons. The $277 million facility, set to open to users this spring in Dongguan, is expected to yield big dividends in materials science, chemistry, and biology. More world class machines are on the way, as China this year starts construction on four other major accelerator facilities. The building boom is prompting a scramble to find enough engineers and technicians to finish the projects. But if they all come off as planned, the facilities would position China to tackle the next global megaproject: a giant accelerator that would pick up where Europe's Large Hadron Collider leaves off.

"Defensives" or "pesticides"? A history of the use and perception of pesticides in the state of Santa Catarina, Brazil, 1950-2002.

PubMed

Carvalho, Miguel Mundstock Xavier de; Nodari, Eunice Sueli; Nodari, Rubens Onofre

2017-01-01

The article presents a history of the use and perception of pesticides in the state of Santa Catarina, Brazil, between 1950 and 2002. A variety of primary sources were used, including technical newsletters, government reports, agricultural censuses, newspaper articles, data from the state center for toxicological information, and an interview with a key technician from the field. It was found that the use and perception of pesticides passed through different phases in Santa Catarina, much as in other places, with changes in attitude prompted both by the personal experiences of technicians and farmers and by the influence of the broader cultural context and circulation of environmentalist ideas starting in the 1980s.

A comparison of methods for teaching receptive labeling to children with autism spectrum disorders: a systematic replication.

PubMed

Grow, Laura L; Kodak, Tiffany; Carr, James E

2014-01-01

Previous research has demonstrated that the conditional-only method (starting with a multiple-stimulus array) is more efficient than the simple-conditional method (progressive incorporation of more stimuli into the array) for teaching receptive labeling to children with autism spectrum disorders (Grow, Carr, Kodak, Jostad, & Kisamore,). The current study systematically replicated the earlier study by comparing the 2 approaches using progressive prompting with 2 boys with autism. The results showed that the conditional-only method was a more efficient and reliable teaching procedure than the simple-conditional method. The results further call into question the practice of teaching simple discriminations to facilitate acquisition of conditional discriminations. © Society for the Experimental Analysis of Behavior.

Ascending infection of foot tendons in diabetic patients.

PubMed

Mismar, Ayman; Yousef, Mohammad; Badran, Darwish; Younes, Nidal

2013-12-01

Bone and soft tissue infection in the foot of diabetic patients is a well-described issue in the literature. A sound anatomical knowledge of the foot anatomy and compartments is mandatory to understand the mechanisms of infection spread. We describe four cases of diabetic foot infection complicated by long ascending infection. All did not respond initially to antibiotic treatment and the usual surgical debridement and were cured only after excision of the infected tendons. We highlight a rare but serious complication of the diabetic foot disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition so that a prompt diagnosis is made and appropriate treatment started, thereby reducing the risk of major lower limb amputations.

WNP-2, securities fraud investigation are fired up

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

Not Available

1984-03-01

Washington's WNP-2 nuclear plant faces a securities fraud investigation just as it is ready to start operating on schedule. The investigation's outcome and WNP-2's performance will determine whether WNP-1 and WNP-3 will be financed. Angry bondholders who did not receive interest on their investments in January prompted Congressional hearings, at which it was learned that institutional buyers had pulled out of the Washington Public Power Supply System project and unloaded the bonds on thousands of unsuspecting individuals for whom tax-free municipal bonds are inappropriate. Securities Exchange Commission investigators will focus on the initial offering and disclosure by the issuer tomore » determine if the Wall Street unloading was legal. (DCK)« less

Implementing RTI[superscript 2]: Reports from the Field. Policy Brief

ERIC Educational Resources Information Center

Dawkins, Shardae

2014-01-01

Starting in 2014-15, districts across the state of Tennessee must implement a Response to Instruction and Intervention (RTI[superscript 2]) plan. RTI[superscript 2] is an instructional framework which provides ongoing monitoring of student performance and progress through the use of universal student screeners and interventions targeted at…

Evaluation of the Implementation of Family Life and HIV Education Programme in Nigeria.

PubMed

Udegbe, Bola I; Fayehun, Funke; Isiugo-Abanihe, Uche C; Nwagwu, Williams; Isiugo-Abanihe, Ifeoma; Nwokocha, Ezebunwa

2015-06-01

Family Life and HIV Education (FLHE) programme was introduced nationwide in Nigeria in 2003. Since then little is known about the patterns of its implementation across the states in the six geo-political zones in Nigeria. This study represents an attempt to fill this lacuna in the FLHE literature in Nigeria. Quantitative data was collected from the Federal Ministry of Education and the State Ministries of Education on all salient aspects of FLHE implementation. The findings from data collected in 35 states and the Abuja Federal Capital Territory show large variations in the year of adoption of the programme, level of implementation of the programme, the proportion of implementing schools that are reporting to the coordinating government ministries/agencies, the level to which schools have been supplied with relevant curriculum, and promptness of distribution of materials across the zones. All these indices did not show significant level of interdependence. In general, there were higher levels of FLHE activities in the South than the North. Several problems affect implementation of FLHE in Nigeria, most of which will require increased financial and technical support from government and other organizations. The FLHE programme has had positive effects in the states and among schools where the implementation has been effective, underscoring the need for a more effective implementation of the programmes throughout the country.

Challenges to Implementing Communicable Disease Surveillance in New York City Evacuation Shelters After Hurricane Sandy, November 2012

PubMed Central

Ridpath, Alison D.; Bregman, Brooke; Jones, Lucretia; Reddy, Vasudha; Waechter, HaeNa

2015-01-01

Hurricane Sandy hit New York City (NYC) on October 29, 2012. Before and after the storm, 73 temporary evacuation shelters were established. The total census of these shelters peaked at approximately 6,800 individuals. Concern about the spread of communicable diseases in shelters prompted the NYC Department of Health and Mental Hygiene (DOHMH) to rapidly develop a surveillance system to report communicable diseases and emergency department transports from shelters. We describe the implementation of this system. Establishing effective surveillance in temporary shelters was challenging and required in-person visits by DOHMH staff to ensure reporting. After system establishment, surveillance data were used to identify some potential disease clusters. For the future, we recommend pre-event planning for disease surveillance. PMID:25552754

Reorganizing the General Clinical Research Center to improve the clinical and translational research enterprise.

PubMed

Allen, David; Ripley, Elizabeth; Coe, Antoinette; Clore, John

2013-12-01

In 2010, Virginia Commonwealth University (VCU) was granted a Clinical and Translational Science Award which prompted reorganization and expansion of their clinical research infrastructure. A case study approach is used to describe the implementation of a business and cost recovery model for clinical and translational research and the transformation of VCU's General Clinical Research Center and Clinical Trials Office to a combined Clinical Research Services entity. We outline the use of a Plan, Do, Study, Act cycle that facilitated a thoughtful transition process, which included the identification of required changes and cost recovery processes for implementation. Through this process, the VCU Center for Clinical and Translational Research improved efficiency, increased revenue recovered, reduced costs, and brought a high level of fiscal responsibility through financial reporting.

