The kunitz protease inhibitor domain of protease nexin-2 inhibits factor XIa and murine carotid artery and middle cerebral artery thrombosis

PubMed Central

Wu, Wenman; Li, Hongbo; Navaneetham, Duraiswamy; Reichenbach, Zachary W.; Tuma, Ronald F.

2012-01-01

Coagulation factor XI (FXI) plays an important part in both venous and arterial thrombosis, rendering FXIa a potential target for the development of antithrombotic therapy. The kunitz protease inhibitor (KPI) domain of protease nexin-2 (PN2) is a potent, highly specific inhibitor of FXIa, suggesting its possible role in the inhibition of FXI-dependent thrombosis in vivo. Therefore, we examined the effect of PN2KPI on thrombosis in the murine carotid artery and the middle cerebral artery. Intravenous administration of PN2KPI prolonged the clotting time of both human and murine plasma, and PN2KPI inhibited FXIa activity in both human and murine plasma in vitro. The intravenous administration of PN2KPI into WT mice dramatically decreased the progress of FeCl3-induced thrombus formation in the carotid artery. After a similar initial rate of thrombus formation with and without PN2KPI treatment, the propagation of thrombus formation after 10 minutes and the amount of thrombus formed were significantly decreased in mice treated with PN2KPI injection compared with untreated mice. In the middle cerebral artery occlusion model, the volume and fraction of ischemic brain tissue were significantly decreased in PN2KPI-treated compared with untreated mice. Thus, inhibition of FXIa by PN2KPI is a promising approach to antithrombotic therapy. PMID:22674803

Kunitz Proteinase Inhibitors Limit Water Stress Responses in White Clover (Trifolium repens L.) Plants.

PubMed

Islam, Afsana; Leung, Susanna; Nikmatullah, Aluh; Dijkwel, Paul P; McManus, Michael T

2017-01-01

The response of plants to water deficiency or drought is a complex process, the perception of which is triggered at the molecular level before any visible morphological responses are detected. It was found that different groups of plant proteinase inhibitors (PIs) are induced and play an active role during abiotic stress conditions such as drought. Our previous work with the white clover ( Trifolium repens L.) Kunitz Proteinase Inhibitor ( Tr-KPI ) gene family showed that Tr-KPIs are differentially regulated to ontogenetic and biotic stress associated cues and that, at least some members of this gene family may be required to maintain cellular homeostasis. Altered cellular homeostasis may also affect abiotic stress responses and therefore, we aimed to understand if distinct Tr-PKI members function during drought stress. First, the expression level of three Tr-KPI genes, Tr-KPI1 , Tr-KPI2 , and Tr-KPI5 , was measured in two cultivars and one white clover ecotype with differing capacity to tolerate drought. The expression of Tr-KPI1 and Tr-KPI5 increased in response to water deficiency and this was exaggerated when the plants were treated with a previous period of water deficiency. In contrast, proline accumulation and increased expression of Tr-NCED1 , a gene encoding a protein involved in ABA biosynthesis, was delayed in plants that experienced a previous drought period. RNAi knock-down of Tr-KPI1 and Tr-KPI5 resulted in increased proline accumulation in leaf tissue of plants grown under both well-watered and water-deficit conditions. In addition, increased expression of genes involved in ethylene biosynthesis was found. The data suggests that Tr-KPIs , particularly Tr-KPI5 , have an explicit function during water limitation. The results also imply that the Tr-KPI family has different in planta proteinase targets and that the functions of this protein family are not solely restricted to one of storage proteins or in response to biotic stress.

Kunitz Proteinase Inhibitors Limit Water Stress Responses in White Clover (Trifolium repens L.) Plants

PubMed Central

Islam, Afsana; Leung, Susanna; Nikmatullah, Aluh; Dijkwel, Paul P.; McManus, Michael T.

2017-01-01

The response of plants to water deficiency or drought is a complex process, the perception of which is triggered at the molecular level before any visible morphological responses are detected. It was found that different groups of plant proteinase inhibitors (PIs) are induced and play an active role during abiotic stress conditions such as drought. Our previous work with the white clover (Trifolium repens L.) Kunitz Proteinase Inhibitor (Tr-KPI) gene family showed that Tr-KPIs are differentially regulated to ontogenetic and biotic stress associated cues and that, at least some members of this gene family may be required to maintain cellular homeostasis. Altered cellular homeostasis may also affect abiotic stress responses and therefore, we aimed to understand if distinct Tr-PKI members function during drought stress. First, the expression level of three Tr-KPI genes, Tr-KPI1, Tr-KPI2, and Tr-KPI5, was measured in two cultivars and one white clover ecotype with differing capacity to tolerate drought. The expression of Tr-KPI1 and Tr-KPI5 increased in response to water deficiency and this was exaggerated when the plants were treated with a previous period of water deficiency. In contrast, proline accumulation and increased expression of Tr-NCED1, a gene encoding a protein involved in ABA biosynthesis, was delayed in plants that experienced a previous drought period. RNAi knock-down of Tr-KPI1 and Tr-KPI5 resulted in increased proline accumulation in leaf tissue of plants grown under both well-watered and water-deficit conditions. In addition, increased expression of genes involved in ethylene biosynthesis was found. The data suggests that Tr-KPIs, particularly Tr-KPI5, have an explicit function during water limitation. The results also imply that the Tr-KPI family has different in planta proteinase targets and that the functions of this protein family are not solely restricted to one of storage proteins or in response to biotic stress. PMID:29046678

Functional characterization and novel rickettsiostatic effects of a Kunitz-type serine protease inhibitor from the tick Dermacentor variabilis.

PubMed

Ceraul, Shane M; Dreher-Lesnick, Sheila M; Mulenga, Albert; Rahman, M Sayeedur; Azad, Abdu F

2008-11-01

Here we report the novel bacteriostatic function of a five-domain Kunitz-type serine protease inhibitor (KPI) from the tick Dermacentor variabilis. As ticks feed, they release anticoagulants, anti-inflammatory and immunosuppressive molecules that mediate the formation of the feeding lesion on the mammalian host. A number of KPIs have been isolated and characterized from tick salivary gland extracts. Interestingly, we observe little D. variabilis KPI gene expression in the salivary gland and abundant expression in the midgut. However, our demonstration of D. variabilis KPI's anticoagulant properties indicates that D. variabilis KPI may be important for blood meal digestion in the midgut. In addition to facilitating long-term attachment and blood meal acquisition, gene expression studies of Drosophila, legumes, and ticks suggest that KPIs play some role in the response to microbial infection. Similarly, in this study, we show that challenge of D. variabilis with the spotted fever group rickettsia, Rickettsia montanensis, results in sustained D. variabilis KPI gene expression in the midgut. Furthermore, our in vitro studies show that D. variabilis KPI limits rickettsial colonization of L929 cells (mouse fibroblasts), implicating D. variabilis KPI as a bacteriostatic protein, a property that may be related to D. variabilis KPI's trypsin inhibitory capability. This work suggests that anticoagulants play some role in the midgut during feeding and that D. variabilis KPI may be involved as part of the tick's defense response to rickettsiae.

Functional Characterization and Novel Rickettsiostatic Effects of a Kunitz-Type Serine Protease Inhibitor from the Tick Dermacentor variabilis▿

PubMed Central

Ceraul, Shane M.; Dreher-Lesnick, Sheila M.; Mulenga, Albert; Rahman, M. Sayeedur; Azad, Abdu F.

2008-01-01

Here we report the novel bacteriostatic function of a five-domain Kunitz-type serine protease inhibitor (KPI) from the tick Dermacentor variabilis. As ticks feed, they release anticoagulants, anti-inflammatory and immunosuppressive molecules that mediate the formation of the feeding lesion on the mammalian host. A number of KPIs have been isolated and characterized from tick salivary gland extracts. Interestingly, we observe little D. variabilis KPI gene expression in the salivary gland and abundant expression in the midgut. However, our demonstration of D. variabilis KPI's anticoagulant properties indicates that D. variabilis KPI may be important for blood meal digestion in the midgut. In addition to facilitating long-term attachment and blood meal acquisition, gene expression studies of Drosophila, legumes, and ticks suggest that KPIs play some role in the response to microbial infection. Similarly, in this study, we show that challenge of D. variabilis with the spotted fever group rickettsia, Rickettsia montanensis, results in sustained D. variabilis KPI gene expression in the midgut. Furthermore, our in vitro studies show that D. variabilis KPI limits rickettsial colonization of L929 cells (mouse fibroblasts), implicating D. variabilis KPI as a bacteriostatic protein, a property that may be related to D. variabilis KPI's trypsin inhibitory capability. This work suggests that anticoagulants play some role in the midgut during feeding and that D. variabilis KPI may be involved as part of the tick's defense response to rickettsiae. PMID:18779339

The kunitz protease inhibitor form of the amyloid precursor protein (KPI/APP) inhibits the proneuropeptide processing enzyme prohormone thiol protease (PTP). Colocalization of KPI/APP and PTP in secretory vesicles.

PubMed

Hook, V Y; Sei, C; Yasothornsrikul, S; Toneff, T; Kang, Y H; Efthimiopoulos, S; Robakis, N K; Van Nostrand, W

1999-01-29

Proteolytic processing of proenkephalin and proneuropeptides is required for the production of active neurotransmitters and peptide hormones. Variations in the extent of proenkephalin processing in vivo suggest involvement of endogenous protease inhibitors. This study demonstrates that "protease nexin 2 (PN2)," the secreted form of the kunitz protease inhibitor (KPI) of the amyloid precursor protein (APP), potently inhibited the proenkephalin processing enzyme known as prohormone thiol protease (PTP), with a Ki,app of 400 nM. Moreover, PTP and PN2 formed SDS-stable complexes that are typical of kunitz protease inhibitor interactions with target proteases. In vivo, KPI/APP (120 kDa), as well as a truncated form of KPI/APP that resembles PN2 in apparent molecular mass (110 kDa), were colocalized with PTP and (Met)enkephalin in secretory vesicles of adrenal medulla (chromaffin granules). KPI/APP (110-120 kDa) was also detected in pituitary secretory vesicles that contain PTP. In chromaffin cells, calcium-dependent secretion of KPI/APP with PTP and (Met)enkephalin demonstrated the colocalization of these components in functional secretory vesicles. These results suggest a role for KPI/APP inhibition of PTP in regulated secretory vesicles. In addition, these results are the first to identify an endogenous protease target of KPI/APP, which is developmentally regulated in aging and Alzheimer's disease.

A novel transmembrane Ser/Thr kinase complexes with protein phosphatase-1 and inhibitor-2.

PubMed

Wang, Hong; Brautigan, David L

2002-12-20

Protein kinases and protein phosphatases exert coordinated control over many essential cellular processes. Here, we describe the cloning and characterization of a novel human transmembrane protein KPI-2 (Kinase/Phosphatase/Inhibitor-2) that was identified by yeast two-hybrid using protein phosphatase inhibitor-2 (Inh2) as bait. KPI-2 mRNA was predominantly expressed in skeletal muscle. KPI-2 is a 1503-residue protein with two predicted transmembrane helices at the N terminus, a kinase domain, followed by a C-terminal domain. The transmembrane helices were sufficient for targeting proteins to the membrane. KPI-2 kinase domain has about 60% identity with its closest relative, a tyrosine kinase. However, it only exhibited serine/threonine kinase activity in autophosphorylation reactions or with added substrates. KPI-2 kinase domain phosphorylated protein phosphatase-1 (PP1C) at Thr(320), which attenuated PP1C activity. KPI-2 C-terminal domain directly associated with PP1C, and this required a VTF motif. Inh2 associated with KPI-2 C-terminal domain with and without PP1C. Thus, KPI-2 is a kinase with sites to associate with PP1C and Inh2 to form a regulatory complex that is localized to membranes.

Accuracy of national key performance indicator reporting from two Aboriginal medical services: potential to underestimate the performance of primary health care.

PubMed

2017-05-09

Objective The aim of the present study was to assess the accuracy of extracting national key performance indicator (nKPI) data for the Online Community Health Reporting Environment for Health Services (OCHREStreams) program using the Pen Computer Systems (Leichhardt, NSW, Australia) Clinical Audit Tool (CAT) from Communicare (Telstra Health Communicare Systems, Perth, WA, Australia), a commonly used patient information management system (PIMS) in Aboriginal primary care. Methods Two Aboriginal Community-Controlled Health Services (ACCHSs) were recruited to the present study. A sample of regular clients aged ≥55 years from each ACCHS was selected and a subset of 13 nKPIs was examined. A manual case note audit of the nKPI subset within Communicare was undertaken by a clinician at each participating ACCHS and acted as a 'gold standard' comparator for three query methods: (1) internal Communicare nKPI reports; (2) PenCS CAT nKPI manual filtering (a third-party data-extraction tool); and (3) nKPI data submitted to the Improvement Foundation qiConnect portal. Results No errors were found in nKPI data extraction from Communicare using the CAT and subsequent submission to the qiConnect portal. However, the Communicare internal nKPI report included deceased clients and past patients, and we can be very confident that deceased clients and past patients are also included in the qiConnect portal data. This resulted in inflation of client denominators and an underestimation of health service performance, particularly for nKPIs recording activity in the past 6 months. Several minor errors were also detected in Communicare internal nKPI reports. Conclusions CAT accurately extracts a subset of nKPI data from Communicare. However, given the widespread use of Communicare in ACCHSs, the inclusion of deceased clients and past patients in the OCHREStreams nKPI data program is likely to have resulted in systematic under-reporting of health service performance nationally. What is known about the topic? There has been limited validation of health data exported via data-extraction tools in Australia. More specifically, there are no current published data describing the accuracy of the CAT in mapping health data extracted from Communicare or the accuracy of internal nKPI reports generated by Communicare. Further, no systematic review has been undertaken to assess the accuracy of the nKPI data submission pathway from PIMSs at the health service level to the OCHREStreams qiConnect portal using the CAT. What does this paper add? The CAT accurately extracts a subset of nKPI data from Communicare and accurately submits this to the qiConnect portal. Minor errors exist in some Communicare internal nKPI reports. The inclusion of deceased clients and past patients in the nKPI reporting system for ACCHSs is likely to have resulted in systematic under-reporting of health service performance nationally through this program. What are the implications for practitioners? The inclusion of deceased clients and past patients in the OCHREStreams nKPI program limits the usefulness of these data for local quality improvement activities and national monitoring of health service performance for participating ACCHSs. The use of the CAT by ACCHSs independently from the OCHREStreams program can enable deceased clients and past patients to be excluded from reports that can provide more accurate nKPI data from Communicare for local quality improvement and planning purposes.

Two Kazal-type protease inhibitors from Macrobrachium nipponense and Eriocheir sinensis: comparative analysis of structure and activities.

PubMed

Qian, Ye-Qing; Li, Ye; Yang, Fan; Yu, Yan-Qin; Yang, Jin-Shu; Yang, Wei-Jun

2012-03-01

Kazal-type inhibitors (KPIs) play important roles in many biological and physiological processes, such as blood clotting, the immune response and reproduction. In the present study, two male reproductive tract KPIs, termed Man-KPI and Ers-KPI, were identified in Macrobrachium nipponense and Eriocheir sinensis, respectively. The inhibitory activities of recombinant Man-KPI and Ers-KPI against chymotrypsin, elastase, trypsin and thrombin were determined. The results showed that both of them strongly inhibit chymotrypsin and elastase. Kinetic studies were performed to elucidate their inhibition mechanism. Furthermore, individual domains were also expressed to learn further which domain contributes to the inhibitory activities of intact KPIs. Only Man-KPI_domain3 is active in the inhibition of chymotrypsin and elastase. Meanwhile, Ers-KPI_domain2 and 3 are responsible for inhibition of chymotrypsin, and Ers-KPI_domains2, 3 and 4 are responsible for the inhibition of elastase. Meanwhile, the inhibitory activities of these two KPIs toward Macrobrachium rosenbergii, M. nipponense and E. sinensis sperm were compared with that of the Kazal-type peptidase inhibitor (MRPINK) characterized from the M. rosenbergii reproductive tract in a previous study. The results demonstrated that KPIs can completely inhibit the gelatinolytic activities of sperm proteases from their own species, while different levels of cross-inhibition were observed between KPI and proteases from different species. These results may provide new perspective to further clarify the mechanism of KPI-proteases interaction in the male reproductive system. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

APP with Kunitz type protease inhibitor domain (KPI) correlates with neuritic plaque density but not with cortical synaptophysin immunoreactivity in Alzheimer's disease and non-demented aged subjects: a multifactorial analysis.

PubMed

Zhan, S S; Sandbrink, R; Beyreuther, K; Schmitt, H P

1995-01-01

The formation of beta A4 amyloid protein in neuritic plaques in Alzheimer's disease (AD) and advanced age is a complex process that involves a number of both cellular and molecular mechanisms, the interrelations of which are not yet completely understood. We have examined quantitatively, in AD and aged controls an extended spectrum of amyloid plaque-related cellular and molecular factors and the cortical synaptophysin immunoreactivity (synaptic density) in order to check for interrelations between them by multifactorial analysis. In 3 cases of senile dementia of the Alzheimer type (SDAT) aged 72, 80 and 82 years, and 9 controls aged 43-88 (mean age 65) years, the cortical synaptophysin immunoreactivity was assessed, together with the numbers of neurons, astrocytes and microglial cells, senile plaques, of tangle-bearing neurons, and the amount of beta A4 amyloid precursor protein (APP) with and without the Kunitz type serine protease inhibitor (KPI) domain. The main results were: APP including the KPI domain (KPI-APP) correlated with the number of neuritic plaques, regardless of whether they occurred in SDAT or non-demented controls. There was no significant difference in the amount of KPI-APP between SDAT and controls. Conversely, APP695 (without KPI) was significantly reduced in SDAT. KPI-APP did not correlate with the synaptophysin immunoreactivity (RGVA), while APP695 showed a significant correlation with the latter in all evaluations. It also correlated with the neuron counts, which was not true for KPI-APP. These results support previous findings indicating that KPI-APP is an important local factor for amyloid deposition in the neuritic plaques, both in AD and in non-demented aged people. On the contrary, KPI-APP does not seem to be significantly involved in the mechanisms of synaptic change outside of the plaques.