Interventions that involve parents to improve children's weight-related nutrition intake and activity patterns - what nutrition and activity targets and behaviour change techniques are associated with intervention effectiveness?

PubMed

Golley, R K; Hendrie, G A; Slater, A; Corsini, N

2011-02-01

Parent involvement is an important component of obesity prevention interventions. However, the best way to support parents remains unclear. This review identifies interventions targeting parents to improve children's weight status, dietary and/or activity patterns, examines whether intervention content and behaviour change techniques employed are associated with effectiveness. Seventeen studies, in English, 1998-2008, were included. Studies were evaluated by two reviewers for study quality, nutrition/activity content and behaviour change techniques using a validated quality assessment tool and behaviour change technique taxonomy. Study findings favoured intervention effectiveness in 11 of 17 studies. Interventions that were considered effective had similar features: better study quality, parents responsible for participation and implementation, greater parental involvement and inclusion of prompt barrier identification, restructure the home environment, prompt self-monitoring, prompt specific goal setting behaviour change techniques. Energy intake/density and food choices were more likely to be targeted in effective interventions. The number of lifestyle behaviours targeted did not appear to be associated with effectiveness. Intervention effectiveness was favoured when behaviour change techniques spanned the spectrum of behaviour change process. The review provides guidance for researchers to make informed decisions on how best to utilize resources in interventions to support and engage parents, and highlights a need for improvement in intervention content reporting practices. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.

Promoting Hand Hygiene With a Lighting Prompt.

PubMed

Diegel-Vacek, Lauren; Ryan, Catherine

2016-10-01

The objective of this pilot study was to assess an automatic sink light design intervention as a prompt for clinician hand hygiene (as defined by World Health Organization [WHO]). Healthcare-associated infections (HAIs) are still leading causes of morbidity and mortality and contribute to burdens on our healthcare system. Hand hygiene has been related to reducing the rate of HAIs and positively impacting both patient and hospital outcomes. This pilot study was a prospective, longitudinal observational study of a convenience sample of healthcare clinicians. In one inpatient room, clinicians were exposed to a hand hygiene reminder that consisted of a light turning on over the sink as they entered. A control room (the adjacent inpatient room) did not have the intervention. A total of 88 clinician encounters were monitored during the study. On the first observation day at the initial activation of the signal light system, the percentage of clinicians performing hand hygiene upon entering a room was only 7% in the control room and 23% in the intervention room. During the second observation (Day 14), those percentages were 16% in the control room and 30% in the intervention room. During the third observation (Day 21), those percentages were 23% in the control room and 23% in the intervention room. The healthcare system frequently relies on expensive technology to improve healthcare delivery, but implementation of low-cost, low-technology methods such as this light may be effective in prompting hand hygiene. © The Author(s) 2016.

Using simple technology to prompt multistep tasks in the home for people with dementia: An exploratory study comparing prompting formats.

PubMed

Boyd, Hazel C; Evans, Nina M; Orpwood, Roger D; Harris, Nigel D

2017-05-01

Objectives To investigate the relative effectiveness of different prompts for people with dementia during multistep tasks in the home, to inform prompting technology design. Methods Nine pairs of participants (one with dementia and a partner or relative) participated at home. The participants with mild to moderate dementia (5M/4F, aged 73-86 years) functioned at the Planned or Exploratory levels of the Pool Activity Level instrument. A touchscreen computer displayed different prompts during two set tasks: "card-and-envelope" and "CD player." The trials were scored to establish the relative effectiveness of the prompts. Individual tasks were also explored. Results Text and audio prompts were each more effective than video or picture prompts for a card-and-envelope task, but this was not seen in a CD player task. The differences may be related to the type of actions within the tasks; the card-and-envelope actions were easier to convey verbally; the CD player actions lent themselves to visual prompts. Conclusions Designers of technology-based prompts for people with dementia should consider that the effectiveness of different prompts is likely to be task dependent. Familiar, unambiguous language can increase the success of tailored prompts. There are significant practical challenges associated with choosing and deconstructing everyday tasks at home.

Think twice: A cognitive perspective of an antibiotic timeout intervention to improve antibiotic use.

PubMed

Jones, Makoto; Butler, Jorie; Graber, Christopher J; Glassman, Peter; Samore, Matthew H; Pollack, Lori A; Weir, Charlene; Goetz, Matthew Bidwell

2017-07-01

To understand clinicians' impressions of and decision-making processes regarding an informatics-supported antibiotic timeout program to re-evaluate the appropriateness of continuing vancomycin and piperacillin/tazobactam. We implemented a multi-pronged informatics intervention, based on Dual Process Theory, to prompt discontinuation of unwarranted vancomycin and piperacillin/tazobactam on or after day three in a large Veterans Affairs Medical Center. Two workflow changes were introduced to facilitate cognitive deliberation about continuing antibiotics at day three: (1) teams completed an electronic template note, and (2) a paper summary of clinical and antibiotic-related information was provided to clinical teams. Shortly after starting the intervention, six focus groups were conducted with users or potential users. Interviews were recorded and transcribed. Iterative thematic analysis identified recurrent themes from feedback. Themes that emerged are represented by the following quotations: (1) captures and controls attention ("it reminds us to think about it"), (2) enhances informed and deliberative reasoning ("it makes you think twice"), (3) redirects decision direction ("…because [there was no indication] I just [discontinued] it without even trying"), (4) fosters autonomy and improves team empowerment ("the template… forces the team to really discuss it"), and (5) limits use of emotion-based heuristics ("my clinical concern is high enough I think they need more aggressive therapy…"). Requiring template completion to continue antibiotics nudged clinicians to re-assess the appropriateness of specified antibiotics. Antibiotic timeouts can encourage deliberation on overprescribed antibiotics without substantially curtailing autonomy. An effective nudge should take into account clinician's time, workflow, and thought processes. Published by Elsevier Inc.

Physiologic and psychosocial approaches to global management of the hemodialysis patient in the Southern Alberta Renal Program.