Advancing Forward-Looking Metrics: A Linear Program Optimization and Robust Variable Selection for Change in Stock Levels as a Result of Recurring MICAP Parts

DTIC Science & Technology

2013-06-01

Kobu, 2007) Gunasekaran and Kobu also presented six observations as they relate to these key performance indicators ( KPI ), as follows: 1...Internal business process (50% of the KPI ) and customers (50% of the KPI ) play a significant role in SC environments. This implies that internal business...process PMs have significant impact on the operational performance. 2. The most widely used PM is financial performance (38% of the KPI ). This

In vivo neuronal synthesis and axonal transport of Kunitz protease inhibitor (KPI)-containing forms of the amyloid precursor protein.

PubMed

Moya, K L; Confaloni, A M; Allinquant, B

1994-11-01

We have shown previously that the amyloid precursor protein (APP) is synthesized in retinal ganglion cells and is rapidly transported down the axons, and that different molecular weight forms of the precursor have different developmental time courses. Some APP isoforms contain a Kunitz protease inhibitor (KPI) domain, and APP that lacks the KPI domain is considered the predominant isoform in neurons. We now show that, among the various rapidly transported APPs, a 140-kDa isoform contains the KPI domain. This APP isoform is highly expressed in rapidly growing retinal axons, and it is also prominent in adult axon endings. This 140-kDa KPI-containing APP is highly sulfated compared with other axonally transported isoforms. These results show that APP with the KPI domain is a prominent isoform synthesized in neurons in vivo, and they suggest that the regulation of protease activity may be an important factor during the establishment of neuronal connections.

Functional and conformational properties of phaseolin (Phaseolus vulgris L.) and kidney bean protein isolate: a comparative study.

PubMed

Yin, Shou-Wei; Tang, Chuan-He; Wen, Qi-Biao; Yang, Xiao-Quan

2010-03-15

Kidney bean (Phaseolus vulgris L.) seed is an underutilised plant protein source with good potential to be applied in the food industry. Phaseolin (also named G1 globulin) represents about 50 g kg(-1) of total storage protein in the seed. The aim of the present study was to characterise physicochemical, functional and conformational properties of phaseolin, and to compare these properties with those of kidney bean protein isolate (KPI). Compared with kidney bean protein isolate (KPI), the acid-extracted phaseolin-rich protein product (PRP) had much lower protein recovery of 320 g kg(-1) (dry weight basis) but higher phaseolin purity (over 950 g kg(-1)). PRP contained much lower sulfhydryl (SH) and disulfide bond contents than KPI. Differential scanning calorimetry analyses showed that the phaseolin in PRP was less denatured than in KPI. Thermal analyses in the presence or absence of dithiothreitol, in combination with SH and SS content analyses showed the contributions of SS to the thermal stability of KPI. The analyses of near-UV circular dichroism and intrinsic fluorescence spectra indicated more compacted tertiary conformation of the proteins in PRP than in KPI. PRP exhibited much better protein solubility, emulsifying activity index, and gel-forming ability than KPI. The relatively poor functional properties of KPI may be associated with protein denaturation/unfolding, with subsequent protein aggregation. The results presented here suggest the potential for acid-extracted PRP to be applied in food formulations, in view of its functional properties.

Corrigendum to ;Rational solutions to the KPI equation and multi rogue waves; [Ann. Physics V 367 (2016) 1-5

NASA Astrophysics Data System (ADS)

Gaillard, P.

2017-12-01

The author regrets the error of bracket in the expression (2) of the KPI equation in the page 2 at the beginning of the second section. The correct expression of the KPI equation is the following one:

Relative increase in Alzheimer's disease of soluble forms of cerebral Abeta amyloid protein precursor containing the Kunitz protease inhibitory domain.

PubMed

Moir, R D; Lynch, T; Bush, A I; Whyte, S; Henry, A; Portbury, S; Multhaup, G; Small, D H; Tanzi, R E; Beyreuther, K; Masters, C L

1998-02-27

Although a number of studies have examined amyloid precursor protein (APP) mRNA levels in Alzheimer's disease (AD), no clear consensus has emerged as to whether the levels of transcripts for isoforms containing a Kunitz protease inhibitory (KPI)-encoded region are increased or decreased in AD. Here we compare AD and control brain for the relative amounts of APP protein containing KPI to APP protein lacking this domain. APP protein was purified from the soluble subcellular fraction and Triton X-100 membrane pellet extract of one hemisphere of AD (n = 10), normal (n = 7), and neurological control (n = 5) brains. The amount of KPI-containing APP in the purified protein samples was determined using two independent assay methods. The first assay exploited the inhibitory action of KPI-containing APP on trypsin. The second assay employed reflectance analysis of Western blots. The proportion of KPI-containing forms of APP in the soluble subcellular fraction of AD brains is significantly elevated (p < 0.01) compared with controls. Species containing a KPI domain comprise 32-41 and 76-77% of purified soluble APP from control and AD brains, respectively. For purified membrane-associated APP, 72-77 and 65-82% of control and AD samples, respectively, contain a KPI domain. Since KPI-containing species of APP may be more amyloidogenic (Ho, L., Fukuchi, K., and Yonkin, S. G. (1996) J. Biol. Chem. 271, 30929-30934), our findings support an imbalance of isoforms as one possible mechanism for amyloid deposition in sporadic AD.

A Comparison of Mobile and Fixed Device Access on User Engagement Associated With Women, Infants, and Children (WIC) Online Nutrition Education.

PubMed

Brusk, John J; Bensley, Robert J

2016-11-15

Online health education has expanded its reach due to cost-effective implementation and demonstrated effectiveness. However, a limitation exists with the evaluation of online health education implementations and how the impact of the system is attenuated by the extent to which a user engages with it. Moreover, the current online health education research does not consider how this engagement has been affected by the transition from fixed to mobile user access over the last decade. This paper focuses on comparing the impact mobile versus fixed devices have on user engagement key performance indicators (KPI) associated with the wichealth website (.org), an Internet-based parent-child feeding intervention offered to clients associated with the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Data were collected from 612,201 nutrition education lessons completed by 305,735 unique WIC participants in 21 states over a 1-year period. Data consisted of system-collected measures, profile items, and items from an exit survey administered at the conclusion of each lesson. User engagement was defined based on 3 KPIs associated with usage of the wichealth website: number of link views, link view time, and progression in stage of readiness to change. Independent samples t tests were used to compare KPIs between fixed only and mobile only device users and paired samples t tests were used to compare KPIs within users who completed at least one lesson each on both a fixed and mobile device. A logistic regression was performed to estimate the odds of KPI performance thresholds in the independent samples study group given access device type while controlling for confounding of user characteristics associated with these KPIs. Analysis of 8 user characteristics (lessons completed, race, ethnicity, language, state of residence, pregnancy status, beginning stage of change, and preferred nutrition education method) were significantly (P<.001) related to various KPI differences between mobile and fixed device access. Non-mobile users were significantly (P<.001) more likely to engage based on all 3 KPIs, even after logistic regression control for the potential confounding related to the strongly associated user characteristics identified. The findings of this study support the idea that online health education developers need to seriously consider access device when creating programs. Online health education developers need to take extra effort to truly understand access patterns of populations being served, and whether or not access device will influence user engagement performance indicators. ©John J Brusk, Robert J Bensley. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 15.11.2016.

[Polymorphism of KPI-A genes from plants of the subgenus Potatoe (sect. Petota, Estolonifera and Lycopersicum) and subgenus Solanum].

PubMed

Krinitsyna, A A; Mel'nikova, N V; Belenikin, M S; Poltronieri, P; Santino, A; Kudriavtseva, A V; Savilova, A M; Speranskaia, A S

2013-01-01

Kunitz-type proteinase inhibitor proteins of group A (KPI-A) are involved in the protection of potato plants from pathogens and pests. Although sequences of large number of the KPI-A genes from different species of cultivated potato (Solanum tuberosum subsp. tuberosum) and a few genes from tomato (Solanum lycopersicum) are known to date, information about the allelic diversity of these genes in other species of the genus Solanum is lacking. In our work, the consensus sequences of the KPI-A genes were established in two species of subgenus Potatoe sect. Petota (Solanum tuberosum subsp. andigenum--5 genes and Solanum stoloniferum--2 genes) and in the subgenus Solanum (Solanum nigrum--5 genes) by amplification, cloning, sequencing and subsequent analysis. The determined sequences of KPI-A genes were 97-100% identical to known sequences of the cultivated potato of sect. Petota (cultivated potato Solanum tuberosum subsp. tuberosum) and sect. Etuberosum (S. palustre). The interspecific variability of these genes did not exceed the intraspecific variability for all studied species except Solanum lycopersicum. The distribution of highly variable and conserved sequences in the mature protein-encoding regions was uniform for all investigated KPI-A genes. However, our attempts to amplify the homologous genes using the same primers and the genomes of Solanum dulcamarum, Solanum lycopersicum and Mandragora officinarum resulted in no product formation. Phylogenetic analysis of KPI-A diversity showed that the sequences of the S. lycopersicum form independent cluster, whereas KPI-A of S. nigrum and species of sect. Etuberosum and sect. Petota are closely related and do not form species-specific subclasters. Although Solanum nigrum is resistant to all known races of economically one of the most important diseases of solanaceous plants oomycete Phytophthora infestans aminoacid sequences encoding by KPI-A genes from its genome have nearly or absolutely no differences to the same from genomes of cultivated potatoes involved by P. infestans.

Constraints on the phase gamma and new physics from B --> kpi decays

PubMed

He; Hsueh; Shi

2000-01-03

Recent results from CLEO on B-->Kpi indicate that the phase gamma may be substantially different from that obtained from other fit to the KM matrix elements in the standard model. We show that gamma extracted using B-->Kpi,pipi is sensitive to new physics occurring at loop level. It provides a powerful method to probe new physics in electroweak penguin interactions. Using effects due to anomalous gauge couplings as an example, we show that within the allowed ranges for these couplings information about gamma obtained from B-->Kpi,pipi can be very different from the standard model prediction.

Grade Assignment by Ki-67 Proliferative Index, Mitotic Count, and Phosphohistone H3 Count in Surgically Resected Gastrointestinal and Pancreatic Neuroendocrine Tumors.

PubMed

Murphy, Claire E; McCormick, Kinsey A; Shankaran, Veena; Reddi, Deepti M; Swanson, Paul E; Upton, Melissa P; Papanicolau-Sengos, Antonios; Khor, Sara; Westerhoff, Maria

The aim of this study was to evaluate the concordance in grade assignment for gastroenteropancreatic neuroendocrine tumors using mitotic count (MC), Ki-67 proliferative index (KPI), and phosphohistone H3 count (PHH3C). Resected gastroenteropancreatic neuroendocrine tumors were graded based on MC, KPI, and PHH3C. Concordance was determined using a weighted κ statistic. Median survival across each grade category was determined using Kaplan-Meier methods. Of the 110 patients, the majority had gastrointestinal primaries and grade 1 or 2 tumors. Rates of discordance in grade assignment were 29% of cases for KPI versus MC (κW = 0.26), 32% for PHH3C versus MC (κW = 0.34), and 32% for PHH3C versus KPI (κW = 0.37). There was fair agreement between grading by KPI and MC. Relative to grade by KPI and MC, PHH3C tended to upgrade tumors. The proportion alive at 3 and 5 years was not significantly different for patients with grade 1 versus grade 2 tumors. The concordance between KPI and MC was fair. Phosphohistone H3 count tended to upgrade tumors using the cutoffs established by MC. Grade 1 and grade 2 tumors were associated with similar survival regardless of grading method. The overall relevance of the current cutoff values used in grading neuroendocrine tumors may need to be revisited.

A novel uPAg-KPI fusion protein inhibits the growth and invasion of human ovarian cancer cells in vitro.

PubMed

Zhao, Li-Ping; Xu, Tian-Min; Kan, Mu-Jie; Xiao, Ye-Chen; Cui, Man-Hua

2016-05-01

Urokinase-type plasminogen activator (uPA) acts by breaking down the basement membrane and is involved in cell proliferation, migration and invasion. These actions are mediated by binding to the uPA receptor (uPAR) via its growth factor domain (GFD). The present study evaluated the effects of uPAg-KPI, a fusion protein of uPA-GFD and a kunitz protease inhibitor (KPI) domain that is present in the amyloid β-protein precursor. Using SKOV-3 cells, an ovarian cancer cell line, we examined cell viability, migration, invasion and also protein expression. Furthermore, we examined wound healing, and migration and invasion using a Transwell assay. Our data showed that uPAg-KPI treatment reduced the viability of ovarian cancer SKOV-3 cells in both a concentration and time-dependent manner by arresting tumor cells at G1/G0 phase of the cell cycle. The IC50 of uPAg-KPI was 0.5 µg/µl after 48 h treatment. At this concentration, uPAg-KPI also inhibited tumor cell colony formation, wound closure, as well as cell migration and invasion capacity. At the protein level, western blot analysis demonstrated that uPAg-KPI exerted no significant effect on the expression of total extracellular signal-regulated kinase (ERK)1/ERK2 and AKT, whereas it suppressed levels of phosphorylated ERK1/ERK2 and AKT. Thus, we suggest that this novel uPAg-KPI fusion protein reduced cell viability, colony formation, wound healing and the invasive ability of human ovarian cancer SKOV-3 cells in vitro by regulating ERK and AKT signaling. Further studies using other cell lines will confirm these findings.

A novel uPAg-KPI fusion protein inhibits the growth and invasion of human ovarian cancer cells in vitro

PubMed Central

ZHAO, LI-PING; XU, TIAN-MIN; KAN, MU-JIE; XIAO, YE-CHEN; CUI, MAN-HUA

2016-01-01

Urokinase-type plasminogen activator (uPA) acts by breaking down the basement membrane and is involved in cell proliferation, migration and invasion. These actions are mediated by binding to the uPA receptor (uPAR) via its growth factor domain (GFD). The present study evaluated the effects of uPAg-KPI, a fusion protein of uPA-GFD and a kunitz protease inhibitor (KPI) domain that is present in the amyloid β-protein precursor. Using SKOV-3 cells, an ovarian cancer cell line, we examined cell viability, migration, invasion and also protein expression. Furthermore, we examined wound healing, and migration and invasion using a Transwell assay. Our data showed that uPAg-KPI treatment reduced the viability of ovarian cancer SKOV-3 cells in both a concentration and time-dependent manner by arresting tumor cells at G1/G0 phase of the cell cycle. The IC50 of uPAg-KPI was 0.5 µg/µl after 48 h treatment. At this concentration, uPAg-KPI also inhibited tumor cell colony formation, wound closure, as well as cell migration and invasion capacity. At the protein level, western blot analysis demonstrated that uPAg-KPI exerted no significant effect on the expression of total extracellular signal-regulated kinase (ERK)1/ERK2 and AKT, whereas it suppressed levels of phosphorylated ERK1/ERK2 and AKT. Thus, we suggest that this novel uPAg-KPI fusion protein reduced cell viability, colony formation, wound healing and the invasive ability of human ovarian cancer SKOV-3 cells in vitro by regulating ERK and AKT signaling. Further studies using other cell lines will confirm these findings. PMID:27035617

Finding time for KPI initiatives.

PubMed

Wolfskill, Sandra J

2007-12-01

To develop a KPI reporting program for your revenue cycle, strategies for success include: carefully forming a small team to develop and report KPIs; targeting a maximum of two new, significant financial KPIs and two process KPIs per segment of the revenue cycle every six to 12 months; ensuring that the KPIs reported answer critical questions about revenue cycle performance; regularly sharing KPI results with staff.

Service-Oriented Architecture Approach to MAGTF Logistics Support Systems

DTIC Science & Technology

2013-09-01

Support System-Marine Corps IT Information Technology KPI Key Performance Indicators LCE Logistics Command Element ITV In-transit Visibility LCM...building blocks, options, KPI (key performance indicators), design decisions and the corresponding; the physical attributes which is the second attribute... KPI ) that they impact. h. Layer 8 (Information Architecture) The business intelligence layer and information architecture safeguards the inclusion

Expression and activity analysis of a new fusion protein targeting ovarian cancer cells.

PubMed

Su, Manman; Chang, Weiqin; Wang, Dingding; Cui, Manhua; Lin, Yang; Wu, Shuying; Xu, Tianmin

2015-09-01

The aim of the present study was to develop a new therapeutic drug to improve the prognosis of ovarian cancer patients. Human urokinase-type plasminogen activator (uPA)17-34-kunitz-type protease inhibitor (KPI) eukaryotic expression vector was constructed and recombinant human uPA17-34-KPI (rhuPA17-34-KPI) in P. pastoris was expressed. In the present study, the DNA sequences that encode uPA 17-34 amino acids were created according to the native amino acids sequence and inserted into the KPI-pPICZαC vector, which was constructed. Then, uPA17‑34-KPI-pPICZαC was transformed into P. pastoris X-33, and rhuPA17-34-KPI was expressed by induction of methanol. The bioactivities of a recombinant fusion protein were detected with trypsin inhibition analysis, and the inhibitory effects on the growth of ovarian cancer cells were identified using the TUNEL assay, in vitro wound‑healing assay and Matrigel model analysis. The results of the DNA sequence analysis of the recombinant vector uPA17-34-KPI‑pPICZα demonstrated that the DNA‑encoding human uPA 17-34 amino acids, 285-288 amino acids of amyloid precursor protein (APP) and 1-57 amino acids of KPI were correctly inserted into the pPICZαC vector. Following induction by methonal, the fusion protein with a molecular weight of 8.8 kDa was observed using SDS-PAGE and western blot analysis. RhuPA17-34-KPI was expressed in P. pastoris with a yield of 50 mg/l in a 50-ml tube. The recombinant fusion protein was able to inhibit the activity of trypsin, inhibit growth and induce apoptosis of SKOV3 cells, and inhibit the invasion and metastasis of ovarian cancer cells. By considering uPA17-34 amino acid specific binding uPAR as the targeted part of fusion protein and utilizing the serine protease inhibitor activity of KPI, it was found that the recombinant fusion protein uPA17-34-KPI inhibited the invasion and metastasis of ovarian tumors, and may therefore be regarded as effective in targeted treatment.

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

Amyloid precursor protein mRNA levels in Alzheimer's disease brain.