PubMed

Cormier, Tina; Magat, Ofelia; Hager, Suzy; Ng, Fanny; Lee, Miran

2012-01-01

As frontline nurses, we know firsthand the many challenges of renal disease faced by our patients and the impact on their lives and their families. How can we help them cope with their illness? How can we improve their quality of life? How can we prevent the complications inherent to the disease? How do we know we are doing a good job? Where do we start? The purpose of this presentation is to showcase the global management of the hemodialysis (HD) patient. It provides a collaborative and systematic approach to assessing, implementing, evaluating and coordinating the physiologic and the psychosocial aspects of their care. It is a model of case management followed by the Southern Alberta Renal Program (SARP) in meeting the many and complex needs of our hemodialysis patients. The quality indicators, to name a few, that relate to the physiologic aspects of their care are dialysis adequacy and fluid removal, improved blood pressure (BP) control, maintenance and improved vascular access function, anemia, bone and mineral disease management, nutritional, and diabetes management. The psychosocial aspects of care encompass goals of care, residential support, transportation, and mobility programs in the community. There may be positive implications resulting from our practice that we believe would be invaluable in terms of improved patient care, increased adherence to therapeutic regimens, improved mortality and morbidity and overall enhanced quality of life. Moreover, better communication would possibly be fostered and wise and prompt use of resources may be a result. To date, we have not done studies to prove or disprove these outcomes.

Towards a New Strategy for Diagnosis of Congenital Trypanosoma cruzi Infection

PubMed Central

Abras, Alba; Ballart, Cristina; Berenguer, Pere; Llovet, Teresa; Herrero, Mercedes; Tebar, Silvia; Pinazo, María-Jesús; Posada, Elizabeth; Martí, Carmen; Fumadó, Victoria; Bosch, Jordi; Coll, Oriol; Juncosa, Teresa; Ginovart, Gemma; Armengol, Josep; Gascón, Joaquim; Portús, Montserrat; Gállego, Montserrat

2017-01-01

ABSTRACT The immigration of Latin American women of childbearing age has spread the congenital transmission of Chagas disease to areas of nonendemicity, and the disease is now a worldwide problem. Some European health authorities have implemented screening programs to prevent vertical transmission, but the lack of a uniform protocol calls for the urgent establishment of a new strategy common to all laboratories. Our aims were to (i) analyze the trend of passive IgG antibodies in the newborn by means of five serological tests for the diagnosis and follow-up of congenital Trypanosoma cruzi infection, (ii) assess the utility of these techniques for diagnosing a congenital transmission, and (iii) propose a strategy for a prompt, efficient, and cost-effective diagnosis of T. cruzi infection. In noninfected newborns, a continuous decreasing trend of passive IgG antibodies was observed, but none of the serological assays seroreverted in any the infants before 12 months. From 12 months onwards, serological tests achieved negative results in all the samples analyzed, with the exception of the highly sensitive chemiluminescent microparticle immunoassay (CMIA). In contrast, in congenitally infected infants, the antibody decline was detected only after treatment initiation. In order to improve the diagnosis of congenital T. cruzi infection, we propose a new strategy involving fewer tests that allows significant cost savings. The protocol could start 1 month after birth with a parasitological test and/or a PCR. If negative, a serological test would be carried out at 9 months, which if positive, would be followed by another at around 12 months for confirmation. PMID:28202792

Post-disaster health effects: strategies for investigation and data collection. Experiences from the Enschede firework disaster

PubMed Central

Roorda, J; van Stiphout, W A H J; Huijsman-Rubingh, R

2004-01-01

Background: Public health policy is increasingly concerned with the care for victims of a disaster. This article describes the design and implementation of an epidemiological study, which seeks to match care services to the specific problems of persons affected by a large scale incident. The study was prompted by the explosion of a firework depot in Enschede, the Netherlands. Study population: All those directly affected by this incident (residents, emergency services personnel, and people who happened to be in the area at the time), some of whom suffered personal loss or injury. The project investigates both the physical and psychological effects of the disaster, as well as the target group's subsequent call on healthcare services. Study design: A questionnaire based follow up survey of those directly affected and an ongoing monitoring of health problems relying on reports from healthcare professionals. The follow up survey started three weeks after the incident and was repeated 18 months and almost four years after the incident. The monitoring is conducted over a four year period by general practitioners, the local mental health services department, occupational health services, and the youth healthcare services department. It provides ongoing information. Results and Conclusions: The results of the study are regularly discussed with healthcare professionals and policy makers, and are made known to the research participants. The paper also explains the considerations that were made in designing the study to help others making up their research plans when confronted with possible health effects of a disaster. PMID:15547056

Strengthening Head Start Families: Reducing High Risk through Mental Health Prevention/Intervention (MHP/IP). Overview and Final Report.

ERIC Educational Resources Information Center

Hutchison, Mary Ann; And Others

The Mental Health Prevention/Intervention Project (MHP/IP) was designed to provide and assess comprehensive and effective mental health services to Head Start children, parents, families, and staff. Sponsored by the Latin American Civic Association (LACA) in Los Angeles, the 14-month intervention was implemented and assessed on three levels: (1)…

A Demonstration of Individualized Positive Behavior Support Interventions by Head Start Staff to Address Children's Challenging Behavior

ERIC Educational Resources Information Center

Voorhees, Mary D.; Walker, Virginia L.; Snell, Martha E.; Smith, Carol G.

2013-01-01

Following the implementation of Tier 1 and Tier 2 Positive Behavior Support (PBS) strategies in six Head Start (HS) classrooms, three children in two classrooms were identified who had significant behavioral challenges and met the criteria for the use of individualized PBS. The purpose of this demonstration was to evaluate whether the effects of…

Lessons Learned in Dreamland: How a Small Urban Charter School Overcame Start-Up Woes to Increase Reading Scores 28 Percent

ERIC Educational Resources Information Center

Carter, Carolyn J.

2011-01-01

Charter school administrators weathered start-up woes, among them challenging students with unmet needs, verbal assaults, dwindling student enrollment, and a first-year budget deficit exceeding $200,000 to implement a reading improvement strategy that holds promise for helping at-risk students read better, a point particularly underscored…

Conversion from intravenous to oral medications: assessment of a computerized intervention for hospitalized patients.