PubMed

Preece, Paul; Virley, David J; Costandi, Moheb; Coombes, Robert; Moss, Stephen J; Mudge, Anne W; Jazin, Elena; Cairns, Nigel J

2004-03-17

Insoluble beta-amyloid deposits in Alzheimer's disease (AD) brain are proteolytically derived from the membrane bound amyloid precursor protein (APP). The APP gene is differentially spliced to produce isoforms that can be classified into those containing a Kunitz-type serine protease inhibitor domain (K(+), APP(751), APP(770), APRP(365) and APRP(563)), and those without (K(-), APP(695) and APP(714)). Given the hypothesis that Abeta is a result of aberrant catabolism of APP, differential expression of mRNA isoforms containing protease inhibitors might play an active role in the pathology of AD. We took 513 cerebral cortex samples from 90 AD and 81 control brains and quantified the mRNA isoforms of APP with TaqMan real-time RT-PCR. After adjustment for age at death, brain pH and gender we found a change in the ratio of KPI(+) to KPI(-) mRNA isoforms of APP. Three separate probes, designed to recognise only KPI(+) mRNA species, gave increases of between 28% and 50% in AD brains relative to controls (p=0.002). There was no change in the mRNA levels of KPI-(APP 695) (p=0.898). Therefore, whilst KPI-mRNA levels remained stable the KPI(+) species increased specifically in the AD brains.

Key performance indicators in British military trauma.

PubMed

Stannard, Adam; Tai, Nigel R; Bowley, Douglas M; Midwinter, Mark; Hodgetts, Tim J

2008-08-01

Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

The Kunitz-protease inhibitor domain in amyloid precursor protein reduces cellular mitochondrial enzymes expression and function.

PubMed

Chua, Li-Min; Lim, Mei-Li; Wong, Boon-Seng

2013-08-09

Mitochondrial dysfunction is a prominent feature of Alzheimer's disease (AD) and this can be contributed by aberrant metabolic enzyme function. But, the mechanism causing this enzymatic impairment is unclear. Amyloid precursor protein (APP) is known to be alternatively spliced to produce three major isoforms in the brain (APP695, APP751, APP770). Both APP770 and APP751 contain the Kunitz Protease Inhibitory (KPI) domain, but the former also contain an extra OX-2 domain. APP695 on the other hand, lacks both domains. In AD, up-regulation of the KPI-containing APP isoforms has been reported. But the functional contribution of this elevation is unclear. In the present study, we have expressed and compared the effect of the non-KPI containing APP695 and the KPI-containing APP751 on mitochondrial function. We found that the KPI-containing APP751 significantly decreased the expression of three major mitochondrial metabolic enzymes; citrate synthase, succinate dehydrogenase and cytochrome c oxidase (COX IV). This reduction lowers the NAD(+)/NADH ratio, COX IV activity and mitochondrial membrane potential. Overall, this study demonstrated that up-regulation of the KPI-containing APP isoforms is likely to contribute to the impairment of metabolic enzymes and mitochondrial function in AD. Copyright © 2013 Elsevier Inc. All rights reserved.

Expression of APP pathway mRNAs and proteins in Alzheimer's disease.

PubMed

Matsui, Toshifumi; Ingelsson, Martin; Fukumoto, Hiroaki; Ramasamy, Karunya; Kowa, Hisatomo; Frosch, Matthew P; Irizarry, Michael C; Hyman, Bradley T

2007-08-03

In both trisomy 21 and rare cases of triplication of amyloid precursor protein (APP) Alzheimer's disease (AD) pathological changes are believed to be secondary to increased expression of APP. We hypothesized that sporadic AD may also be associated with changes in transcription of APP or its metabolic partners. To address this issue, temporal neocortex of 27 AD and 21 non-demented control brains was examined to assess mRNA levels of APP isoforms (total APP, APP containing the Kunitz protease inhibitor domain [APP-KPI] and APP770) and APP metabolic enzymatic partners (the APP cleaving enzymes beta-secretase [BACE] and presenilin-1 [PS-1], and putative clearance molecules, low-density lipoprotein receptor protein [LRP] and apolipoprotein E [apoE]). Furthermore, we evaluated how changes in APP at the mRNA level affect the amount of Tris buffer extractable APP protein and Abeta40 and 42 peptides in AD and control brains. As assessed by quantitative PCR, APP-KPI (p=0.007), APP770 (p=0.004), PS-1 (p=0.004), LRP (p=0.003), apoE (p=0.0002) and GFAP (p<0.0001) mRNA levels all increased in AD, and there was a shift from APP695 (a neuronal isoform) towards KPI containing isoforms that are present in glia as well. APP-KPI mRNA levels correlated with soluble APPalpha-KPI protein (sAPPalpha-KPI) levels measured by ELISA (tau=0.33, p=0.015 by Kendall's rank correlation); in turn, soluble APPalpha-KPI protein levels positively correlated with Tris-extractable, soluble Abeta40 (p=0.046) and 42 levels (p=0.007). The ratio of soluble APPalpha-KPI protein levels to total APP protein increased in AD, and also correlated with GFAP protein levels in AD. These results suggest that altered transcription of APP in AD is proportionately associated with Abeta peptide, may occur in the context of gliosis, and may contribute to Abeta deposition in sporadic AD.

Amyloid precursor protein gene isoforms in Alzheimer's disease and other neurodegenerative disorders.

PubMed

Panegyres, P K; Zafiris-Toufexis, K; Kakulas, B A

2000-02-15

Differential expression of the amyloid precursor protein gene (APP) may be important in the development of amyloidosis in Alzheimer's disease (AD) and experimentally in the brain's response to injury. Controversial data suggests that APP isoforms containing the Kunitz protease inhibitor isoform (APP KPI+) are over expressed in the brains of patients with AD when compared to the non-Kunitz protease inhibitor containing isoforms (APP KPI-). We have investigated this hypothesis using a quantitative analysis of gene expression on brain tissue collected at post-mortem. In situ hybridization has been used with synthetic oligonucleotide probes labelled with 35S to detect the two principal splice variants of APP: APP 695 (KPI-) and APP 751 (KPI+). A prospective brain bank of frozen brain specimens has been established and includes pathologically proven AD (n=15) and other neurodegenerative disorders as controls (n=18). The controls consist of frontal lobe atrophy (n=4), Huntington's disease (n=5), Parkinson's disease (n=4), motor neuron disease (n=2), multi-infarct dementia (n=1), multisystem atrophy (n=1), and subacute sclerosing panencephalitis (n=1). We have observed no significant differences in the expression of APP 695 KPI- mRNA in frontal lobe: 17.49+/-3.26 optical density (OD) units of mRNA expression in AD vs. 16.13+/-1.76 OD units mRNA in controls (P=0.80, linear regression); or temporal lobe: 14.73+/-2.96 in AD vs. 16.49+/-2.15 in controls (P=0.55). No significant differences have been found in APP 751 KPI+ in frontal lobe: 12.86+/-2.98 in AD vs. 13.70+/-2.88 in controls (P=0.97); and temporal lobe: 13.31+/-4.93 in AD vs. 11.07+/-1.99 in controls (P=0. 65). Analysis of the ratios of APP 751 KPI+ OD units of mRNA to APP 695 KPI- mRNA revealed a trend to an increased ratio which did not reach statistical significance: frontal lobe APP 751 KPI+/APP 695 KPI- 1.92+/-1.04 in AD vs. 0.86+/-0.17 in controls (P=0.54); temporal lobe 2.54+/-1.59 in AD vs. 0.96+/-0.11 controls (P=0.34). Our data has not revealed differential expression of APP mRNA isoforms in AD and supports the hypothesis that post-translational events in APP metabolism are important in amyloidogenesis and the pathogenesis of AD.

LRP-mediated clearance of Abeta is inhibited by KPI-containing isoforms of APP.

PubMed

Moir, Robert D; Tanzi, Rudolph E

2005-04-01

The pathogenesis of Alzheimer's disease (AD) involves the abnormal accumulation and deposition of beta-amyloid in cerebral blood vessels and in the brain parenchyma. Critical in modulating beta-amyloid deposition in brain is the flux of Abeta across the blood brain barrier. The low-density lipoprotein receptor-related protein (LRP), is a large endocytic receptor that mediates the efflux of Abeta out of brain and into the periphery. The first step in the LRP-mediated clearance of Abeta involves the formation of a complex between Abeta and the LRP ligands apolipoprotein E (apoE) or alpha(2)-macroglobulin (alpha(2)M). The Abeta/chaperone complexes then bind to LRP via binding sites on apoE or alpha(2)M. The efflux of Abeta/chaperone complexes out of the neuropil and into the periphery may be attenuated by LRP-ligands that compete with apoE or alpha(2)M for LRP binding. LRP is also the cell surface receptor for Kunitz Protease Inhibitor (KPI) containing isoforms of Abeta's parent protein, the amyloid protein precursor (APP). Protein and mRNA levels of KPI-containing APP isoforms (APP-KPI) are elevated in AD brain and are associated with increased Abeta production. In this study we show that soluble non-amyloidogenic APP-KPI can also inhibit the uptake of Abeta/alpha(2)M in a cell culture model of LRP mediated Abeta clearance. Clearance of Abeta/apoE complexes was not inhibited by APP-KPI. Our findings are consistent with studies showing that apoE and alpha(2)M have discrete binding sites on LRP. Most significantly, our data suggests that the elevated levels of APP-KPI in AD brain may attenuate the clearance of Abeta, the proteins own amyloidogenic catabolic product.

Conformational study of red kidney bean (Phaseolus vulgaris L.) protein isolate (KPI) by tryptophan fluorescence and differential scanning calorimetry.

PubMed

Yin, Shou-Wei; Tang, Chuan-He; Yang, Xiao-Quan; Wen, Qi-Biao

2011-01-12

Fluorescence and differential scanning calorimetry (DSC) were used to study changes in the conformation of red kidney bean (Phaseolus vulgaris L.) protein isolate (KPI) under various environmental conditions. The possible relationship between fluorescence data and DSC characteristics was also discussed. Tryptophan fluorescence and fluorescence quenching analyses indicated that the tryptophan residues in KPI, exhibiting multiple fluorophores with different accessibilities to acrylamide, are largely buried in the hydrophobic core of the protein matrix, with positively charged side chains close to at least some of the tryptophan residues. GdnHCl was more effective than urea and SDS in denaturing KPI. SDS and urea caused variable red shifts, 2-5 nm, in the emission λ(max), suggesting the conformational compactness of KPI. The result was further supported by DSC characteristics that a discernible endothermic peak was still detected up to 8 M urea or 30 mM SDS, also evidenced by the absence of any shift in emission maximum (λ(max)) at different pH conditions. Marked decreases in T(d) and enthalpy (ΔH) were observed at extreme alkaline and/or acidic pH, whereas the presence of NaCl resulted in higher T(d) and ΔH, along with greater cooperativity of the transition. Decreases in T(d) and ΔH were observed in the presence of protein perturbants, for example, SDS and urea, indicating partial denaturation and decrease in thermal stability. Dithiothreitol and N-ethylmaleimide have a slight effect on the thermal properties of KPI. Interestingly, a close linear relationship between the T(d) (or ΔH) and the λ(max) was observed for KPI in the presence of 0-6 M urea.

A KPI-based process monitoring and fault detection framework for large-scale processes.

PubMed

Zhang, Kai; Shardt, Yuri A W; Chen, Zhiwen; Yang, Xu; Ding, Steven X; Peng, Kaixiang

2017-05-01

Large-scale processes, consisting of multiple interconnected subprocesses, are commonly encountered in industrial systems, whose performance needs to be determined. A common approach to this problem is to use a key performance indicator (KPI)-based approach. However, the different KPI-based approaches are not developed with a coherent and consistent framework. Thus, this paper proposes a framework for KPI-based process monitoring and fault detection (PM-FD) for large-scale industrial processes, which considers the static and dynamic relationships between process and KPI variables. For the static case, a least squares-based approach is developed that provides an explicit link with least-squares regression, which gives better performance than partial least squares. For the dynamic case, using the kernel representation of each subprocess, an instrument variable is used to reduce the dynamic case to the static case. This framework is applied to the TE benchmark process and the hot strip mill rolling process. The results show that the proposed method can detect faults better than previous methods. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Multiple branches of travelling waves for the Gross–Pitaevskii equation

NASA Astrophysics Data System (ADS)

Chiron, David; Scheid, Claire

2018-06-01

Explicit solitary waves are known to exist for the Kadomtsev–Petviashvili-I (KP-I) equation in dimension 2. We first address numerically the question of their Morse index. The results confirm that the lump solitary wave has Morse index one and that the other explicit solutions correspond to excited states. We then turn to the 2D Gross–Pitaevskii (GP) equation, which in some long wave regime converges to the KP-I equation. Numerical simulations have already shown that a branch of travelling waves of GP converges to a ground state of KP-I, expected to be the lump. In this work, we perform numerical simulations showing that other explicit solitary waves solutions to the KP-I equation give rise to new branches of travelling waves of GP corresponding to excited states.

Do clinical safety charts improve paramedic key performance indicator results? (A clinical improvement programme evaluation).

PubMed

Ebbs, Phillip; Middleton, Paul M; Bonner, Ann; Loudfoot, Allan; Elliott, Peter

2012-07-01

Is the Clinical Safety Chart clinical improvement programme (CIP) effective at improving paramedic key performance indicator (KPI) results within the Ambulance Service of New South Wales? The CIP intervention area was compared with the non-intervention area in order to determine whether there was a statistically significant improvement in KPI results. The CIP was associated with a statistically significant improvement in paramedic KPI results within the intervention area. The strategies used within this CIP are recommended for further consideration.

De Novo Synthesis of Phosphorylated Triblock Copolymers with Pathogen Virulence-Suppressing Properties That Prevent Infection-Related Mortality

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

Mao, Jun; Zaborin, Alexander; Poroyko, Valeriy

Phosphate is a key and universal "cue" in response to which bacteria either enhance their virulence when local phosphate is scarce or downregulate it when phosphate is adundant. Phosphate becomes depleted in the mammalian gut following physiologic stress and serves as a major trigger for colonizing bacteria to express virulence. This process cannot be reversed with oral supplementation of inorganic phosphate because it is nearly completely absorbed in the proximal small intestine. In the present study, we describe the de novo synthesis of phosphorylated polyethylene glycol compounds with three defined ABA (hydrophilic/-phobic/-philic) structures, ABA-PEG10k-Pi10, ABA-PEG16k-Pi14, and ABA-PEG20k-Pi20, and linear polymermore » PEG20k-Pi20 absent of the hydrophobic block. The 10k, 16k, and 20k demonstrate the molecular weights of the poly(ethylene glycol) block, and Pi10, Pi14, and Pi20 represent the repeating units of phosphate. Polymers were tested for their efficacy against Pseudomonas aeruginosa virulence in vitro and in vivo by assessing the expression of the phosphate sensing protein PstS, the production of key virulence factor pyocyanin, and Caenorhabditis elegans killing assays. Results indicate that all phosphorylated polymers suppressed phosphate sensing, virulence expression, and lethality in P. aeruginosa. Among all of the phosphorylated polymers, ABA-PEG20kPi20 displayed the greatest degree of protection against P. aeruginosa. To define the role of the hydrophobic core in ABA-PEG20k-Pi20 in the above response, we synthesized PEG20k-Pi20 in which the hydrophobic core is absent. Results indicate that the hypdrophobic core of ABA-PEG20k-Pi20 is a key structure in its protective effect against P. aeruginosa, in part due to its ability to coat the surface of bacteria. Taken together, the synthesis of novel polymers with defined structures and levels of phosphorylation may elucidate their antivirulence action against clinically important and lethal pathogens such as P. aeruginosa« less

Structural features of the KPI domain control APP dimerization, trafficking, and processing.

PubMed

Ben Khalifa, Naouel; Tyteca, Donatienne; Marinangeli, Claudia; Depuydt, Mathieu; Collet, Jean-François; Courtoy, Pierre J; Renauld, Jean-Christophe; Constantinescu, Stefan; Octave, Jean-Noël; Kienlen-Campard, Pascal

2012-02-01

The two major isoforms of human APP, APP695 and APP751, differ by the presence of a Kunitz-type protease inhibitor (KPI) domain in the extracellular region. APP processing and function is thought to be regulated by homodimerization. We used bimolecular fluorescence complementation (BiFC) to study dimerization of different APP isoforms and mutants. APP751 was found to form significantly more homodimers than APP695. Mutation of dimerization motifs in the TM domain did not affect fluorescence complementation, but native folding of KPI is critical for APP751 homodimerization. APP751 and APP695 dimers were mostly localized at steady state in the Golgi region, suggesting that most of the APP751 and 695 dimers are in the secretory pathway. Mutation of the KPI led to the retention of the APP homodimers in the endoplasmic reticulum. We finally showed that APP751 is more efficiently processed through the nonamyloidogenic pathway than APP695. These findings provide new insight on the particular role of KPI domain in APP dimerization. The correlation observed between dimerization, subcellular localization, and processing suggests that dimerization acts as an efficient regulator of APP trafficking in the secretory compartments that has major consequences on its processing.

The Proposal of Key Performance Indicators in Facility Management and Determination the Weights of Significance

NASA Astrophysics Data System (ADS)

Rimbalová, Jarmila; Vilčeková, Silvia

2013-11-01

The practice of facilities management is rapidly evolving with the increasing interest in the discourse of sustainable development. The industry and its market are forecasted to develop to include non-core functions, activities traditionally not associated with this profession, but which are increasingly being addressed by facilities managers. The scale of growth in the built environment and the consequential growth of the facility management sector is anticipated to be enormous. Key Performance Indicators (KPI) are measure that provides essential information about performance of facility services delivery. In selecting KPI, it is critical to limit them to those factors that are essential to the organization reaching its goals. It is also important to keep the number of KPI small just to keep everyone's attention focused on achieving the same KPIs. This paper deals with the determination of weights of KPI of FM in terms of the design and use of sustainable buildings.

The intact Kunitz domain protects the amyloid precursor protein from being processed by matriptase-2.

PubMed

Beckmann, Anna-Madeleine; Glebov, Konstantin; Walter, Jochen; Merkel, Olaf; Mangold, Martin; Schmidt, Frederike; Becker-Pauly, Christoph; Gütschow, Michael; Stirnberg, Marit

2016-08-01

Proteolytic processing of the amyloid precursor protein (APP) leads to amyloid-β (Aβ) peptides. So far, the mechanism of APP processing is insufficiently characterized at the molecular level. Whereas the knowledge of Aβ generation by several proteases has been expanded, the contribution of the Kunitz-type protease inhibitor domain (KPI) present in two major APP isoforms to the complex proteolytic processing of APP is poorly understood. In this study, we have identified KPI-containing APP as a very potent, slow-binding inhibitor for the membrane-bound proteolytic regulator of iron homeostasis matriptase-2 by forming stable complexes with its target protease in HEK cells. Inhibition and complex formation depend on the intact KPI domain. By inhibiting matriptase-2, KPI-containing APP is protected from matriptase-2-mediated proteolysis within the Aβ region, thus preventing the generation of N-terminally truncated Aβ.

Tetrahydroxystilbene glucoside modulates amyloid precursor protein processing via activation of AKT-GSK3β pathway in cells and in APP/PS1 transgenic mice.

PubMed

Yin, Xiaomin; Chen, Chen; Xu, Ting; Li, Lin; Zhang, Lan

2018-01-01

Alternative splicing of amyloid precursor protein (APP) exon 7 generates the isoforms containing a Kunitz protease inhibitor (KPI) domain. APP-KPI levels in the brain are correlated with amyloid beta (Aβ) production. Here, we determined the effect of Tetrahydroxystilbene glucoside (TSG) on the AKT-GSK3β pathway. We found GSK3β increased APP-KPI inclusion level and interacted with the splicing factor ASF. TSG was intragastrically administered to 5-month-old APP/PS1 transgenic mice for 12 months. We found that the activated the AKT-GSK3β signaling pathway suppressed APP-KPI inclusion. Moreover, TSG treatment attenuated amyloid deposition in APP/PS1 mice. This study demonstrates the neuroprotective effect of TSG on APP expression, suggesting that TSG may be beneficial for AD prevention and treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Health policies on dialysis modality selection: a nationwide population cohort study

PubMed Central

Lin, Yi-Chun; Lin, Yen-Chung; Kao, Chih-Chin; Chen, Hsi-Hsien; Hsu, Chih-Cheng; Wu, Mai-Szu

2017-01-01

Objectives In Taiwan, peritoneal dialysis (PD) and haemodialysis are fully accessible to patients with end-stage renal disease. However, the usage of PD is considered low in Taiwan. Since 2005, 4 major policies have been implemented by Taiwan's Ministry of Health and Welfare, namely a multidisciplinary predialysis care programme and usage increasing the PD incidence as a key performance indicator (KPI) for hospital accreditation, both of which were implemented in 2006; reimbursement of the glucose-free dialysate, icodextrin that was implemented in 2007; and insurance reimbursement for renting automated PD machines that was implemented in 2008. The aim of this study was to analyse the associations between the PD promotional policies and the actual PD selection rates. Setting We analysed data within the Taiwan Renal Registry Data System from 2006 to 2013, focusing on the PD incidence in relation to the timings of the 4 PD promotional policies; then we stratified the results according to age, sex and the presence of diabetes mellitus. Participants From 2006 to 2013, 115 565 patients were enrolled in this study. The mean (SD) age of patients on PD was 54.6 (15.7) years. Results During the time frame in which the 4 PD promotional policies were implemented, the PD incidence increased from 12.8% in 2006 to 15.1% in 2009. The PD incidence started to decline in 2010 (13.8%) when the hospital accreditation policy was repealed. The 3 remaining policies were weakly associated with the PD incidence. The observational analysis determined that the patients' ages, sexes and diabetes mellitus incidence rates were relatively stable from 2006 to 2013. Conclusions Of the 4 health policies intended to promote PD usage, using increasing the PD incidence as a KPI for hospital accreditation had the strongest association with the PD incidence. PMID:28077410

Fredholm and Wronskian representations of solutions to the KPI equation and multi-rogue waves

NASA Astrophysics Data System (ADS)

Gaillard, Pierre

2016-06-01

We construct solutions to the Kadomtsev-Petviashvili equation (KPI) in terms of Fredholm determinants. We deduce solutions written as a quotient of Wronskians of order 2N. These solutions, called solutions of order N, depend on 2N - 1 parameters. When one of these parameters tends to zero, we obtain N order rational solutions expressed as a quotient of two polynomials of degree 2N(N + 1) in x, y, and t depending on 2N - 2 parameters. So we get with this method an infinite hierarchy of solutions to the KPI equation.

Measurement of the absolute branching fraction of D0-->K-pi+.

PubMed

Aubert, B; Bona, M; Boutigny, D; Karyotakis, Y; Lees, J P; Poireau, V; Prudent, X; Tisserand, V; Zghiche, A; Garra Tico, J; Grauges, E; Lopez, L; Palano, A; Eigen, G; Ofte, I; Stugu, B; Sun, L; Abrams, G S; Battaglia, M; Brown, D N; Button-Shafer, J; Cahn, R N; Groysman, Y; Jacobsen, R G; Kadyk, J A; Kerth, L T; Kolomensky, Yu G; Kukartsev, G; Lopes Pegna, D; Lynch, G; Mir, L M; Orimoto, T J; Pripstein, M; Roe, N A; Ronan, M T; Tackmann, K; Wenzel, W A; Del Amo Sanchez, P; Hawkes, C M; Watson, A T; Held, T; Koch, H; Lewandowski, B; Pelizaeus, M; Schroeder, T; Steinke, M; Cottingham, W N; Walker, D; Asgeirsson, D J; Cuhadar-Donszelmann, T; Fulsom, B G; Hearty, C; Knecht, N S; Mattison, T S; McKenna, J A; Khan, A; Saleem, M; Teodorescu, L; Blinov, V E; Bukin, A D; Druzhinin, V P; Golubev, V B; Onuchin, A P; Serednyakov, S I; Skovpen, Yu I; Solodov, E P; Todyshev, K Yu; Bondioli, M; Curry, S; Eschrich, I; Kirkby, D; Lankford, A J; Lund, P; Mandelkern, M; Martin, E C; Stoker, D P; Abachi, S; Buchanan, C; Foulkes, S D; Gary, J W; Liu, F; Long, O; Shen, B C; Zhang, L; Paar, H P; Rahatlou, S; Sharma, V; Berryhill, J W; Campagnari, C; Cunha, A; Dahmes, B; Hong, T M; Kovalskyi, D; Richman, J D; Beck, T W; Eisner, A M; Flacco, C J; Heusch, C A; Kroseberg, J; Lockman, W S; Schalk, T; Schumm, B A; Seiden, A; Williams, D C; Wilson, M G; Winstrom, L O; Chen, E; Cheng, C H; Dvoretskii, A; Fang, F; Hitlin, D G; Narsky, I; Piatenko, T; Porter, F C; Mancinelli, G; Meadows, B T; Mishra, K; Sokoloff, M D; Blanc, F; Bloom, P C; Chen, S; Ford, W T; Hirschauer, J F; Kreisel, A; Nagel, M; Nauenberg, U; Olivas, A; Smith, J G; Ulmer, K A; Wagner, S R; Zhang, J; Gabareen, A M; Soffer, A; Toki, W H; Wilson, R J; Winklmeier, F; Zeng, Q; Altenburg, D D; Feltresi, E; Hauke, A; Jasper, H; Merkel, J; Petzold, A; Spaan, B; Wacker, K; Brandt, T; Klose, V; Lacker, H M; Mader, W F; Nogowski, R; Schubert, J; Schubert, K R; Schwierz, R; Sundermann, J E; Volk, A; Bernard, D; Bonneaud, G R; Latour, E; Lombardo, V; Thiebaux, Ch; Verderi, M; Clark, P J; Gradl, W; Muheim, F; Playfer, S; Robertson, A I; Xie, Y; Andreotti, M; Bettoni, D; Bozzi, C; Calabrese, R; Cecchi, A; Cibinetto, G; Franchini, P; Luppi, E; Negrini, M; Petrella, A; Piemontese, L; Prencipe, E; Santoro, V; Anulli, F; Baldini-Ferroli, R; Calcaterra, A; de Sangro, R; Finocchiaro, G; Pacetti, S; Patteri, P; Peruzzi, I M; Piccolo, M; Rama, M; Zallo, A; Buzzo, A; Contri, R; Lo Vetere, M; Macri, M M; Monge, M R; Passaggio, S; Patrignani, C; Robutti, E; Santroni, A; Tosi, S; Chaisanguanthum, K S; Morii, M; Wu, J; Dubitzky, R S; Marks, J; Schenk, S; Uwer, U; Bard, D J; Dauncey, P D; Flack, R L; Nash, J A; Nikolich, M B; Panduro Vazquez, W; Behera, P K; Chai, X; Charles, M J; Mallik, U; Meyer, N T; Ziegler, V; Cochran, J; Crawley, H B; Dong, L; Eyges, V; Meyer, W T; Prell, S; Rosenberg, E I; Rubin, A E; Gritsan, A V; Guo, Z J; Lae, C K; Denig, A G; Fritsch, M; Schott, G; Arnaud, N; Béquilleux, J; Davier, M; Grosdidier, G; Höcker, A; Lepeltier, V; Le Diberder, F; Lutz, A M; Pruvot, S; Rodier, S; Roudeau, P; Schune, M H; Serrano, J; Sordini, V; Stocchi, A; Wang, W F; Wormser, G; Lange, D J; Wright, D M; Chavez, C A; Forster, I J; Fry, J R; Gabathuler, E; Gamet, R; Hutchcroft, D E; Payne, D J; Schofield, K C; Touramanis, C; Bevan, A J; George, K A; Di Lodovico, F; Menges, W; Sacco, R; Cowan, G; Flaecher, H U; Hopkins, D A; Jackson, P S; McMahon, T R; Salvatore, F; Wren, A C; Brown, D N; Davis, C L; Allison, J; Barlow, N R; Barlow, R J; Chia, Y M; Edgar, C L; Lafferty, G D; West, T J; Yi, J I; Anderson, J; Chen, C; Jawahery, A; Roberts, D A; Simi, G; Tuggle, J M; Blaylock, G; Dallapiccola, C; Hertzbach, S S; Li, X; Moore, T B; Salvati, E; Saremi, S; Cowan, R; Fisher, P H; Sciolla, G; Sekula, S J; Spitznagel, M; Taylor, F; Yamamoto, R K; McLachlin, S E; Patel, P M; Robertson, S H; Lazzaro, A; Palombo, F; Bauer, J M; Cremaldi, L; Eschenburg, V; Godang, R; Kroeger, R; Sanders, D A; Summers, D J; Zhao, H W; Brunet, S; Côté, D; Simard, M; Taras, P; Viaud, F B; Nicholson, H; De Nardo, G; Fabozzi, F; Lista, L; Monorchio, D; Sciacca, C; Baak, M A; Raven, G; Snoek, H L; Jessop, C P; Losecco, J M; Benelli, G; Corwin, L A; Gan, K K; Honscheid, K; Hufnagel, D; Kagan, H; Kass, R; Morris, J P; Rahimi, A M; Regensburger, J J; Ter-Antonyan, R; Wong, Q K; Blount, N L; Brau, J; Frey, R; Igonkina, O; Kolb, J A; Lu, M; Rahmat, R; Sinev, N B; Strom, D; Strube, J; Torrence, E; Gagliardi, N; Gaz, A; Margoni, M; Morandin, M; Pompili, A; Posocco, M; Rotondo, M; Simonetto, F; Stroili, R; Voci, C; Ben-Haim, E; Briand, H; Chauveau, J; David, P; Del Buono, L; de la Vaissière, Ch; Hamon, O; Hartfiel, B L; Leruste, Ph; Malclès, J; Ocariz, J; Perez, A; Gladney, L; Biasini, M; Covarelli, R; Manoni, E; Angelini, C; Batignani, G; Bettarini, S; Calderini, G; Carpinelli, M; Cenci, R; Cervelli, A; Forti, F; Giorgi, M A; Lusiani, A; Marchiori, G; Mazur, M A; Morganti, M; Neri, N; Paoloni, E; Rizzo, G; Walsh, J J; Haire, M; Biesiada, J; Elmer, P; Lau, Y P; Lu, C; Olsen, J; Smith, A J S; Telnov, A V; Baracchini, E; Bellini, F; Cavoto, G; D'Orazio, A; Del Re, D; Di Marco, E; Faccini, R; Ferrarotto, F; Ferroni, F; Gaspero, M; Jackson, P D; Li Gioi, L; Mazzoni, M A; Morganti, S; Piredda, G; Polci, F; Renga, F; Voena, C; Ebert, M; Schröder, H; Waldi, R; Adye, T; Castelli, G; Franek, B; Olaiya, E O; Ricciardi, S; Roethel, W; Wilson, F F; Aleksan, R; Emery, S; Escalier, M; Gaidot, A; Ganzhur, S F; de Monchenault, G Hamel; Kozanecki, W; Legendre, M; Vasseur, G; Yèche, Ch; Zito, M; Chen, X R; Liu, H; Park, W; Purohit, M V; Wilson, J R; Allen, M T; Aston, D; Bartoldus, R; Bechtle, P; Berger, N; Claus, R; Coleman, J P; Convery, M R; Dingfelder, J C; Dorfan, J; Dubois-Felsmann, G P; Dujmic, D; Dunwoodie, W; Field, R C; Glanzman, T; Gowdy, S J; Graham, M T; Grenier, P; Hast, C; Hryn'ova, T; Innes, W R; Kelsey, M H; Kim, H; Kim, P; Leith, D W G S; Li, S; Luitz, S; Luth, V; Lynch, H L; Macfarlane, D B; Marsiske, H; Messner, R; Muller, D R; O'Grady, C P; Perazzo, A; Perl, M; Pulliam, T; Ratcliff, B N; Roodman, A; Salnikov, A A; Schindler, R H; Schwiening, J; Snyder, A; Stelzer, J; Su, D; Sullivan, M K; Suzuki, K; Swain, S K; Thompson, J M; Va'vra, J; van Bakel, N; Wagner, A P; Weaver, M; Wisniewski, W J; Wittgen, M; Wright, D H; Yarritu, A K; Yi, K; Young, C C; Burchat, P R; Edwards, A J; Majewski, S A; Petersen, B A; Wilden, L; Ahmed, S; Alam, M S; Bula, R; Ernst, J A; Jain, V; Pan, B; Saeed, M A; Wappler, F R; Zain, S B; Bugg, W; Krishnamurthy, M; Spanier, S M; Eckmann, R; Ritchie, J L; Ruland, A M; Schilling, C J; Schwitters, R F; Izen, J M; Lou, X C; Ye, S; Bianchi, F; Gallo, F; Gamba, D; Pelliccioni, M; Bomben, M; Bosisio, L; Cartaro, C; Cossutti, F; Della Ricca, G; Lanceri, L; Vitale, L; Azzolini, V; Lopez-March, N; Martinez-Vidal, F; Milanes, D A; Oyanguren, A; Albert, J; Banerjee, Sw; Bhuyan, B; Hamano, K; Kowalewski, R; Nugent, I M; Roney, J M; Sobie, R J; Back, J J; Harrison, P F; Latham, T E; Mohanty, G B; Pappagallo, M; Band, H R; Chen, X; Dasu, S; Flood, K T; Hollar, J J; Kutter, P E; Pan, Y; Pierini, M; Prepost, R; Wu, S L; Yu, Z; Neal, H

2008-02-08

We measure the absolute branching fraction for D(0)-->K(-)pi(+) using partial reconstruction of B(0)-->D(*+)Xl(-)nu(l) decays, in which only the charged lepton and the pion from the decay D(*+)-->D(0)pi(+) are used. Based on a data sample of 230 x 10(6) BB pairs collected at the Upsilon(4S) resonance with the BABAR detector at the PEP-II asymmetric-energy B factory at SLAC, we obtain B(D(0)-->K(-)pi(+)) = (4.007+/-0.037+/-0.072)%, where the first uncertainty is statistical and the second is systematic.

Lost region in amyloid precursor protein (APP) through TALEN-mediated genome editing alters mitochondrial morphology.

PubMed

Wang, Yajie; Wu, Fengyi; Pan, Haining; Zheng, Wenzhong; Feng, Chi; Wang, Yunfu; Deng, Zixin; Wang, Lianrong; Luo, Jie; Chen, Shi

2016-02-29

Alzheimer's disease (AD) is characterized by amyloid-β (Aβ) deposition in the brain. Aβ plaques are produced through sequential β/γ cleavage of amyloid precursor protein (APP), of which there are three main APP isoforms: APP695, APP751 and APP770. KPI-APPs (APP751 and APP770) are known to be elevated in AD, but the reason remains unclear. Transcription activator-like (TAL) effector nucleases (TALENs) induce mutations with high efficiency at specific genomic loci, and it is thus possible to knock out specific regions using TALENs. In this study, we designed and expressed TALENs specific for the C-terminus of APP in HeLa cells, in which KPI-APPs are predominantly expressed. The KPI-APP mutants lack a 12-aa region that encompasses a 5-aa trans-membrane (TM) region and 7-aa juxta-membrane (JM) region. The mutated KPI-APPs exhibited decreased mitochondrial localization. In addition, mitochondrial morphology was altered, resulting in an increase in spherical mitochondria in the mutant cells through the disruption of the balance between fission and fusion. Mitochondrial dysfunction, including decreased ATP levels, disrupted mitochondrial membrane potential, increased ROS generation and impaired mitochondrial dehydrogenase activity, was also found. These results suggest that specific regions of KPI-APPs are important for mitochondrial localization and function.

Peptide microarray analysis of substrate specificity of the transmembrane Ser/Thr kinase KPI-2 reveals reactivity with cystic fibrosis transmembrane conductance regulator and phosphorylase.

PubMed

Wang, Hong; Brautigan, David L

2006-11-01

Human lemur (Lmr) kinases are predicted to be Tyr kinases based on sequences and are related to neurotrophin receptor Trk kinases. This study used homogeneous recombinant KPI-2 (Lmr2, LMTK2, Cprk, brain-enriched protein kinase) kinase domain and a library of 1,154 peptides on a microarray to analyze substrate specificity. We found that KPI-2 is strictly a Ser/Thr kinase that reacts with Ser either preceded by or followed by Pro residues but unlike other Pro-directed kinases does not strictly require an adjacent Pro residue. The most reactive peptide in the library corresponds to Ser-737 of cystic fibrosis transmembrane conductance regulator, and the recombinant R domain of cystic fibrosis transmembrane conductance regulator was a preferred substrate. Furthermore the KPI-2 kinase phosphorylated peptides corresponding to the single site in phosphorylase and purified phosphorylase b, making this only the second known phosphorylase b kinase. Phosphorylase was used as a specific substrate to show that KPI-2 is inhibited in living cells by addition of nerve growth factor or serum. The results demonstrate the utility of the peptide library to probe specificity and discover kinase substrates and offer a specific assay that reveals hormonal regulation of the activity of this unusual transmembrane kinase.