PubMed

Fischer, Michael A; Solomon, Daniel H; Teich, Jonathan M; Avorn, Jerry

2003-11-24

Many hospitalized patients continue to receive intravenous medications longer than necessary. Earlier conversion from the intravenous to the oral route could increase patient safety and comfort, reduce costs, and facilitate earlier discharge from the hospital without compromising clinical care. We examined the effect of a computer-based intervention to prompt physicians to switch appropriate patients from intravenous to oral medications. This study was performed at Brigham and Women's Hospital, an academic tertiary care hospital at which all medications are ordered online. We targeted 5 medications with equal oral and intravenous bioavailability: fluconazole, levofloxacin, metronidazole, ranitidine, and amiodarone. We used the hospital's computerized order entry system to prompt physicians to convert appropriate intravenous medications to the oral route. We measured the total use of the targeted medications via each route in the 4 months before and after the implementation of the intervention. We also measured the rate at which physicians responded to the intervention when prompted. The average intravenous defined daily dose declined by 11.1% (P =.002) from the preintervention to the postintervention period, while the average oral defined daily dose increased by 3.7% (P =.002). Length of stay, case-mix index, and total drug use at the hospital increased during the study period. The average total monthly use of the intravenous preparation of all of the targeted medications declined in the 4 months after the intervention began, compared with the 4 months before. In 35.6% of 1045 orders for which a prompt was generated, the physician either made a conversion from the intravenous to the oral version or canceled the order altogether. Computer-generated reminders can produce a substantial reduction in excessive use of targeted intravenous medications. As online prescribing becomes more common, this approach can be used to reduce excess use of intravenous medications, with potential benefits in patient comfort, safety, and cost.

Delaying Middle School and High School Start Times Promotes Student Health and Performance: An American Academy of Sleep Medicine Position Statement.

PubMed

Watson, Nathaniel F; Martin, Jennifer L; Wise, Merrill S; Carden, Kelly A; Kirsch, Douglas B; Kristo, David A; Malhotra, Raman K; Olson, Eric J; Ramar, Kannan; Rosen, Ilene M; Rowley, James A; Weaver, Terri E; Chervin, Ronald D

2017-04-15

During adolescence, internal circadian rhythms and biological sleep drive change to result in later sleep and wake times. As a result of these changes, early middle school and high school start times curtail sleep, hamper a student's preparedness to learn, negatively impact physical and mental health, and impair driving safety. Furthermore, a growing body of evidence shows that delaying school start times positively impacts student achievement, health, and safety. Public awareness of the hazards of early school start times and the benefits of later start times are largely unappreciated. As a result, the American Academy of Sleep Medicine is calling on communities, school boards, and educational institutions to implement start times of 8:30 AM or later for middle schools and high schools to ensure that every student arrives at school healthy, awake, alert, and ready to learn. © 2017 American Academy of Sleep Medicine

Effects of implementing electronic medical records on primary care billings and payments: a before-after study.

PubMed

Jaakkimainen, R Liisa; Shultz, Susan E; Tu, Karen

2013-09-01

Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before-after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians' monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Implementation of EMRs by primary care physicians did not result in decreased billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff.

Prompt gamma-ray imaging for small animals

NASA Astrophysics Data System (ADS)

Xu, Libai

Small animal imaging is recognized as a powerful discovery tool for small animal modeling of human diseases, which is providing an important clue to complete understanding of disease mechanisms and is helping researchers develop and test new treatments. The current small animal imaging techniques include positron emission tomography (PET), single photon emission tomography (SPECT), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). A new imaging modality called prompt gamma-ray imaging (PGI) has been identified and investigated primarily by Monte Carlo simulation. Currently it is suggested for use on small animals. This new technique could greatly enhance and extend the present capabilities of PET and SPECT imaging from ingested radioisotopes to the imaging of selected non-radioactive elements, such as Gd, Cd, Hg, and B, and has the great potential to be used in Neutron Cancer Therapy to monitor neutron distribution and neutron-capture agent distribution. This approach consists of irradiating small animals in the thermal neutron beam of a nuclear reactor to produce prompt gamma rays from the elements in the sample by the radiative capture (n, gamma) reaction. These prompt gamma rays are emitted in energies that are characteristic of each element and they are also produced in characteristic coincident chains. After measuring these prompt gamma rays by surrounding spectrometry array, the distribution of each element of interest in the sample is reconstructed from the mapping of each detected signature gamma ray by either electronic collimations or mechanical collimations. In addition, the transmitted neutrons from the beam can be simultaneously used for very sensitive anatomical imaging, which provides the registration for the elemental distributions obtained from PGI. The primary approach is to use Monte Carlo simulation methods either with the specific purpose code CEARCPG, developed at NC State University or with the general purpose codes GEANT4 or MCNP5, to predict results and investigate the feasibility of this new imaging idea. Benchmark experiments have been conducted to test the capability of the code to simulate prompt gamma rays, which are produced by following the nuclear structures of each irradiated isotope, and coincidence counting techniques, which are considered the most important improvement in neutron-related gamma-ray detection applications to reduce gamma background and improve system signal-to-noise ratios. With coincidence prompt gamma rays available, two major imaging techniques, electronic collimations and mechanic collimations, are implemented in the simulation to illustrate the feasibility of imaging elemental distribution by this new technique. The expectation maximization algorithm is employed in electronic collimation to reconstruct images. The common SPECT imaging algorithms are used in mechanical collimation to get an image. Several critical topics concerning practical applications have already been discussed, such as the radiation dose to the mouse and the detection efficiency of high-energy gamma rays. The funding of this work is provided by the Center for Engineering Application of Radioisotopes (CEAR) at North Carolina State University (NCSU) and Nuclear Engineering Education Research.

Using simple technology to prompt multistep tasks in the home for people with dementia: An exploratory study comparing prompting formats

PubMed Central

Evans, Nina M; Orpwood, Roger D; Harris, Nigel D

2015-01-01

Objectives To investigate the relative effectiveness of different prompts for people with dementia during multistep tasks in the home, to inform prompting technology design. Methods Nine pairs of participants (one with dementia and a partner or relative) participated at home. The participants with mild to moderate dementia (5M/4F, aged 73–86 years) functioned at the Planned or Exploratory levels of the Pool Activity Level instrument. A touchscreen computer displayed different prompts during two set tasks: “card-and-envelope” and “CD player.” The trials were scored to establish the relative effectiveness of the prompts. Individual tasks were also explored. Results Text and audio prompts were each more effective than video or picture prompts for a card-and-envelope task, but this was not seen in a CD player task. The differences may be related to the type of actions within the tasks; the card-and-envelope actions were easier to convey verbally; the CD player actions lent themselves to visual prompts. Conclusions Designers of technology-based prompts for people with dementia should consider that the effectiveness of different prompts is likely to be task dependent. Familiar, unambiguous language can increase the success of tailored prompts. There are significant practical challenges associated with choosing and deconstructing everyday tasks at home. PMID:26428634

Effectiveness of an integrated handwriting program for first-grade students: a pilot study.