Partitioning of monomethylmercury between freshwater algae and water.

PubMed

Miles, C J; Moye, H A; Phlips, E J; Sargent, B

2001-11-01

Phytoplankton-water monomethylmercury (MeHg) partition constants (KpI) have been determined in the laboratory for two green algae Selenastrum capricornutum and Cosmarium botrytis, the blue-green algae Schizothrix calcicola, and the diatom Thallasiosira spp., algal species that are commonly found in natural surface waters. Two methods were used to determine KpI, the Freundlich isotherm method and the flow-through/dialysis bag method. Both methods yielded KpI values of about 10(6.6) for S. capricornutum and were not significantly different. The KpI for the four algae studied were similar except for Schizothrix, which was significantly lower than S. capricornutum. The KpI for MeHg and S. capricornutum (exponential growth) was not significantly different in systems with predominantly MeHgOH or MeHgCl species. This is consistent with other studies that show metal speciation controls uptake kinetics, but the reactivity with intracellular components controls steady-state concentrations. Partitioning constants determined with exponential and stationary phase S. capricornutum cells at the same conditions were not significantly different, while the partitioning constant for exponential phase, phosphorus-limited cells was significantly lower, suggesting that P-limitation alters the ecophysiology of S. capricornutum sufficiently to impact partitioning, which may then ultimately affect mercury levels in higher trophic species.

A Low-Molecular-Weight Gelator Composed of Pyrene and Fluorene Moieties for Effective Charge Transfer in Supramolecular Ambidextrous Gel.

PubMed

Reddy, Samala Murali Mohan; Dorishetty, Pramod; Augustine, George; Deshpande, Abhijit P; Ayyadurai, Niraikulam; Shanmugam, Ganesh

2017-11-28

Charge-transfer (CT) gel materials obtained from low-molecular-weight (LMW) compounds through a supramolecular self-assembly approach have received fascinating attention by many researchers because of their interesting material property and potential applications. However, most of the CT gel materials constructed were of organogels while the construction of CT gels in the form of a hydrogel is a challenge because of the solubility issue in water, which considerably limits the use of CT hydrogels. Herein, for the first time, we report a new LMW gelator [N α -(fluorenylmethoxycarbonyl)-N ε -(δ-butyric-1-pyrenyl)-l-lysine, (FmKPy)], composed of two functional moieties such as fluorenylmethoxycarbonyl and pyrene, which not only parade both hydro and organo (ambidextrous) supramolecular gel formation but also exhibit CT ambidextrous gels when mixed with an electron acceptor such as 2,4,7-trinitro-9-fluorenone (TNF). This finding is significant as the established CT organogelator in the literature did not form an organogel in the absence of an electron acceptor or lose their gelation property upon the addition of the acceptor. CT between pyrene and TNF was confirmed by the color change as well as the appearance of the CT band in the visible region of the absorption spectrum. CT between FmKPy and TNF was supported by the solvent dilution method using tetrahydrofuran as the gel breaker and pyrene fluorescence quenching in the case compound containing pyrene and TNF. The morphology of FmKPy ambidextrous gels indicates the fibrous nature while the self-assembled structure is primarily stabilized by π-π stacking among fluorenyl and pyrenyl moieties and hydrogen bonding between amide groups. The FmKPy-TNF CT ambidextrous gel retains the fibrous nature; however, the size of the fibers changed. In FmKPy-TNF CT gels, TNF is intercalated between pyrene moieties in the self-assembled structure as confirmed by fluorescence quenching and powder X-ray diffraction. The FmKPy ambidextrous gel exhibits significant properties such as low minimum gelation concentration (MGC), thixotropic nature, pH stimuli response, and high thermal stability. Upon the addition of TNF, the FmKPy-TNF CT ambidextrous gel maintains all these properties except MGC which increased for FmKPy-TNF. Because pyrene-based LMW organogels have been developed widely for many applications while their hydrogels were limited, the current finding of the pyrene-based ambidextrous fluorescent gel with the CT property provides a wide opportunity to use FmKPy as a soft material maker and also for potential applications in fields like surface coating, three-dimensional printing, and so forth.

Kazal-type proteinase inhibitor from disk abalone (Haliotis discus discus): molecular characterization and transcriptional response upon immune stimulation.

PubMed

Wickramaarachchi, W D Niroshana; De Zoysa, Mahanama; Whang, Ilson; Wan, Qiang; Lee, Jehee

2013-09-01

Proteinases and proteinase inhibitors are involved in several biological and physiological processes in all multicellular organisms. Proteinase inhibitors play a key role in regulating the activity of the respective proteinases. Among serine proteinase inhibitors, kazal-type proteinase inhibitors (KPIs) are widely found in mammals, avians, and a variety of invertebrates. In this study, we describe the identification of a kazal-type serine proteinase inhibitor (Ab-KPI) from the disk abalone, Haliotis discus discus, which is presumably involved in innate immunity. The full-length cDNA of Ab-KPI includes 600 bp nucleotides with an open reading frame (ORF) encoding a polypeptide of 143 amino acids. The deduced amino acid sequence of Ab-KPI contains a putative 17-amino acid signal peptide and two tandem kazal domains with high similarity to other kazal-type SPIs. Each kazal domain consists of reactive site (P1) residue containing a leucine (L), and a threonine (T) located in the second amino acid position after the second conserved cysteine of each domain. Temporal expression of Ab-KPI was assessed by real time quantitative PCR in hemocytes and mantle tissue following bacterial and viral hemorrhagic septicemia virus (VHSV) challenge, and tissue injury. At 6 h post-bacterial and -VHSV challenge, Ab-KPI expression in hemocytes was increased 14-fold and 4-fold, respectively, compared to control samples. The highest up-regulations upon tissue injury were shown at 9 h and 12 h in hemocytes and mantle, respectively. The transcriptional modulation of Ab-KPI following bacterial and viral challenges and tissue injury indicates that it might be involved in immune defense as well as wound healing process in abalone. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evidence for D0-D(0) mixing using the CDF II detector.

PubMed

Aaltonen, T; Adelman, J; Akimoto, T; Albrow, M G; González, B Alvarez; Amerio, S; Amidei, D; Anastassov, A; Annovi, A; Antos, J; Aoki, M; Apollinari, G; Apresyan, A; Arisawa, T; Artikov, A; Ashmanskas, W; Attal, A; Aurisano, A; Azfar, F; Azzi-Bacchetta, P; Azzurri, P; Bacchetta, N; Badgett, W; Barbaro-Galtieri, A; Barnes, V E; Barnett, B A; Baroiant, S; Bartsch, V; Bauer, G; Beauchemin, P-H; Bedeschi, F; Bednar, P; Behari, S; Bellettini, G; Bellinger, J; Belloni, A; Benjamin, D; Beretvas, A; Beringer, J; Berry, T; Bhatti, A; Binkley, M; Bisello, D; Bizjak, I; Blair, R E; Blocker, C; Blumenfeld, B; Bocci, A; Bodek, A; Boisvert, V; Bolla, G; Bolshov, A; Bortoletto, D; Boudreau, J; Boveia, A; Brau, B; Bridgeman, A; Brigliadori, L; Bromberg, C; Brubaker, E; Budagov, J; Budd, H S; Budd, S; Burkett, K; Busetto, G; Bussey, P; Buzatu, A; Byrum, K L; Cabrera, S; Campanelli, M; Campbell, M; Canelli, F; Canepa, A; Carlsmith, D; Carosi, R; Carrillo, S; Carron, S; Casal, B; Casarsa, M; Castro, A; Catastini, P; Cauz, D; Cavalli-Sforza, M; Cerri, A; Cerrito, L; Chang, S H; Chen, Y C; Chertok, M; Chiarelli, G; Chlachidze, G; Chlebana, F; Cho, K; Chokheli, D; Chou, J P; Choudalakis, G; Chuang, S H; Chung, K; Chung, W H; Chung, Y S; Ciobanu, C I; Ciocci, M A; Clark, A; Clark, D; Compostella, G; Convery, M E; Conway, J; Cooper, B; Copic, K; Cordelli, M; Cortiana, G; Crescioli, F; Cuenca Almenar, C; Cuevas, J; Culbertson, R; Cully, J C; Dagenhart, D; Datta, M; Davies, T; de Barbaro, P; De Cecco, S; Deisher, A; De Lentdecker, G; De Lorenzo, G; Dell'orso, M; Demortier, L; Deng, J; Deninno, M; De Pedis, D; Derwent, P F; Di Giovanni, G P; Dionisi, C; Di Ruzza, B; Dittmann, J R; D'Onofrio, M; Donati, S; Dong, P; Donini, J; Dorigo, T; Dube, S; Efron, J; Erbacher, R; Errede, D; Errede, S; Eusebi, R; Fang, H C; Farrington, S; Fedorko, W T; Feild, R G; Feindt, M; Fernandez, J P; Ferrazza, C; Field, R; Flanagan, G; Forrest, R; Forrester, S; Franklin, M; Freeman, J C; Furic, I; Gallinaro, M; Galyardt, J; Garberson, F; Garcia, J E; Garfinkel, A F; Gerberich, H; Gerdes, D; Giagu, S; Giakoumopolou, V; Giannetti, P; Gibson, K; Gimmell, J L; Ginsburg, C M; Giokaris, N; Giordani, M; Giromini, P; Giunta, M; Glagolev, V; Glenzinski, D; Gold, M; Goldschmidt, N; Golossanov, A; Gomez, G; Gomez-Ceballos, G; Goncharov, M; González, O; Gorelov, I; Goshaw, A T; Goulianos, K; Gresele, A; Grinstein, S; Grosso-Pilcher, C; Grundler, U; Guimaraes da Costa, J; Gunay-Unalan, Z; Haber, C; Hahn, K; Hahn, S R; Halkiadakis, E; Hamilton, A; Han, B-Y; Han, J Y; Handler, R; Happacher, F; Hara, K; Hare, D; Hare, M; Harper, S; Harr, R F; Harris, R M; Hartz, M; Hatakeyama, K; Hauser, J; Hays, C; Heck, M; Heijboer, A; Heinemann, B; Heinrich, J; Henderson, C; Herndon, M; Heuser, J; Hewamanage, S; Hidas, D; Hill, C S; Hirschbuehl, D; Hocker, A; Hou, S; Houlden, M; Hsu, S-C; Huffman, B T; Hughes, R E; Husemann, U; Huston, J; Incandela, J; Introzzi, G; Iori, M; Ivanov, A; Iyutin, B; James, E; Jayatilaka, B; Jeans, D; Jeon, E J; Jindariani, S; Johnson, W; Jones, M; Joo, K K; Jun, S Y; Jung, J E; Junk, T R; Kamon, T; Kar, D; Karchin, P E; Kato, Y; Kephart, R; Kerzel, U; Khotilovich, V; Kilminster, B; Kim, D H; Kim, H S; Kim, J E; Kim, M J; Kim, S B; Kim, S H; Kim, Y K; Kimura, N; Kirsch, L; Klimenko, S; Klute, M; Knuteson, B; Ko, B R; Koay, S A; Kondo, K; Kong, D J; Konigsberg, J; Korytov, A; Kotwal, A V; Kraus, J; Kreps, M; Kroll, J; Krumnack, N; Kruse, M; Krutelyov, V; Kubo, T; Kuhlmann, S E; Kuhr, T; Kulkarni, N P; Kusakabe, Y; Kwang, S; Laasanen, A T; Lai, S; Lami, S; Lammel, S; Lancaster, M; Lander, R L; Lannon, K; Lath, A; Latino, G; Lazzizzera, I; Lecompte, T; Lee, J; Lee, J; Lee, Y J; Lee, S W; Lefèvre, R; Leonardo, N; Leone, S; Levy, S; Lewis, J D; Lin, C; Lin, C S; Linacre, J; Lindgren, M; Lipeles, E; Lister, A; Litvintsev, D O; Liu, T; Lockyer, N S; Loginov, A; Loreti, M; Lovas, L; Lu, R-S; Lucchesi, D; Lueck, J; Luci, C; Lujan, P; Lukens, P; Lungu, G; Lyons, L; Lys, J; Lysak, R; Lytken, E; Mack, P; Macqueen, D; Madrak, R; Maeshima, K; Makhoul, K; Maki, T; Maksimovic, P; Malde, S; Malik, S; Manca, G; Manousakis, A; Margaroli, F; Marino, C; Marino, C P; Martin, A; Martin, M; Martin, V; Martínez, M; Martínez-Ballarín, R; Maruyama, T; Mastrandrea, P; Masubuchi, T; Mattson, M E; Mazzanti, P; McFarland, K S; McIntyre, P; McNulty, R; Mehta, A; Mehtala, P; Menzemer, S; Menzione, A; Merkel, P; Mesropian, C; Messina, A; Miao, T; Miladinovic, N; Miles, J; Miller, R; Mills, C; Milnik, M; Mitra, A; Mitselmakher, G; Miyake, H; Moed, S; Moggi, N; Moon, C S; Moore, R; Morello, M; Movilla Fernandez, P; Mülmenstädt, J; Mukherjee, A; Muller, Th; Mumford, R; Murat, P; Mussini, M; Nachtman, J; Nagai, Y; Nagano, A; Naganoma, J; Nakamura, K; Nakano, I; Napier, A; Necula, V; Neu, C; Neubauer, M S; Nielsen, J; Nodulman, L; Norman, M; Norniella, O; Nurse, E; Oh, S H; Oh, Y D; Oksuzian, I; Okusawa, T; Oldeman, R; Orava, R; Osterberg, K; Pagan Griso, S; Pagliarone, C; Palencia, E; Papadimitriou, V; Papaikonomou, A; Paramonov, A A; Parks, B; Pashapour, S; Patrick, J; Pauletta, G; Paulini, M; Paus, C; Pellett, D E; Penzo, A; Phillips, T J; Piacentino, G; Piedra, J; Pinera, L; Pitts, K; Plager, C; Pondrom, L; Portell, X; Poukhov, O; Pounder, N; Prakoshyn, F; Pronko, A; Proudfoot, J; Ptohos, F; Punzi, G; Pursley, J; Rademacker, J; Rahaman, A; Ramakrishnan, V; Ranjan, N; Redondo, I; Reisert, B; Rekovic, V; Renton, P; Rescigno, M; Richter, S; Rimondi, F; Ristori, L; Robson, A; Rodrigo, T; Rogers, E; Rolli, S; Roser, R; Rossi, M; Rossin, R; Roy, P; Ruiz, A; Russ, J; Rusu, V; Saarikko, H; Safonov, A; Sakumoto, W K; Salamanna, G; Saltó, O; Santi, L; Sarkar, S; Sartori, L; Sato, K; Savoy-Navarro, A; Scheidle, T; Schlabach, P; Schmidt, E E; Schmidt, M A; Schmidt, M P; Schmitt, M; Schwarz, T; Scodellaro, L; Scott, A L; Scribano, A; Scuri, F; Sedov, A; Seidel, S; Seiya, Y; Semenov, A; Sexton-Kennedy, L; Sfyria, A; Shalhout, S Z; Shapiro, M D; Shears, T; Shepard, P F; Sherman, D; Shimojima, M; Shochet, M; Shon, Y; Shreyber, I; Sidoti, A; Sinervo, P; Sisakyan, A; Slaughter, A J; Slaunwhite, J; Sliwa, K; Smith, J R; Snider, F D; Snihur, R; Soderberg, M; Soha, A; Somalwar, S; Sorin, V; Spalding, J; Spinella, F; Spreitzer, T; Squillacioti, P; Stanitzki, M; Denis, R St; Stelzer, B; Stelzer-Chilton, O; Stentz, D; Strologas, J; Stuart, D; Suh, J S; Sukhanov, A; Sun, H; Suslov, I; Suzuki, T; Taffard, A; Takashima, R; Takeuchi, Y; Tanaka, R; Tecchio, M; Teng, P K; Terashi, K; Thom, J; Thompson, A S; Thompson, G A; Thomson, E; Tipton, P; Tiwari, V; Tkaczyk, S; Toback, D; Tokar, S; Tollefson, K; Tomura, T; Tonelli, D; Torre, S; Torretta, D; Tourneur, S; Trischuk, W; Tu, Y; Turini, N; Ukegawa, F; Uozumi, S; Vallecorsa, S; van Remortel, N; Varganov, A; Vataga, E; Vázquez, F; Velev, G; Vellidis, C; Veszpremi, V; Vidal, M; Vidal, R; Vila, I; Vilar, R; Vine, T; Vogel, M; Volobouev, I; Volpi, G; Würthwein, F; Wagner, P; Wagner, R G; Wagner, R L; Wagner-Kuhr, J; Wagner, W; Wakisaka, T; Wallny, R; Wang, S M; Warburton, A; Waters, D; Weinberger, M; Wester, W C; Whitehouse, B; Whiteson, D; Wicklund, A B; Wicklund, E; Williams, G; Williams, H H; Wilson, P; Winer, B L; Wittich, P; Wolbers, S; Wolfe, C; Wright, T; Wu, X; Wynne, S M; Yagil, A; Yamamoto, K; Yamaoka, J; Yamashita, T; Yang, C; Yang, U K; Yang, Y C; Yao, W M; Yeh, G P; Yoh, J; Yorita, K; Yoshida, T; Yu, G B; Yu, I; Yu, S S; Yun, J C; Zanello, L; Zanetti, A; Zaw, I; Zhang, X; Zheng, Y; Zucchelli, S

2008-03-28

We measure the time dependence of the ratio of decay rates for the rare decay D{0}-->K{+}pi{-} to the Cabibbo-favored decay D{0}-->K{-}pi;{+}. A signal of 12.7x10;{3} D{0}-->K{+}pi{-} decays was obtained using the Collider Detector at Fermilab II detector at the Fermilab Tevatron with an integrated luminosity of 1.5 fb;{-1}. We measure the D0-D[over ]{0} mixing parameters (R_{D},y{'},x{'2}), and find that the data are inconsistent with the no-mixing hypothesis with a probability equivalent to 3.8 Gaussian standard deviations.

Peanut Seed Cultivars with Contrasting Resistance to Aspergillus parasiticus Colonization Display Differential Temporal Response of Protease Inhibitors.