PubMed

Case-Smith, Jane; Holland, Terri; Bishop, Beth

2011-01-01

We developed and piloted a program for first-grade students to promote development of legible handwriting and writing fluency. The Write Start program uses a coteaching model in which occupational therapists and teachers collaborate to develop and implement a handwriting-writing program. The small-group format with embedded individualized supports allows the therapist to guide and monitor student performance and provide immediate feedback. The 12-wk program was implemented with 1 class of 19 students. We administered the Evaluation of Children's Handwriting Test, Minnesota Handwriting Assessment, and Woodcock-Johnson Fluency and Writing Samples test at baseline, immediately after the Write Start program, and at the end of the school year. Students made large, significant gains in handwriting legibility and speed and in writing fluency that were maintained at 6-mo follow-up. The Write Start program appears to promote handwriting and writing skills in first-grade students and is ready for further study in controlled trials.

Examination of a Regressive Prompt-Delay Procedure for Improving Sight-Word Reading

ERIC Educational Resources Information Center

Daly, Edward J., III.; Hess, Polly M.; Sommerhalder, Mackenzie; Strong, Whitney; Johnsen, Mallory; O'Connor, Maureen A.; Young, Nicholas D.

2016-01-01

The current two-experiment study examined the effects of a regressive prompt-delay procedure on sight-word reading of four elementary school students. In contrast to traditional progressive prompt-delay procedures in which the latency of prompts is increased, the regressive prompt-delay latency is decreased over time. Data indicate that…

Investigating the Effect of Discussion Prompts on Knowledge Construction

ERIC Educational Resources Information Center

Howell, Ginger S.

2014-01-01

The purpose of this study was to examine the effect of Andrews' (1980) three structured divergent prompt designs (Playground prompt, Brainstorm prompt, and Focal prompt) on knowledge construction. Sixty-five online graduate participants at a university in a South Atlantic state were a part of the study. Students' posts were analyzed using the…

A heterogeneous hierarchical architecture for real-time computing

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

Skroch, D.A.; Fornaro, R.J.

The need for high-speed data acquisition and control algorithms has prompted continued research in the area of multiprocessor systems and related programming techniques. The result presented here is a unique hardware and software architecture for high-speed real-time computer systems. The implementation of a prototype of this architecture has required the integration of architecture, operating systems and programming languages into a cohesive unit. This report describes a Heterogeneous Hierarchial Architecture for Real-Time (H{sup 2} ART) and system software for program loading and interprocessor communication.

Microarray Technology for the Diagnosis of Fetal Chromosomal Aberrations: Which Platform Should We Use?

PubMed Central

Karampetsou, Evangelia; Morrogh, Deborah; Chitty, Lyn

2014-01-01

The advantage of microarray (array) over conventional karyotype for the diagnosis of fetal pathogenic chromosomal anomalies has prompted the use of microarrays in prenatal diagnostics. In this review we compare the performance of different array platforms (BAC, oligonucleotide CGH, SNP) and designs (targeted, whole genome, whole genome, and targeted, custom) and discuss their advantages and disadvantages in relation to prenatal testing. We also discuss the factors to consider when implementing a microarray testing service for the diagnosis of fetal chromosomal aberrations. PMID:26237396

Collaborating to improve the use of free-energy and other quantitative methods in drug discovery

NASA Astrophysics Data System (ADS)

Sherborne, Bradley; Shanmugasundaram, Veerabahu; Cheng, Alan C.; Christ, Clara D.; DesJarlais, Renee L.; Duca, Jose S.; Lewis, Richard A.; Loughney, Deborah A.; Manas, Eric S.; McGaughey, Georgia B.; Peishoff, Catherine E.; van Vlijmen, Herman

2016-12-01

In May and August, 2016, several pharmaceutical companies convened to discuss and compare experiences with Free Energy Perturbation (FEP). This unusual synchronization of interest was prompted by Schrödinger's FEP+ implementation and offered the opportunity to share fresh studies with FEP and enable broader discussions on the topic. This article summarizes key conclusions of the meetings, including a path forward of actions for this group to aid the accelerated evaluation, application and development of free energy and related quantitative, structure-based design methods.

Thermodynamic effects of single-qubit operations in silicon-based quantum computing

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

Lougovski, Pavel; Peters, Nicholas A.

Silicon-based quantum logic is a promising technology to implement universal quantum computing. It is widely believed that a millikelvin cryogenic environment will be necessary to accommodate silicon-based qubits. This prompts a question of the ultimate scalability of the technology due to finite cooling capacity of refrigeration systems. In this work, we answer this question by studying energy dissipation due to interactions between nuclear spin impurities and qubit control pulses. Furthermore, we demonstrate that this interaction constrains the sustainable number of single-qubit operations per second for a given cooling capacity.

Thermodynamic effects of single-qubit operations in silicon-based quantum computing

DOE PAGES

Lougovski, Pavel; Peters, Nicholas A.

2018-05-21

Silicon-based quantum logic is a promising technology to implement universal quantum computing. It is widely believed that a millikelvin cryogenic environment will be necessary to accommodate silicon-based qubits. This prompts a question of the ultimate scalability of the technology due to finite cooling capacity of refrigeration systems. In this work, we answer this question by studying energy dissipation due to interactions between nuclear spin impurities and qubit control pulses. Furthermore, we demonstrate that this interaction constrains the sustainable number of single-qubit operations per second for a given cooling capacity.

The Effect of Extra Small Group Session during PBL Implementation on Student's Achievement

ERIC Educational Resources Information Center

Khalil, Mahmoud Salah; Al Rukban, Mohammad Othman

2010-01-01

Problem based learning (PBL) started to spread in health professions in Saudi Arabia at the beginning of this century. There are several challenges facing its implementation such as defects on interpersonal communications and self-directed learning. These challenges would affect students' performance in small group discussions and their…

Improving the Pro-Social Skills of Transitioning Urban Youth: A Summer Camp Approach

ERIC Educational Resources Information Center

Allen, Korrie; Akinyanju, Kim; Milliken, Tammi; Lorek, Edward; Walker, Tamu Thomas

2011-01-01

School systems often implement character education initiatives in reaction to a violent event. Following the school shootings that occurred in the 1990s, many school systems started to implement character education and violence prevention programs. Unfortunately, because the efforts were reactive, little thought was given to sustainability…

Head Start Teachers' Perceptions of Implementing Classroom Positive Behavior Support: Insights for Teacher Training

ERIC Educational Resources Information Center

Novetsky, Jason S.