PubMed

Müller, Virginia; Bonacci, Gustavo; Batthyany, Carlos; Amé, María V; Carrari, Fernando; Gieco, Jorge; Asis, Ramón

2017-04-01

Significant efforts are being made to minimize aflatoxin contamination in peanut seeds and one possible strategy is to understand and exploit the mechanisms of plant defense against fungal infection. In this study we have identified and characterized, at biochemical and molecular levels, plant protease inhibitors (PPIs) produced in peanut seeds of the resistant PI 337394 and the susceptible Forman cultivar during Aspergillus parasiticus colonization. With chromatographic methods and 2D-electrophoresis-mass spectrometry we have isolated and identified four variants of Bowman-Birk trypsin inhibitor (BBTI) and a novel Kunitz-type protease inhibitor (KPI) produced in response to A. parasiticus colonization. KPI was detected only in the resistant cultivar, while BBTI was produced in the resistant cultivar in a higher concentration than susceptible cultivar and with different isoforms. The kinetic expression of KPI and BBTI genes along with trypsin inhibitory activity was analyzed in both cultivars during infection. In the susceptible cultivar an early PPI activity response was associated with BBTI occurrence. Meanwhile, in the resistant cultivar a later response with a larger increase in PPI activity was associated with BBTI and KPI occurrence. The biological significance of PPI in seed defense against fungal infection was analyzed and linked to inhibitory properties on enzymes released by the fungus during infection, and to the antifungal effect of KPI.

Human Kunitz-type protease inhibitor engineered for enhanced matrix retention extends longevity of fibrin biomaterials.

PubMed

Briquez, Priscilla S; Lorentz, Kristen M; Larsson, Hans M; Frey, Peter; Hubbell, Jeffrey A

2017-08-01

Aprotinin is a broad-spectrum serine protease inhibitor used in the clinic as an anti-fibrinolytic agent in fibrin-based tissue sealants. However, upon re-exposure, some patients suffer from hypersensitivity immune reactions likely related to the bovine origin of aprotinin. Here, we aimed to develop a human-derived substitute to aprotinin. Based on sequence homology analyses, we identified the Kunitz-type protease inhibitor (KPI) domain of human amyloid-β A4 precursor protein as being a potential candidate. While KPI has a lower intrinsic anti-fibrinolytic activity than aprotinin, we reasoned that its efficacy is additionally limited by its fast release from fibrin material, just as aprotinin's is. Thus, we engineered KPI variants for controlled retention in fibrin biomaterials, using either covalent binding through incorporation of a substrate for the coagulation transglutaminase Factor XIIIa or through engineering of extracellular matrix protein super-affinity domains for sequestration into fibrin. We showed that both engineered KPI variants significantly slowed plasmin-mediated fibrinolysis in vitro, outperforming aprotinin. In vivo, our best engineered KPI variant (incorporating the transglutaminase substrate) extended fibrin matrix longevity by 50%, at a dose at which aprotinin did not show efficacy, thus qualifying it as a competitive substitute of aprotinin in fibrin sealants. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Business Intelligence in Hospital Management.

PubMed

Escher, Achim; Hainc, Nicolin; Boll, Daniel

2016-01-01

Business intelligence (BI) is a worthwhile investment, and will play a significant role in hospital management in the near future. Implementation of BI is challenging and requires resources, skills, and a strategy, but enables management to have easy access to relevant analysis of data and visualization of important key performance indicators (KPI). Modern BI applications will help to overcome shortages of common "hand-made" analysis, save time and money, and will enable even managers to do "self-service" analysis and reporting.

Whitham modulation theory for the Kadomtsev- Petviashvili equation.

PubMed

Ablowitz, Mark J; Biondini, Gino; Wang, Qiao

2017-08-01

The genus-1 Kadomtsev-Petviashvili (KP)-Whitham system is derived for both variants of the KP equation; namely the KPI and KPII equations. The basic properties of the KP-Whitham system, including symmetries, exact reductions and its possible complete integrability, together with the appropriate generalization of the one-dimensional Riemann problem for the Korteweg-de Vries equation are discussed. Finally, the KP-Whitham system is used to study the linear stability properties of the genus-1 solutions of the KPI and KPII equations; it is shown that all genus-1 solutions of KPI are linearly unstable, while all genus-1 solutions of KPII are linearly stable within the context of Whitham theory.

Whitham modulation theory for the Kadomtsev- Petviashvili equation

NASA Astrophysics Data System (ADS)

Ablowitz, Mark J.; Biondini, Gino; Wang, Qiao

2017-08-01

The genus-1 Kadomtsev-Petviashvili (KP)-Whitham system is derived for both variants of the KP equation; namely the KPI and KPII equations. The basic properties of the KP-Whitham system, including symmetries, exact reductions and its possible complete integrability, together with the appropriate generalization of the one-dimensional Riemann problem for the Korteweg-de Vries equation are discussed. Finally, the KP-Whitham system is used to study the linear stability properties of the genus-1 solutions of the KPI and KPII equations; it is shown that all genus-1 solutions of KPI are linearly unstable, while all genus-1 solutions of KPII are linearly stable within the context of Whitham theory.

KPI Student Executive Summary Report, Winter 2002.

ERIC Educational Resources Information Center

Sheridan Coll. (Ontario).

In the mid-1990s, the Ontario Government decided to enhance the accountability of the Colleges of Applied Arts and Technology by measuring and rewarding their performance in meeting specific goals and outcomes. The KPI (Key Performance Indicators) Satisfaction Survey is a tool developed by the Ministry of Training Colleges and Universities in…

Determination of the strong phase in D0-->K+pi- using quantum-correlated measurements.

PubMed

Rosner, J L; Alexander, J P; Cassel, D G; Duboscq, J E; Ehrlich, R; Fields, L; Gibbons, L; Gray, R; Gray, S W; Hartill, D L; Heltsley, B K; Hertz, D; Jones, C D; Kandaswamy, J; Kreinick, D L; Kuznetsov, V E; Mahlke-Krüger, H; Mohapatra, D; Onyisi, P U E; Patterson, J R; Peterson, D; Riley, D; Ryd, A; Sadoff, A J; Shi, X; Stroiney, S; Sun, W M; Wilksen, T; Athar, S B; Patel, R; Yelton, J; Rubin, P; Eisenstein, B I; Karliner, I; Mehrabyan, S; Lowrey, N; Selen, M; White, E J; Wiss, J; Mitchell, R E; Shepherd, M R; Besson, D; Pedlar, T K; Cronin-Hennessy, D; Gao, K Y; Hietala, J; Kubota, Y; Klein, T; Lang, B W; Poling, R; Scott, A W; Zweber, P; Dobbs, S; Metreveli, Z; Seth, K K; Tomaradze, A; Libby, J; Powell, A; Wilkinson, G; Ecklund, K M; Love, W; Savinov, V; Lopez, A; Mendez, H; Ramirez, J; Ge, J Y; Miller, D H; Sanghi, B; Shipsey, I P J; Xin, B; Adams, G S; Anderson, M; Cummings, J P; Danko, I; Hu, D; Moziak, B; Napolitano, J; He, Q; Insler, J; Muramatsu, H; Park, C S; Thorndike, E H; Yang, F; Artuso, M; Blusk, S; Khalil, S; Li, J; Mountain, R; Nisar, S; Randrianarivony, K; Sultana, N; Skwarnicki, T; Stone, S; Wang, J C; Zhang, L M; Bonvicini, G; Cinabro, D; Dubrovin, M; Lincoln, A; Rademacker, J; Asner, D M; Edwards, K W; Naik, P; Briere, R A; Ferguson, T; Tatishvili, G; Vogel, H; Watkins, M E

2008-06-06

We exploit the quantum coherence between pair-produced D0 and D[over]0 in psi(3770) decays to study charm mixing, which is characterized by the parameters x and y, and to make a first determination of the relative strong phase delta between D0-->K+pi- and D[over]0-->K+pi-. Using 281 pb(-1) of e+e- collision data collected with the CLEO-c detector at Ecm=3.77 GeV, as well as branching fraction input and time-integrated measurements of RM identical with (x2 + y2)/2 and RWS identical with Gamma(D0-->K+pi-)/Gamma(D[over]0-->K+pi-) from other experiments, we find cosdelta=1.03(-0.17)(+0.31)+/-0.06, where the uncertainties are statistical and systematic, respectively. By further including other mixing parameter measurements, we obtain an alternate measurement of cosdelta=1.10+/-0.35+/-0.07, as well as x sindelta=(4.4(-1.8)(+2.7)+/-2.9)x10(-3) and delta=(22(-12-11)(+11+9)) degrees .

Survival of patients with head and neck cancer. Impact of physical status and comorbidities.

PubMed

Sadat, F; Wienke, A; Dunst, J; Kuhnt, T

2012-01-01

Prognostic factors (e.g., gender, tumor stage, and hypoxia) have an impact on survival in patients with head and neck cancer. Thus, the impact of physical status and comorbidities on treatment decision and survival were evaluated. A total of 169 primary, inoperable patients with squamous cell cancer of the head and neck were retrospectively investigated. Patients were treated with hyperfractionated accelerated radio(chemo)therapy (HARcT) or hypofractionated radio(chemo)therapy (HypoRcT). Depending on the individual patient's situation (Karnofsky Performance Index, KPI), treatment for patients with a KPI of 80-100% was generally radiochemotherapy and for patients with a KPI ≤ 70% treatment was radiotherapy alone. In addition, all comorbidities were evaluated. Uni- and multivariate proportional hazards model were used, and overall survival (OS) was estimated by the Kaplan-Meier method. Treatment consisted of HARcT for 76 patients (45%), HART for 28 patients (17%), HypoRcT for 14 patients(8%), and HypoRT for 51 patients (30%). Of the patients, 107 patients (63%) presented with a KPI of 80-100%. OS (20%) was significantly better for patients with a KPI of 80-100%, while the OS for patients with a KPI ≤ 70% was 8% (p < 0.001). Good KPI, total irradiation dose (> 70 Gy), and chemotherapy were significant prognostic factors for better OS. Our retrospective analysis shows that performance status with dependency on comorbidities was an independent risk factor for OS.

Evaluation of keratoconus progression.

PubMed

Shajari, Mehdi; Steinwender, Gernot; Herrmann, Kim; Kubiak, Kate Barbara; Pavlovic, Ivana; Plawetzki, Elena; Schmack, Ingo; Kohnen, Thomas

2018-06-01

To define variables for the evaluation of keratoconus progression and to determine cut-off values. In this retrospective cohort study (2010-2016), 265 eyes of 165 patients diagnosed with keratoconus underwent two Scheimpflug measurements (Pentacam) that took place 1 year apart ±3 months. Variables used for keratoconus detection were evaluated for progression and a correlation analysis was performed. By logistic regression analysis, a keratoconus progression index (KPI) was defined. Receiver-operating characteristic curve (ROC) analysis was performed and Youden Index calculated to determine cut-off values. Variables used for keratoconus detection showed a weak correlation with each other (eg, correlation r=0.245 between RPImin and Kmax, p<0.001). Therefore, we used parameters that took several variables into consideration (eg, D-index, index of surface variance, index for height asymmetry, KPI). KPI was defined by logistic regression and consisted of a Pachymin coefficient of -0.78 (p=0.001), a maximum elevation of back surface coefficient of 0.27 and coefficient of corneal curvature at the zone 3 mm away from the thinnest point on the posterior corneal surface of -12.44 (both p<0.001). The two variables with the highest Youden Index in the ROC analysis were D-index and KPI: D-index had a cut-off of 0.4175 (70.6% sensitivity) and Youden Index of 0.606. Cut-off for KPI was -0.78196 (84.7% sensitivity) and a Youden Index of 0.747; both 90% specificity. Keratoconus progression should be defined by evaluating parameters that consider several corneal changes; we suggest D-index and KPI to detect progression. © 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.

Instability following total knee arthroplasty.

PubMed

Rodriguez-Merchan, E Carlos

2011-10-01

Background Knee prosthesis instability (KPI) is a frequent cause of failure of total knee arthroplasty. Moreover, the degree of constraint required to achieve immediate and long-term stability in total knee arthroplasty (TKA) is frequently debated. Questions This review aims to define the problem, analyze risk factors, and review strategies for prevention and treatment of KPI. Methods A PubMed (MEDLINE) search of the years 2000 to 2010 was performed using two key words: TKA and instability. One hundred and sixty-five initial articles were identified. The most important (17) articles as judged by the author were selected for this review. The main criteria for selection were that the articles addressed and provided solutions to the diagnosis and treatment of KPI. Results Patient-related risk factors predisposing to post-operative instability include deformity requiring a large surgical correction and aggressive ligament release, general or regional neuromuscular pathology, and hip or foot deformities. KPI can be prevented in most cases with appropriate selection of implants and good surgical technique. When ligament instability is anticipated post-operatively, the need for implants with a greater degree of constraint should be anticipated. In patients without significant varus or valgus malalignment and without significant flexion contracture, the posterior cruciate ligament (PCL) can be retained. However, the PCL should be sacrificed when deformity exists particularly in patients with rheumatoid arthritis, previous patellectomy, previous high tibial osteotomy or distal femoral osteotomy, and posttraumatic osteoarthritis with disruption of the PCL. In most cases, KPI requires revision surgery. Successful outcomes can only be obtained if the cause of KPI is identified and addressed. Conclusions Instability following TKA is a common cause of the need for revision. Typically, knees with deformity, rheumatoid arthritis, previous patellectomy or high tibial osteotomy, and posttraumatic arthritis carry higher risks of post-operative instability and are indications for more constrained TKA designs. Instability following TKA usually requires revision surgery which must address the cause of the instability for success.

Introduction of Renal Key Performance Indicators Associated with Increased Uptake of Peritoneal Dialysis in a Publicly Funded Health Service.

PubMed

Toussaint, Nigel D; McMahon, Lawrence P; Dowling, Gregory; Holt, Stephen G; Smith, Gillian; Safe, Maria; Knight, Richard; Fair, Kathleen; Linehan, Leanne; Walker, Rowan G; Power, David A

2017-01-01

♦ BACKGROUND: Increased demand for treatment of end-stage kidney disease has largely been accommodated by a costly increase in satellite hemodialysis (SHD) in most jurisdictions. In the Australian State of Victoria, a marked regional variation in the uptake of home-based dialysis suggests that use of home therapies could be increased as an alternative to SHD. An earlier strategy based solely on increased remuneration had failed to increase uptake of home therapies. Therefore, the public dialysis funder adopted the incidence and prevalence of home-based dialysis therapies as a key performance indicator (KPI) for its health services to encourage greater uptake of home therapies. ♦ METHODS: A KPI data collection and bench-marking program was established in 2012 by the Victorian Department of Health and Human Services, with data provided monthly by all renal units in Victoria using a purpose-designed website portal. A KPI Working Group was responsible for analyzing data each quarter and ensuring indicators remained accurate and relevant and each KPI had clear definitions and targets. We present a prospective, observational study of all dialysis patients in Victoria over a 4-year period following the introduction of the renal KPI program, with descriptive analyses to evaluate the proportion of patients using home therapies as well as home dialysis modality survival. ♦ RESULTS: Following the introduction of the KPI program, the net growth of dialysis patient numbers in Victoria remained stable over 4 years, at 75 - 80 per year (approximately 4%). However, unlike the previous decade, about 40% of this growth was through an increase in home dialysis, which was almost exclusively peritoneal dialysis (PD). The increase was identified particularly in the young (20 - 49) and the elderly (> 80). Disappointingly, however, 67% of these incident patients ceased PD within 2 years of commencement, 46% of whom transferred to SHD. ♦ CONCLUSIONS: Introduction of a KPI program was associated with an increased uptake of PD but not home HD. This change in clinical practice restricted growth of SHD and reduced pressure on satellite services. The effect was offset by a modest PD technique survival. Many patients in whom PD was unsuccessful were subsequently transferred to SHD rather than home HD. Copyright © 2017 International Society for Peritoneal Dialysis.

KPI Employer Executive Summary Report, Summer 2000-Winter 2001.

ERIC Educational Resources Information Center

Sheridan Coll. (Ontario).

In the mid 1990s, the Ontario Government decided to enhance the accountability of the Colleges of Applied Arts and Technology by measuring and rewarding their performance in meeting specific goals and outcomes. The KPI Satisfaction Survey is a tool developed by the Ministry of Training Colleges and Universities in conjunction with the colleges to…

KPI Student Satisfaction Survey, 2001. Executive Summary Report.

ERIC Educational Resources Information Center

Sheridan Coll. (Ontario).

The KPI (Key Performance Indicators) Student Satisfaction Survey is a paper-based survey distributed to all students in Ontario's Colleges of Applied Arts and Technology. The results of the Sheridan College survey for 2001 are presented in this report. The student population at Sheridan for the winter 2001 survey was 9,134. A total of 6,566…

Activation of extrasynaptic, but not synaptic, NMDA receptors modifies amyloid precursor protein expression pattern and increases amyloid-ß production.

PubMed

Bordji, Karim; Becerril-Ortega, Javier; Nicole, Olivier; Buisson, Alain

2010-11-24

Calcium is a key mediator controlling essential neuronal functions depending on electrical activity. Altered neuronal calcium homeostasis affects metabolism of amyloid precursor protein (APP), leading to increased production of β-amyloid (Aβ), and contributing to the initiation of Alzheimer's disease (AD). A linkage between excessive glutamate receptor activation and neuronal Aβ release was established, and recent reports suggest that synaptic and extrasynaptic NMDA receptor (NMDAR) activation may have distinct consequences in plasticity, gene regulation, and neuronal death. Here, we report for the first time that prolonged activation of extrasynaptic NMDAR, but not synaptic NMDAR, dramatically increased the neuronal production of Aβ. This effect was preceded by a shift from APP695 to Kunitz protease inhibitory domain (KPI) containing APPs (KPI-APPs), isoforms exhibiting an important amyloidogenic potential. Conversely, after synaptic NMDAR activation, we failed to detect any KPI-APP expression and neuronal Aβ production was not modified. Calcium imaging data showed that intracellular calcium concentration after extrasynaptic NMDAR stimulation was lower than after synaptic activation. This suggests distinct signaling pathways for each pool of receptors. We found that modification of neuronal APP expression pattern triggered by extrasynaptic NMDAR activation was regulated at an alternative splicing level involving calcium-/calmodulin-dependent protein kinase IV, but overall APP expression remained identical. Finally, memantine dose-dependently inhibited extrasynaptic NMDAR-induced KPI-APPs expression as well as neuronal Aβ release. Altogether, these data suggest that a chronic activation of extrasynaptic NMDAR promotes amyloidogenic KPI-APP expression leading to neuronal Aβ release, representing a causal risk factor for developing AD.