2009-01-01

Younger children are demonstrating increasingly more serious problem behaviors (Walker, 1998). The present study concerned further investigation of early implementation of a promising behavior management model known as Positive Behavior Support (PBS). PBS has been shown to be successful in elementary and secondary schools (Metzler, Biglan, &…

Best Practice in Using Business Intelligence to Determine Research Strategy

ERIC Educational Resources Information Center

Green, John; Rutherford, Scott; Turner, Thomas

2009-01-01

The authors recognise that there is no "one-size-fits-all" approach to implementing business intelligence strategy within universities. Elements of best practice have been taken from a case study of Imperial College, which may be applied across other institutions. The process starts with implementing and developing systems that capture…

How Principals and Teachers Respond to States' Accountability Systems

ERIC Educational Resources Information Center

Lee, Hyemi

2013-01-01

Since the 1990s, many states have started implementing standards-based reforms and developed their own accountability systems. Each state established academic content and performance standards, implemented test for all the students in grades 3 through 8 annually, and set up annual measurable objectives in reading and mathematics for districts,…

Implementing a National Qualifications Framework in Lithuania

ERIC Educational Resources Information Center

Tutlys, Vidmantas; Spudyte, Irma

2011-01-01

The design of the national qualifications framework (NQF) in Lithuania started in 2006. The NQF was officially approved by the government decree in May 2010. This article explores the influence of the processes of institutional change on the reform of the national system of qualifications in Lithuania through the implementation of the NQF, looking…

A Coordinated Patient Transport System for ICU Patients Requiring Surgery: Impact on Operating Room Efficiency and ICU Workflow.

PubMed

Brown, Michael J; Kor, Daryl J; Curry, Timothy B; Marmor, Yariv; Rohleder, Thomas R

2015-01-01

Transfer of intensive care unit (ICU) patients to the operating room (OR) is a resource-intensive, time-consuming process that often results in patient throughput inefficiencies, deficiencies in information transfer, and suboptimal nurse to patient ratios. This study evaluates the implementation of a coordinated patient transport system (CPTS) designed to address these issues. Using data from 1,557 patient transfers covering the 2006-2010 period, interrupted time series and before and after designs were used to analyze the effect of implementing a CPTS at Mayo Clinic, Rochester. Using a segmented regression for the interrupted time series, on-time OR start time deviations were found to be significantly lower after the implementation of CPTS (p < .0001). The implementation resulted in a fourfold improvement in on-time OR starts (p < .01) while significantly reducing idle OR time (p < .01). A coordinated patient transfer process for moving patient from ICUs to ORs can significantly improve OR efficiency, reduce nonvalue added time, and ensure quality of care by preserving appropriate care provider to patient ratios.

Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study.

PubMed

Ray-Barruel, Gillian; Cooke, Marie; Mitchell, Marion; Chopra, Vineet; Rickard, Claire M

2018-06-04

Millions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%-50% of intravenous (IV) catheters develop complications or stop working before treatment is finished, requiring the insertion of a new device. Improved assessment could prompt timely removal of redundant catheters and prevent IV complications. This study aims to validate an evidence-based PIVC assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice. The protocol outlines a prospective, multicentre, mixed-methods study using an interrupted time-series (multiple measures preintervention and postintervention) implementation at three Australian hospitals between August 2017 and July 2018. The study will examine the effectiveness of the I-DECIDED assessment and decision-making tool in clinical practice on prompting timely PIVC removal and early detection of complications. Primary outcomes are prevalence of redundant PIVCs (defined as device in situ without a clear purpose), IV complications (occlusion, dislodgement, infiltration, extravasation and phlebitis) and substandard dressings (loose, lifting, moist or soiled); device utilisation ratios; and primary bloodstream infection rates. Secondary outcomes including staff barriers and enablers to PIVC assessment and removal, patient participation, documentation of PIVC assessment and decisions taken to continue or remove the PIVC will be recorded. Using the Promoting Action on Research Implementation in Health Services framework, we will undertake staff focus groups, bedside patient interviews and PIVC assessments and chart audits. Patients aged 18 years or more with a PIVC will be eligible for inclusion. Ethical approval from Queensland Health (HREC/17/QPCH/47), Griffith University (Ref No. 2017/152) and St Vincent's Health and Aged Care Human Research and Ethics Committee (Ref No. 17/28). Results will be published. ANZCTR: 12617000067370; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Interviews of Children in a Portuguese Special Judicial Procedure.

PubMed

Peixoto, Carlos Eduardo; Fernandes, Raquel Veludo; Almeida, Telma Sousa; Silva, Júlia Marina; La Rooy, David; Ribeiro, Catarina; Magalhães, Teresa; Lamb, Michael E

2017-05-01

Since 2007, alleged victims of child sexual abuse in Portugal have provided evidence in a mandatory "Declarações para Memória Futura" (DMF; English transl. 'Statement for future use') proceeding. In order to protect children from having to testify in court, interviews conducted at the DMF can be used later as trial evidence because the hearings are conducted by judges. The present study examined 137 interviews with 3- to 17-year-olds conducted in several Portuguese criminal courts. Detailed examination of interview transcripts showed that 69% of all questions asked were option-posing questions, 16% were directive questions, 11% were suggestive questions, and only 3% were open-ended prompts. The vast majority of details provided by children were thus obtained using the risky recognition-based prompts (i.e., option posing and suggestive questions) associated with the risks of contaminating and limiting children's informativeness, both potential threats to the credibility of their testimony. There is an urgent need to address this issue and consider the implementation of a scientifically validated structured interview protocol in Portugal. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Twins prematurity--the influence of prenatal surveillance.

PubMed

Domingues, Ana Patrícia; Fonseca, Etelvina; Belo, Adriana; Moura, Paulo

2015-06-01

To evaluate the influence of the local prenatal surveillance of twin pregnancies in the obstetrical results. A prospective cohort study of multiple pregnancies delivered over a period of 16 years in a tertiary centre was conducted. In this study 861 twin pregnancies were included. They were compared for obstetric complications, gestational age at delivery, mode of delivery and birthweight, according to the place of the surveillance. Of the 861 cases examined, the following obstetric complications were significantly different: metrorrhagia (p = 0.039), infections (p < 0.001), HELLP (p = 0.007), PROMPT (p < 0.001) and fetal death (p = 0.024). The mode of delivery was similar but occurred mostly ≤32 weeks (p < 0.001), the birthweight was mostly <2000 g and occurred more NICU admission (p < 0.001) when surveillance was outside the MPC-MDM. Our results demonstrate the crucial importance of prenatal surveillance be carried in a differentiated referral centers with specific/strict protocols or the urgent implementation of same protocols in all other places of surveillance, since this straight surveillance greatly reduces the occurrence of prenatal complications, mainly PROMPT, PTD.

Prompt directional detection of galactic supernova by combining large liquid scintillator neutrino detectors

NASA Astrophysics Data System (ADS)

Fischer, V.; Chirac, T.; Lasserre, T.; Volpe, C.; Cribier, M.; Durero, M.; Gaffiot, J.; Houdy, T.; Letourneau, A.; Mention, G.; Pequignot, M.; Sibille, V.; Vivier, M.