Xyloglucans from flaxseed kernel cell wall: Structural and conformational characterisation.

PubMed

Ding, Huihuang H; Cui, Steve W; Goff, H Douglas; Chen, Jie; Guo, Qingbin; Wang, Qi

2016-10-20

The structure of ethanol precipitated fraction from 1M KOH extracted flaxseed kernel polysaccharides (KPI-EPF) was studied for better understanding the molecular structures of flaxseed kernel cell wall polysaccharides. Based on methylation/GC-MS, NMR spectroscopy, and MALDI-TOF-MS analysis, the dominate sugar residues of KPI-EPF fraction comprised of (1,4,6)-linked-β-d-glucopyranose (24.1mol%), terminal α-d-xylopyranose (16.2mol%), (1,2)-α-d-linked-xylopyranose (10.7mol%), (1,4)-β-d-linked-glucopyranose (10.7mol%), and terminal β-d-galactopyranose (8.5mol%). KPI-EPF was proposed as xyloglucans: The substitution rate of the backbone is 69.3%; R1 could be T-α-d-Xylp-(1→, or none; R2 could be T-α-d-Xylp-(1→, T-β-d-Galp-(1→2)-α-d-Xylp-(1→, or T-α-l-Araf-(1→2)-α-d-Xylp-(1→; R3 could be T-α-d-Xylp-(1→, T-β-d-Galp-(1→2)-α-d-Xylp-(1→, T-α-l-Fucp-(1→2)-β-d-Galp-(1→2)-α-d-Xylp-(1→, or none. The Mw of KPI-EPF was calculated to be 1506kDa by static light scattering (SLS). The structure-sensitive parameter (ρ) of KPI-EPF was calculated as 1.44, which confirmed the highly branched structure of extracted xyloglucans. This new findings on flaxseed kernel xyloglucans will be helpful for understanding its fermentation properties and potential applications. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Performance Analysis of MYSEA

DTIC Science & Technology

2012-09-01

Services FSD Federated Services Daemon I&A Identification and Authentication IKE Internet Key Exchange KPI Key Performance Indicator LAN Local Area...spection takes place in different processes in the server architecture. Key Performance Indica- tor ( KPI )s associated with the system need to be...application and risk analysis of security controls. Thus, measurement of the KPIs is needed before an informed tradeoff between the performance penalties

Effects of acylation on the functional properties and in vitro trypsin digestibility of red kidney bean (Phaseolus vulgaris L.) protein isolate.

PubMed

Yin, Shou-Wei; Tang, Chuan-He; Wen, Qi-Biao; Yang, Xiao-Quan

2009-01-01

The effects of succinylation and acetylation on some functional properties and the in vitro trypsin digestibility of kidney bean protein isolate (KPI) were investigated. The extent of succinylation or acetylation progressively increased from 0% to 96% to 97%, as the anhydride-to-protein ratio increased from 0 to 1 g/g. Polyacrylamide gel electrophoresis (PAGE) and zeta potential analyses indicated that acylation, especially succinylation, considerably increased the net charge and hydrodynamic radius of the proteins in KPI, especially vicilin. Acylation treatment at various anhydride-to-protein ratios (0.05 to 1 g/g) remarkably improved the protein solubility (PS) and emulsifying activity index (EAI) at neutral pH, but the improvement by succinylation was much better than that by acetylation. Succinylation resulted in a marked decrease in mechanical moduli of heat-induced gels of KPI, while the mechanical moduli were, on the contrary, increased by acetylation. Additionally, in vitro trypsin digestibility was improved by the acylation in an anhydride-type and level-dependent manner. The results suggest that the functional properties of KPI could be modulated by the chemical acylation treatment, using succinic or acetic anhydride at appropriate anhydride-to-protein ratios.

Child behavior check list and Korean personality inventory for children with functional visual loss.

PubMed

Kyung, Sung Eun; Lee, Sang Mi; Lim, Myung Ho

2014-08-01

To investigate the clinical psychiatric characteristics of children with the main complaint of functional visual loss, their behavior and personality were evaluated by the means of the Korean child behavior check list (K-CBCL), and the Korean personality inventory for children (KPI-C). The evaluation was carried out by the K-CBCL and the KPI-C, the domestically standardized tools, with 20 child subjects suspected of functional visual loss, among the patients who visited our hospital, between August, 2005 and December, 2012. The control group included 160 children in general schools of the same region. The 20 patients whose main complaint was functional visual loss were diagnosed as having a functional visual disorder. The child patient group showed a higher score for the K-CBCL and KPI-C sub-scales of somatic complaints, social problems, aggressive behavior, internalizing problems, externalizing problems, total behavioral problems, somatization and hyperactivity, than that of the control group. The results of the K-CBCL and KPI-C tests among children with functional visual loss, were significantly different from those of the normal control group. This result suggested that psychological factors may influence children with a main complaint of functional visual loss.

Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach.

PubMed

Fernandes, Olavo; Gorman, Sean K; Slavik, Richard S; Semchuk, William M; Shalansky, Steve; Bussières, Jean-François; Doucette, Douglas; Bannerman, Heather; Lo, Jennifer; Shukla, Simone; Chan, Winnie W Y; Benninger, Natalie; MacKinnon, Neil J; Bell, Chaim M; Slobodan, Jeremy; Lyder, Catherine; Zed, Peter J; Toombs, Kent

2015-06-01

Key performance indicators (KPIs) are quantifiable measures of quality. There are no published, systematically derived clinical pharmacy KPIs (cpKPIs). A group of hospital pharmacists aimed to develop national cpKPIs to advance clinical pharmacy practice and improve patient care. A cpKPI working group established a cpKPI definition, 8 evidence-derived cpKPI critical activity areas, 26 candidate cpKPIs, and 11 cpKPI ideal attributes in addition to 1 overall consensus criterion. Twenty-six clinical pharmacists and hospital pharmacy leaders participated in an internet-based 3-round modified Delphi survey. Panelists rated 26 candidate cpKPIs using 11 cpKPI ideal attributes and 1 overall consensus criterion on a 9-point Likert scale. A meeting was facilitated between rounds 2 and 3 to debate the merits and wording of candidate cpKPIs. Consensus was reached if 75% or more of panelists assigned a score of 7 to 9 on the consensus criterion during the third Delphi round. All panelists completed the 3 Delphi rounds, and 25/26 (96%) attended the meeting. Eight candidate cpKPIs met the consensus definition: (1) performing admission medication reconciliation (including best-possible medication history), (2) participating in interprofessional patient care rounds, (3) completing pharmaceutical care plans, (4) resolving drug therapy problems, (5) providing in-person disease and medication education to patients, (6) providing discharge patient medication education, (7) performing discharge medication reconciliation, and (8) providing bundled, proactive direct patient care activities. A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care. © The Author(s) 2015.

Solutions of the KPI equation with smooth initial data

NASA Astrophysics Data System (ADS)

Boiti, M.; Pempinelli, F.; Pogrebkov, A.

1994-06-01

The solution $u(t,x,y)$ of the Kadomtsev--Petviashvili I (KPI) equation with given initial data $u(0,x,y)$ belonging to the Schwartz space is considered. No additional special constraints, usually considered in literature, as $\\int\\!dx\\,u(0,x,y)=0$ are required to be satisfied by the initial data. The problem is completely solved in the framework of the spectral transform theory and it is shown that $u(t,x,y)$ satisfies a special evolution version of the KPI equation and that, in general, $\\partial_t u(t,x,y)$ has different left and right limits at the initial time $t=0$. The conditions of the type $\\int\\!dx\\,u(t,x,y)=0$, $\\int\\!dx\\,xu_y(t,x,y)=0$ and so on (first, second, etc. `constraints') are dynamically generated by the evolution equation for $t\

Possibility of large final state interaction phases in light of B --> kpi and pipi data

PubMed

Hou; Yang

2000-05-22

The newly observed &Bmacr;( 0)-->&Kmacr;( 0)pi(0) mode is quite sizable while pi(-)pi(+) is rather small. Data also hint at pi(-)pi(0) greater, similarpi(-)pi(+). Though consistent with zero, central values of CP violating asymmetries in K-pi(+,0) and &Kmacr;( 0)pi(-) show an interesting pattern. Taking cue from these, we suggest that, besides gamma identical witharg(V(*)(ub)) being large, the rescattering phase delta in Kpi and pipi modes may be greater than 90 degrees. If this is true, not only the above trends can be accounted for, but one would also find pi(0)pi(0) approximately pi(-)pi(+,0), and the CP asymmetry in &Bmacr;( 0) vs B0-->pi(-)pi(+) could be as large as -60%. These results can be tested in a couple of years.

Sexual Assault Prevention and Response Website Analysis

DTIC Science & Technology

2014-09-01

IRR inter-rater reliability KPI key performance indicator N17 U.S Navy 21st Century Sailor Office NASASV National Association of Services Against...determine if progress is being made to achieve the desired goal; this is typically done by establishing key performance indicators 22 ( KPI ). After...defining the KPIs , organizations must prioritize the potential solutions and devise a plan for making small incremental changes to accurately assess the

Functional properties and in vitro trypsin digestibility of red kidney bean (Phaseolus vulgaris L.) protein isolate: Effect of high-pressure treatment.

PubMed

Yin, Shou-Wei; Tang, Chuan-He; Wen, Qi-Biao; Yang, Xiao-Quan; Li, Lin

2008-10-15

The effects of high-pressure (HP) treatment at 200-600MPa, prior to freeze-drying, on some functional properties and in vitro trypsin digestibility of vicilin-rich red kidney bean (Phaseolus vulgaris L.) protein isolate (KPI) were investigated. Surface hydrophobicity and free sulfhydryl (SH) and disulfide bond (SS) contents were also evaluated. HP treatment resulted in gradual unfolding of protein structure, as evidenced by gradual increases in fluorescence strength and SS formation from SH groups, and decrease in denaturation enthalpy change. The protein solubility of KPI was significantly improved at pressures of 400MPa or higher, possibly due to formation of soluble aggregate from insoluble precipitate. HP treatment at 200 and 400MPa significantly increased emulsifying activity index (EAI) and emulsion stability index (ESI); however, EAI was significantly decreased at 600MPa (relative to untreated KPI). The thermal stability of the vicilin component was not affected by HP treatment. Additionally, in vitro trypsin digestibility of KPI was decreased only at a pressure above 200MPa and for long incubation time (e.g., 120min). The data suggest that some physiochemical and functional properties of vicilin-rich kidney proteins can be improved by means of high-pressure treatment. Copyright © 2008 Elsevier Ltd. All rights reserved.

Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

NASA Astrophysics Data System (ADS)

Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

2014-09-01

Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

AbetaPP/APLP2 family of Kunitz serine proteinase inhibitors regulate cerebral thrombosis.

PubMed

Xu, Feng; Previti, Mary Lou; Nieman, Marvin T; Davis, Judianne; Schmaier, Alvin H; Van Nostrand, William E

2009-04-29

The amyloid beta-protein precursor (AbetaPP) is best recognized as the precursor to the Abeta peptide that accumulates in the brains of patients with Alzheimer's disease, but less is known about its physiological functions. Isoforms of AbetaPP that contain a Kunitz-type serine proteinase inhibitor (KPI) domain are expressed in brain and, outside the CNS, in circulating blood platelets. Recently, we showed that KPI-containing forms of AbetaPP regulates cerebral thrombosis in vivo (Xu et al., 2005, 2007). Amyloid precursor like protein-2 (APLP2), a closely related homolog to AbetaPP, also possesses a highly conserved KPI domain. Virtually nothing is known of its function. Here, we show that APLP2 also regulates cerebral thrombosis risk. Recombinant purified KPI domains of AbetaPP and APLP2 both inhibit the plasma clotting in vitro. In a carotid artery thrombosis model, both AbetaPP(-/-) and APLP2(-/-) mice exhibit similar significantly shorter times to vessel occlusion compared with wild-type mice indicating a prothrombotic phenotype. Similarly, in an experimental model of intracerebral hemorrhage, both AbetaPP(-/-) and APLP2(-/-) mice produce significantly smaller hematomas with reduced brain hemoglobin content compared with wild-type mice. Together, these results indicate that AbetaPP and APLP2 share overlapping anticoagulant functions with regard to regulating thrombosis after cerebral vascular injury.

Inverse scattering transform for the KPI equation on the background of a one-line soliton*Inverse scattering transform for the KPI equation on the background of a one-line soliton

NASA Astrophysics Data System (ADS)

Fokas, A. S.; Pogrebkov, A. K.

2003-03-01

We study the initial value problem of the Kadomtsev-Petviashvili I (KPI) equation with initial data u(x1,x2,0) = u1(x1)+u2(x1,x2), where u1(x1) is the one-soliton solution of the Korteweg-de Vries equation evaluated at zero time and u2(x1,x2) decays sufficiently rapidly on the (x1,x2)-plane. This involves the analysis of the nonstationary Schrödinger equation (with time replaced by x2) with potential u(x1,x2,0). We introduce an appropriate sectionally analytic eigenfunction in the complex k-plane where k is the spectral parameter. This eigenfunction has the novelty that in addition to the usual jump across the real k-axis, it also has a jump across a segment of the imaginary k-axis. We show that this eigenfunction can be reconstructed through a linear integral equation uniquely defined in terms of appropriate scattering data. In turn, these scattering data are uniquely constructed in terms of u1(x1) and u2(x1,x2). This result implies that the solution of the KPI equation can be obtained through the above linear integral equation where the scattering data have a simple t-dependence.

Driving clinical study efficiency by using a productivity breakdown model: comparative evaluation of a global clinical study and a similar Japanese study.

PubMed

Takahashi, K; Sengoku, S; Kimura, H

2011-02-01

A fundamental management imperative of pharmaceutical companies is to contain surging costs of developing and launching drugs globally. Clinical studies are a research and development (R&D) cost driver. The objective of this study was to develop a productivity breakdown model, or a key performance indicator (KPI) tree, for an entire clinical study and to use it to compare a global clinical study with a similar Japanese study. We, thereby, hope to identify means of improving study productivity. We developed the new clinical study productivity breakdown model, covering operational aspects and cost factors. Elements for improving clinical study productivity were assessed from a management viewpoint by comparing empirical tracking data from a global clinical study with a Japanese study with similar protocols. The following unique and material differences, beyond simple international difference in cost of living, that could affect the efficiency of future clinical trials were identified: (i) more frequent site visits in the Japanese study, (ii) head counts at the Japanese study sites more than double those of the global study and (iii) a shorter enrollment time window of about a third that of the global study at the Japanese study sites. We identified major differences in the performance of the two studies. These findings demonstrate the potential of the KPI tree for improving clinical study productivity. Trade-offs, such as those between reduction in head count at study sites and expansion of the enrollment time window, must be considered carefully. © 2010 Blackwell Publishing Ltd.

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

Meadows, B.T.; /Cincinnati U.

A new approach to the analysis of three body decays is presented. Model-independent results are obtained for the S-wave K{pi} amplitude as a function of K{pi} invariant mass. These are compared with results from K{sup -}{pi}{sup +} elastic scattering, and the prediction of the Watson theorem, that the phase behavior be the same below K{eta}' threshold, is tested. Contributions from I = 1/2 and I = 3/2 are not resolved in this study. If I = 1/2 dominates, however, the Watson theorem does not describe these data well.

Achieving continuous improvement in laboratory organization through performance measurements: a seven-year experience.

PubMed

Salinas, Maria; López-Garrigós, Maite; Gutiérrez, Mercedes; Lugo, Javier; Sirvent, Jose Vicente; Uris, Joaquin

2010-01-01

Laboratory performance can be measured using a set of model key performance indicators (KPIs). The design and implementation of KPIs are important issues. KPI results from 7 years are reported and their implementation, monitoring, objectives, interventions, result reporting and delivery are analyzed. The KPIs of the entire laboratory process were obtained using Laboratory Information System (LIS) registers. These were collected automatically using a data warehouse application, spreadsheets and external quality program reports. Customer satisfaction was assessed using surveys. Nine model laboratory KPIs were proposed and measured. The results of some examples of KPIs used in our laboratory are reported. Their corrective measurements or the implementation of objectives led to improvement in the associated KPIs results. Measurement of laboratory performance using KPIs and a data warehouse application that continuously collects registers and calculates KPIs confirmed the reliability of indicators, indicator acceptability and usability for users, and continuous process improvement.

Multi-component Wronskian solution to the Kadomtsev-Petviashvili equation

NASA Astrophysics Data System (ADS)

Xu, Tao; Sun, Fu-Wei; Zhang, Yi; Li, Juan

2014-01-01

It is known that the Kadomtsev-Petviashvili (KP) equation can be decomposed into the first two members of the coupled Ablowitz-Kaup-Newell-Segur (AKNS) hierarchy by the binary non-linearization of Lax pairs. In this paper, we construct the N-th iterated Darboux transformation (DT) for the second- and third-order m-coupled AKNS systems. By using together the N-th iterated DT and Cramer's rule, we find that the KPII equation has the unreduced multi-component Wronskian solution and the KPI equation admits a reduced multi-component Wronskian solution. In particular, based on the unreduced and reduced two-component Wronskians, we obtain two families of fully-resonant line-soliton solutions which contain arbitrary numbers of asymptotic solitons as y → ∓∞ to the KPII equation, and the ordinary N-soliton solution to the KPI equation. In addition, we find that the KPI line solitons propagating in parallel can exhibit the bound state at the moment of collision.

Methods to uncover an antibody epitope in the KPI domain of Alzheimer's amyloid precursor protein for immunohistochemistry in human brain.

PubMed

Campbell, E; Pearson, R C; Parkinson, D

1999-11-15

A novel polyclonal antibody (Ab993), specific for a KPI domain epitope of APP, was characterised for use in immunoprecipitation, Western blotting and immunohistochemistry. Conditioned medium from NTera2/D1 cells was used for immunoprecipitation and Western blots. Paraffin-embedded human brain sections were used for immunohistochemistry. The antibody recognised KPI-containing APP on Western blots after standard solubilisation but immunoprecipitation of soluble APP required reduction with 2-mercaptoethanol followed by alkylation of reduced sulphydryl bonds with sodium iodoacetate. Immunohistochemical staining of human brain sections was significantly enhanced by this pre-treatment. Microwaving of sections also increased immunolabelling, by a mechanism that was additive to reduction and alkylation. Incubation in 80% formic acid did not confer any enhancement of immunoreactivity. Ab993, applied with the methods reported here, is expected to be valuable in investigations of the pathogenesis of Alzheimer's disease to determine the source of the beta-amyloid peptide.