2015-08-01

Core-collapse supernovae produce an intense burst of electron antineutrinos in the few-tens-of-MeV range. Several Large Liquid Scintillator-based Detectors (LLSD) are currently operated worldwide, being very effective for low energy antineutrino detection through the Inverse Beta Decay (IBD) process. In this article, we develop a procedure for the prompt extraction of the supernova location by revisiting the details of IBD kinematics over the broad energy range of supernova neutrinos. Combining all current scintillator-based detector, we show that one can locate a canonical supernova at 10 kpc with an accuracy of 45 degrees (68% C.L.). After the addition of the next generation of scintillator-based detectors, the accuracy could reach 12 degrees (68% C.L.), therefore reaching the performances of the large water Čerenkov neutrino detectors. We also discuss a possible improvement of the SuperNova Early Warning System (SNEWS) inter-experiment network with the implementation of a directionality information in each experiment. Finally, we discuss the possibility to constrain the neutrino energy spectrum as well as the mass of the newly born neutron star with the LLSD data.

Communication modality sampling for a toddler with Angelman syndrome.

PubMed

Hyppa Martin, Jolene; Reichle, Joe; Dimian, Adele; Chen, Mo

2013-10-01

Vocal, gestural, and graphic communication modes were implemented concurrently with a toddler with Angelman syndrome to identify the most efficiently learned communication mode to emphasize in an initial augmentative communication system. Symbols representing preferred objects were introduced in vocal, gestural, and graphic communication modes using an alternating treatment single-subject experimental design. Conventionally accepted prompting strategies were used to teach symbols in each communication mode. Because the learner did not vocally imitate, vocal mode intervention focused on increasing vocal frequency as an initial step. When graphic and gestural mode performances were compared, the learner most accurately produced requests in graphic mode (percentage of nonoverlapping data = 96). Given the lack of success in prompting vocal productions, a comparison between vocal and the other two communication modes was not made. A growing body of evidence suggests that concurrent modality sampling is a promising low-inference, data-driven procedure that can be used to inform selection of a communication mode(s) for initial emphasis with young children. Concurrent modality sampling can guide clinical decisions regarding the allocation of treatment resources to promote success in building an initial communicative repertoire.

Observed assertive and intrusive maternal feeding behaviors increase child adiposity123

PubMed Central

Ozbeki, Tina N; Appugliese, Danielle P; Kaciroti, Niko; Corwyn, Robert F; Bradley, Robert H

2012-01-01

Background: Few studies have examined observed maternal feeding behaviors and their potential association with child adiposity. The association between maternal prompting to eat and child adiposity has been inconsistent. Objectives: This study sought to identify factors associated with maternal feeding behaviors and to test the hypothesis that more maternal prompts to eat, more assertive prompts, and more intrusiveness are associated with greater child adiposity. Design: Children (n = 1218) and their mothers were videotaped eating a standardized snack at ages 15, 24, and 36 mo. Maternal prompts to eat, the percentage of prompts that were assertive, and intrusiveness were coded. Adjusted regression analyses evaluated predictors of prompts, the percentage of assertive prompts, and intrusiveness and the relation of each of these factors with child adiposity (weight-for-length z score at 15 mo and BMI z score at 24 and 36 mo) after control for the child's race-ethnicity and sex, family income-to-needs ratio, and maternal education, weight status, and depressive symptoms. Results: At 36 mo, mothers gave an average of 9.3 prompts; 61% of prompts were assertive, and 48% of mothers were intrusive. Lower maternal education and minority race-ethnicity were associated with a greater percentage of assertive prompts and intrusiveness. A greater percentage of assertive prompts and intrusiveness, but not total prompts, was associated with higher child adiposity. Conclusions: Assertive prompting and an intrusive style had small but significant associations with greater child adiposity. Future work should focus on maternal motivations for assertive and intrusive feeding styles and mechanisms through which these feeding styles might increase child adiposity. PMID:22277552

Tools to overcome potential barriers to chlamydia screening in general practice: Qualitative evaluation of the implementation of a complex intervention.

PubMed

Ricketts, Ellie J; Francischetto, Elaine O'Connell; Wallace, Louise M; Hogan, Angela; McNulty, Cliodna A M

2016-03-22

Chlamydia trachomatis remains a significant public health problem. We used a complex intervention, with general practice staff, consisting of practice based workshops, posters, computer prompts and testing feedback and feedback to increase routine chlamydia screening tests in under 25 year olds in South West England. We aimed to evaluate how intervention components were received by staff and to understand what determined their implementation into ongoing practice. We used face-to-face and telephone individual interviews with 29 general practice staff analysed thematically within a Normalisation Process Theory Framework which explores: 1. Coherence (if participants understand the purpose of the intervention); 2. Cognitive participation (engagement with and implementation of the intervention); 3. Collective action (work actually undertaken that drives the intervention forwards); 4. Reflexive monitoring (assessment of the impact of the intervention). Our results showed coherence as all staff including receptionists understood the purpose of the training was to make them aware of the value of chlamydia screening tests and how to increase this in their general practice. The training was described by nearly all staff as being of high quality and responsible for creating a shared understanding between staff of how to undertake routine chlamydia screening. Cognitive participation in many general practice staff teams was demonstrated through their engagement by meeting after the training to discuss implementation, which confirmed the role of each staff member and the use of materials. However several participants still felt unable to discuss chlamydia in many consultations or described sexual health as low priority among colleagues. National targets were considered so high for some general practice staff that they didn't engage with the screening intervention. Collective action work undertaken to drive the intervention included use of computer prompts which helped staff remember to make the offer, testing rate feedback and having a designated lead. Ensuring patients collected samples when still in the general practice was not attained in most general practices. Reflexive monitoring showed positive feedback from patients and other staff about the value of screening, and feedback about the general practices testing rates helped sustain activity. A complex intervention including interactive workshops, materials to help implementation and feedback can help chlamydia screening testing increase in general practices.

Improving palliative care provision in primary care: a pre- and post-survey evaluation among PaTz groups.

PubMed

van der Plas, Annicka Gm; Pasman, H Roeline W; Schweitzer, Bart; Onwuteaka-Philipsen, Bregje D

2018-05-01

In PaTz (PAlliatieve Thuis Zorg, palliative care at home), modelled after the Gold Standards Framework, GPs and community nurses meet on a regular basis to identify patients with palliative care needs (the PaTz register), and to discuss care for these patients. To study the effects of the implementation of PaTz, and provide additional analyses on two important elements: the PaTz register and patient discussions. A pre- and post-evaluation among Dutch GPs ( n = 195 before the start of PaTz; n = 166, 1 year after the start of PaTz). The GPs also provided data on recently deceased patients ( n = 460 before the start of PaTz; n = 305 14 months after the start of PaTz). GPs from all 37 PaTz groups filled in questionnaires. Pre- and post-test differences were analysed using multilevel analyses to adjust for PaTz group. Identification of patients with palliative care needs was done systematically for more patients after implementation of PaTz compared with before (54.3% versus 17.6%). After implementation, 64.8% of deceased patients had been included on the PaTz register. For these patients, when compared with patients not included on the PaTz register, preferred place of death was more likely to be known (88.1% of patients not on the register and 97.3% of deceased patients included on the register), GPs were more likely to have considered a possible death sooner (>1 month before death: 53.0% and 80.2%), and conversations on life expectancy, physical complaints, existential issues, and possibilities of care occurred more often (60.8% and 81.3%; 68.6% and 86.1%; 22.5% and 34.2%; 60.8% and 84.0%, respectively). Implementation of PaTz improved systematic identification of palliative care patients within the GP practice. Use of the PaTz register has added value. © British Journal of General Practice 2018.

Engaging Young Students in Scientific Investigations: Prompting for Meaningful Reflection

ERIC Educational Resources Information Center

Wilson, Travis; Perry, Michelle; Anderson, Carolyn J.; Grosshandler, Dean

2012-01-01

This study examined the verbal prompts a tutor used to promote reflection and young students' responses to these prompts. Seven children (ages 8-12) participated in 260 min of one-on-one tutoring to learn scientific concepts related to gear movement; the tutor spontaneously provided these students with 763 prompts for reflection. Prompts reliably…

The Use of Picture Prompts and Prompt Delay to Teach Receptive Labeling

ERIC Educational Resources Information Center

Vedora, Joseph; Barry, Tiffany

2016-01-01

The current study extended research on picture prompts by using them with a progressive prompt delay to teach receptive labeling of pictures to 2 teenagers with autism. The procedure differed from prior research because the auditory stimulus was not presented or was presented only once during the picture-prompt condition. The results indicated…

A Comparison of Two Prompting Procedures for Teaching Basic Skills to Children with Autism

ERIC Educational Resources Information Center

Fentress, Genevieve M.; Lerman, Dorothea C.

2012-01-01

We compared two prompting techniques that are commonly used to teach individuals with autism. In the "most-to-least" (MTL) prompting condition, the therapist initially delivered the most intrusive prompt necessary to achieve a correct response. Prompts were gradually faded across subsequent trials, while errors resulted in the provision of…

Developmental milestones across the programmatic life cycle: implementing the CDC's Colorectal Cancer Screening Demonstration Program.

PubMed

Glover-Kudon, Rebecca; DeGroff, Amy; Rohan, Elizabeth A; Preissle, Judith; Boehm, Jennifer E

2013-08-01

In 2005 through 2009, the Centers for Disease Control and Prevention (CDC) funded 5 sites to implement a colorectal cancer screening program for uninsured, low-income populations. These 5 sites composed a demonstration project intended to explore the feasibility of establishing a national colorectal cancer screening program through various service delivery models. A longitudinal, multiple case study was conducted to understand and document program implementation processes. Using metaphor as a qualitative analytic technique, evaluators identified stages of maturation across the programmatic life cycle. Analysis rendered a working theory of program development during screening implementation. In early stages, program staff built relationships with CDC and local partners around screening readiness, faced real-world challenges putting program policies into practice, revised initial program designs, and developed new professional skills. Midterm implementation was defined by establishing program cohesiveness and expanding programmatic reach. In later stages of implementation, staff focused on sustainability and formal program closeout, which prompted reflection about personal and programmatic accomplishments. Demonstration sites evolved through common developmental stages during screening implementation. Findings elucidate ways to target technical assistance to more efficiently move programs along their maturation trajectory. In practical terms, the time and cost associated with guiding a program to maturity may be potentially shortened to maximize return on investment for both organizations and clients receiving service benefits. © 2013 American Cancer Society.

Impact Findings from the Head Start CARES Demonstration: National Evaluation of Three Approaches to Improving Preschoolers' Social and Emotional Competence. Executive Summary. OPRE Report 2014-44

ERIC Educational Resources Information Center

Morris, Pamela; Mattera, Shira K.; Castells, Nina; Bangser, Michael; Bierman, Karen; Raver, Cybele

2014-01-01

Low-income preschool children face risks to their social-emotional development that can affect them later on. Although there are promising approaches to promoting preschoolers' social-emotional skills, the evidence base is limited, particularly on their effectiveness when implemented at scale. The Head Start CARES demonstration evaluated the…

Healthy Start Programa Madrina: A Promotora Home Visiting Outreach and Education Program to Improve Perinatal Health among Latina Pregnant Women

ERIC Educational Resources Information Center

Bill, Debra E.; Hock-Long, Linda; Mesure, Maryann; Bryer, Pamela; Zambrano, Neydary

2009-01-01

The purpose of this article is to describe the development, implementation, and evaluation of Healthy Start Programa Madrina (HSPM), a home visiting promotora outreach and education program for Latina pregnant women and to present the 10-year findings of the program (1996-2005). Perinatal health disparities continue to persist among low-income…

Prompt remediation of water intrusion corrects the resultant mold contamination in a home.

PubMed

Rockwell, William

2005-01-01

More patients are turning to their allergists with symptoms compatible with allergic rhinitis, allergic sinusitis, and/or bronchial asthma after exposure to mold-contaminated indoor environments. These patients often seek guidance from their allergists in the remediation of the contaminated home or office. The aim of this study was to determine baseline mold spore counts for noncontaminated homes and report a successful mold remediation in one mold-contaminated home. Indoor air quality was tested using volumetric spore counts in 50 homes where homeowners reported no mold-related health problems and in one mold-contaminated home that was remediated. The health of the occupant of the mold-contaminated home also was assessed. Indoor volumetric mold spore counts ranged from 300 to 1200 spores/m3 in the baseline homes. For the successful remediation, the mold counts started at 300 spores/m3, increased to 2800 spores/m3 at the height of the mold contamination, and then fell to 800 spores/m3 after remediation. The occupant's allergic symptoms ceased on complete remediation of the home. Indoor volumetric mold counts taken with the Allergenco MK-3 can reveal a potential indoor mold contamination, with counts above 1000 spores/m3 suggesting indoor mold contamination. Once the presence of indoor mold growth is found, a prompt and thorough remediation can bring mold levels back to near-baseline level and minimize negative health effects for occupants.