Amyloid precursor protein expression is enhanced in human platelets from subjects with Alzheimer's disease and frontotemporal lobar degeneration: a real-time PCR study.

PubMed

Vignini, Arianna; Morganti, Stefano; Salvolini, Eleonora; Sartini, Davide; Luzzi, Simona; Fiorini, Rosamaria; Provinciali, Leandro; Di Primio, Roberto; Mazzanti, Laura; Emanuelli, Monica

2013-12-01

Frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD) represent the most frequent causes of early-onset and late-onset degenerative dementia, respectively. A correct diagnosis entails the choice of appropriate therapies. In this view the present study aimed to identify biomarkers that could improve the differential diagnosis. We recently found an overexpression of platelet amyloid precursor protein (APP) in AD; furthermore, recent studies have suggested the presence of changes in APP processing in FTLD. In this context, we analyzed the mRNA expression level of Total APP (TOT) and APP containing a Kunitz-type serine protease inhibitor domain (KPI) in platelets obtained from AD patients, subjects with FTLD, and healthy subjects. In addition, we evaluated the correlation between platelet APP mRNA expression levels and cognitive impairment.Differential gene expression measurements revealed a significant up-regulation of APP TOT and APP KPI in both AD and FTLD patients compared to the controls (being AD/Controls: 1.67 for APP TOT and 1.47 for APP KPI; FTLD/Controls: 1.62 for APP TOT and 1.51 for APP KPI; p < 0.05), although it is interesting to note that in FTLD patients this expression did not correlate with the severity of cognitive impairment.This could be related to a reduced beta-amyloid (Aβ) formation, caused by an alteration of secretase enzymatic activity, even though a post-transcriptional regulation of APP mRNAs in FTLD cannot be excluded.

AβPP/APLP2 Family of Kunitz Serine Proteinase Inhibitors Regulate Cerebral Thrombosis

PubMed Central

Xu, Feng; Previti, Mary Lou; Nieman, Marvin T.; Davis, Judianne; Schmaier, Alvin H.; Van Nostrand, William E.

2009-01-01

The amyloid β-protein precursor (AβPP) is best recognized as the precursor to the Aβ peptide that accumulates in the brains of patients with Alzheimer’s disease, but less is known about its physiological functions. Isoforms of AβPP that contain a Kunitz-type serine proteinase inhibitor (KPI) domain are expressed in brain and, outside the CNS, in circulating blood platelets. Recently, we showed that KPI-containing forms of AβPP regulates cerebral thrombosis in vivo (Xu et al., 2005 Proc. Natl. Acad. Sci. USA 102:18135–18140; Xu et al. 2007 Stroke 38:2598–2601). Amyloid precursor like protein-2 (APLP2), a closely related homolog to AβPP, also possesses a highly conserved KPI domain. Virtually nothing is known of its function. Here we show that APLP2 also regulates cerebral thrombosis risk. Recombinant purified KPI domains of AβPP and APLP2 both inhibit the plasma clotting in vitro. In a carotid artery thrombosis model both AβPP−/− and APLP2−/− mice exhibit similar significantly shorter times to vessel occlusion compared with wild-type mice indicating a pro-thrombotic phenotype. Similarly, in an experimental model of intracerebral hemorrhage both AβPP−/− and APLP2−/− mice produce significantly smaller hematomas with reduced brain hemoglobin content compared with wild-type mice. Together, these results indicate that AβPP and APLP2 share overlapping anticoagulant functions with regard to regulating thrombosis after cerebral vascular injury. PMID:19403832

Properties of solutions of the Kadomtsev-Petviashvili I equation

NASA Astrophysics Data System (ADS)

Boiti, M.; Pempinelli, F.; Pogrebkov, A.

1994-09-01

The Kadomtsev-Petviashvili I (KPI) equation is considered as a useful laboratory for experimenting with new theoretical tools able to handle the specific features of integrable models in 2+1 dimensions. The linearized version of the KPI equation is first considered by solving the initial value problem for different classes of initial data. Properties of the solutions in different cases are analyzed in details. The obtained results are used as a guideline for studying the properties of the solution u(t,x,y) of the Kadomtsev-Petviashvili I (KPI) equation with given initial data u(0,x,y) belonging to the Schwartz space. The spectral theory associated to KPI is studied in the space of the Fourier transform of the solutions. The variables p={p1,p2} of the Fourier space are shown to be the most convenient spectral variables to use for spectral data. Spectral data are shown to decay rapidly at large p but to be discontinuous at p=0. Direct and inverse problems are solved with special attention to the behavior of all the quantities involved in the neighborhood of t=0 and p=0. It is shown in particular that the solution u(t,x,y) has a time derivative discontinuous at t=0 and that at any t≠0 it does not belong to the Schwartz space no matter how small in norm and rapidly decaying at large distances the initial data are chosen.

Amyloid precursor protein expression is enhanced in human platelets from subjects with Alzheimer's disease and Frontotemporal lobar degeneration: A Real-time PCR study.

PubMed

Vignini, Arianna; Morganti, Stefano; Salvolini, Eleonora; Sartini, Davide; Luzzi, Simona; Fiorini, Rosamaria; Provinciali, Leandro; Di Primio, Roberto; Mazzanti, Laura; Emanuelli, Monica

2013-10-26

Frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD) represent the most frequent causes of early-onset and late-onset degenerative dementia, respectively. A correct diagnosis entails the choice of appropriate therapies. In this view the present study aimed to identify biomarkers that could improve the differential diagnosis. We recently found an overexpression of platelet amyloid precursor protein (APP) in AD; furthermore, recent studies have suggested the presence of changes in APP processing in FTLD. In this context, we analyzed the mRNA expression level of Total APP (TOT) and APP containing a Kunitz-type serine protease inhibitor domain (KPI) in platelets obtained from AD patients, subjects with FTLD, and healthy subjects. In addition, we evaluated the correlation between platelet APP mRNA expression levels and cognitive impairment. Differential gene expression measurements revealed a significant up-regulation of APP TOT and APP KPI in both AD and FTLD patients compared to the controls (being AD/Controls: 1.67 for APP TOT and 1.47 for APP KPI; FTLD/Controls: 1.62 for APP TOT and 1.51 for APP KPI; p<0.05) , although it is interesting to note that in FTLD patients this expression did not correlate with the severity of cognitive impairment. This could be related to a reduced beta-amyloid (Aβ) formation, caused by an alteration of secretase enzymatic activity, even though a post-transcriptional regulation of APP mRNAs in FTLD cannot be excluded. © 2013.

The Benefits of Streamlined Hip Fracture Management in a Regional Hospital.

PubMed

Mow, T C; Lukeis, Jen; Sutherland, A G

2017-06-01

Hip fracture is an increasingly common injury in the growing elderly population. The morbidity and mortality associated with this injury can be reduced by minimizing delays to surgical treatment. We describe the impact of a regional hospital service redesign project that utilized the principles of smart simplicity, a management strategy that lays emphasis on collaboration to achieve desired goals. Prior to the redesign, patients with hip fractures were taking an average of 72 hours for surgical treatment. A hip fracture working group was created to examine closely the process of hip fracture care, and a single key performance indicator (KPI) of "surgery within 48 hours" was adopted. This allowed identification of processes that could be clarified and streamlined, with the agreement of relevant stakeholders, in the creation of a new hip fracture pathway. In the first 3 months of the pathway's implementation, 16 of 18 patients had surgery within 48 hours of presentation. In a 6-month follow-up audit after 2 years of implementation, 36 of 39 patients were treated within 48 hours. This was significantly different to the time to surgery seen in the 12 months prior to the redesign ( P < .001, Student t test). The mean time to surgery was reduced from 72 hours to 36 hours, a saving in an annual acute bed stay cost of A$152 000. Decreased time to the operating room, the cost savings inherent to this, can be achieved with the introduction of the best standard of care. A redesign that mandates collaboration in achieving a single KPI has allowed a significant culture shift in the treatment of hip fractures in our institution in the months following its institution. Collaborative, multidisciplinary collaboration has facilitated a higher standard of care and demonstrated significant cost benefit.

A Comparison of Mobile and Fixed Device Access on User Engagement Associated With Women, Infants, and Children (WIC) Online Nutrition Education

PubMed Central

2016-01-01

Background Online health education has expanded its reach due to cost-effective implementation and demonstrated effectiveness. However, a limitation exists with the evaluation of online health education implementations and how the impact of the system is attenuated by the extent to which a user engages with it. Moreover, the current online health education research does not consider how this engagement has been affected by the transition from fixed to mobile user access over the last decade. Objective This paper focuses on comparing the impact mobile versus fixed devices have on user engagement key performance indicators (KPI) associated with the wichealth website (.org), an Internet-based parent-child feeding intervention offered to clients associated with the US Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods Data were collected from 612,201 nutrition education lessons completed by 305,735 unique WIC participants in 21 states over a 1-year period. Data consisted of system-collected measures, profile items, and items from an exit survey administered at the conclusion of each lesson. User engagement was defined based on 3 KPIs associated with usage of the wichealth website: number of link views, link view time, and progression in stage of readiness to change. Independent samples t tests were used to compare KPIs between fixed only and mobile only device users and paired samples t tests were used to compare KPIs within users who completed at least one lesson each on both a fixed and mobile device. A logistic regression was performed to estimate the odds of KPI performance thresholds in the independent samples study group given access device type while controlling for confounding of user characteristics associated with these KPIs. Results Analysis of 8 user characteristics (lessons completed, race, ethnicity, language, state of residence, pregnancy status, beginning stage of change, and preferred nutrition education method) were significantly (P<.001) related to various KPI differences between mobile and fixed device access. Non-mobile users were significantly (P<.001) more likely to engage based on all 3 KPIs, even after logistic regression control for the potential confounding related to the strongly associated user characteristics identified. Conclusions The findings of this study support the idea that online health education developers need to seriously consider access device when creating programs. Online health education developers need to take extra effort to truly understand access patterns of populations being served, and whether or not access device will influence user engagement performance indicators. PMID:27847351

From nonlinear Schrödinger hierarchy to some (2+1)-dimensional nonlinear pseudodifferential equations

NASA Astrophysics Data System (ADS)

Yang, Xiao; Du, Dianlou

2010-08-01

The Poisson structure on CN×RN is introduced to give the Hamiltonian system associated with a spectral problem which yields the nonlinear Schrödinger (NLS) hierarchy. The Hamiltonian system is proven to be Liouville integrable. Some (2+1)-dimensional equations including NLS equation, Kadomtesev-Petviashvili I (KPI) equation, coupled KPI equation, and modified Kadomtesev-Petviashvili (mKP) equation, are decomposed into Hamilton flows via the NLS hierarchy. The algebraic curve, Abel-Jacobi coordinates, and Riemann-Jacobi inversion are used to obtain the algebrogeometric solutions of these equations.

On the Discrete Spectrum of the Nonstationary Schrödinger Equation and Multipole Lumps of the Kadomtsev-Petviashvili I Equation

NASA Astrophysics Data System (ADS)

Villarroel, Javier; Ablowitz, Mark J.

The discrete spectrum of the nonstationary Schrödinger equation and localized solutions of the Kadomtsev-Petviashvili-I (KPI) equation are studied via the inverse scattering transform. It is shown that there exist infinitely many real and rationally decaying potentials which correspond to a discrete spectrum whose related eigenfunctions have multiple poles in the spectral parameter. An index or winding number is asssociated with each of these solutions. The resulting localized solutions of KPI behave as collection of individual humps with nonuniform dynamics.

Using Discrete Event Simulation to predict KPI's at a Projected Emergency Room.

PubMed

Concha, Pablo; Neriz, Liliana; Parada, Danilo; Ramis, Francisco

2015-01-01

Discrete Event Simulation (DES) is a powerful factor in the design of clinical facilities. DES enables facilities to be built or adapted to achieve the expected Key Performance Indicators (KPI's) such as average waiting times according to acuity, average stay times and others. Our computational model was built and validated using expert judgment and supporting statistical data. One scenario studied resulted in a 50% decrease in the average cycle time of patients compared to the original model, mainly by modifying the patient's attention model.

Fast plasma shutdown by killer pellet injection in JT-60U with reduced heat flux on the divertor plate and avoiding runaway electron generation

NASA Astrophysics Data System (ADS)

Yoshino, R.; Kondoh, T.; Neyatani, Y.; Itami, K.; Kawano, Y.; Isei, N.

1997-02-01

A killer pellet is an impurity pellet that is injected into a tokamak plasma in order to terminate a discharge without causing serious damage to the tokamak machine. In JT-60U neon ice pellets have been injected into OH and NB heated plasmas and fast plasma shutdowns have been demonstrated without large vertical displacement. The heat pulse on the divertor plate has been greatly reduced by killer pellet injection (KPI), but a low-power heat flux tail with a long time duration is observed. The total energy on the divertor plate increases with longer heat flux tail, so it has been reduced by shortening the tail. Runaway electron (RE) generation has been observed just after KPI and/or in the later phase of the plasma current quench. However, RE generation has been avoided when large magnetic perturbations are excited. These experimental results clearly show that KPI is a credible fast shutdown method avoiding large vertical displacement, reducing heat flux on the divertor plate, and avoiding (or minimizing) RE generation.

Lump Solitons in Surface Tension Dominated Flows

NASA Astrophysics Data System (ADS)

Milewski, Paul; Berger, Kurt

1999-11-01

The Kadomtsev-Petviashvilli I equation (KPI) which models small-amplitude, weakly three-dimensional surface-tension dominated long waves is integrable and allows for algebraically decaying lump solitary waves. It is not known (theoretically or numerically) whether the full free-surface Euler equations support such solutions. We consider an intermediate model, the generalised Benney-Luke equation (gBL) which is isotropic (not weakly three-dimensional) and contains KPI as a limit. We show numerically that: 1. gBL supports lump solitary waves; 2. These waves collide elastically and are stable; 3. They are generated by resonant flow over an obstacle.

Rational solutions to the KPI equation and multi rogue waves

NASA Astrophysics Data System (ADS)

Gaillard, Pierre

2016-04-01

We construct here rational solutions to the Kadomtsev-Petviashvili equation (KPI) as a quotient of two polynomials in x, y and t depending on several real parameters. This method provides an infinite hierarchy of rational solutions written in terms of polynomials of degrees 2 N(N + 1) in x, y and t depending on 2 N - 2 real parameters for each positive integer N. We give explicit expressions of the solutions in the simplest cases N = 1 and N = 2 and we study the patterns of their modulus in the (x , y) plane for different values of time t and parameters.

Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type.

PubMed

Li, Ya-Jun; Yi, Ping-Yong; Li, Ji-Wei; Liu, Xian-Ling; Liu, Xi-Yu; Zhou, Fang; OuYang, Zhou; Sun, Zhong-Yi; Huang, Li-Jun; He, Jun-Qiao; Yao, Yuan; Fan, Zhou; Tang, Tian; Jiang, Wen-Qi

2017-01-17

The role of body mass index (BMI) in lymphoma survival outcomes is controversial. The prognostic significance of BMI in extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is unclear. We evaluated the prognostic role of BMI in patients with ENKTL. We retrospectively analyzed 742 patients with newly diagnosed ENKTL. The prognostic value of BMI was compared between patients with low BMIs (< 20.0 kg/m2) and patients with high BMIs (≥ 20.0 kg/m2). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) was also evaluated and compared with that of the BMI classification. Patients with low BMIs tended to exhibit higher Eastern Cooperative Oncology Group performance status (ECOG PS) scores (≥ 2) (P = 0.001), more frequent B symptoms (P < 0.001), lower albumin levels (P < 0.001), higher KPI scores (P = 0.03), and lower rates of complete remission (P < 0.001) than patients with high BMIs, as well as inferior progression-free survival (PFS, P = 0.003), and inferior overall survival (OS, P = 0.001). Multivariate analysis demonstrated that age > 60 years, mass > 5 cm, stage III/IV, elevated LDH levels, albumin levels < 35 g/L and low BMIs were independent adverse predictors of OS. The BMI classification was found to be superior to the IPI with respect to predicting patient outcomes among low-risk patients and the KPI with respect to distinguishing between intermediate-low- and high-intermediate-risk patients. Higher BMI at the time of diagnosis is associated with improved overall survival in ENKTL. Using the BMI classification may improve the IPI and KPI prognostic models.

Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type

PubMed Central

Li, Ya-Jun; Yi, Ping-Yong; Li, Ji-Wei; Liu, Xian-Ling; Liu, Xi-Yu; Zhou, Fang; OuYang, Zhou; Sun, Zhong-Yi; Huang, Li-Jun; He, Jun-Qiao; Yao, Yuan; Fan, Zhou; Tang, Tian; Jiang, Wen-Qi

2017-01-01

Objectives: The role of body mass index (BMI) in lymphoma survival outcomes is controversial. The prognostic significance of BMI in extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is unclear. We evaluated the prognostic role of BMI in patients with ENKTL. Methods: We retrospectively analyzed 742 patients with newly diagnosed ENKTL. The prognostic value of BMI was compared between patients with low BMIs (< 20.0 kg/m2) and patients with high BMIs (≥ 20.0 kg/m2). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) was also evaluated and compared with that of the BMI classification. Results: Patients with low BMIs tended to exhibit higher Eastern Cooperative Oncology Group performance status (ECOG PS) scores (≥ 2) (P = 0.001), more frequent B symptoms (P < 0.001), lower albumin levels (P < 0.001), higher KPI scores (P = 0.03), and lower rates of complete remission (P < 0.001) than patients with high BMIs, as well as inferior progression-free survival (PFS, P = 0.003), and inferior overall survival (OS, P = 0.001). Multivariate analysis demonstrated that age > 60 years, mass > 5 cm, stage III/IV, elevated LDH levels, albumin levels < 35 g/L and low BMIs were independent adverse predictors of OS. The BMI classification was found to be superior to the IPI with respect to predicting patient outcomes among low-risk patients and the KPI with respect to distinguishing between intermediate-low- and high-intermediate-risk patients. Conclusions: Higher BMI at the time of diagnosis is associated with improved overall survival in ENKTL. Using the BMI classification may improve the IPI and KPI prognostic models. PMID:28002803

Effect of surgical decompression of spinal metastases in acute treatment - Predictors of neurological outcome.

PubMed

Hohenberger, Christoph; Schmidt, Corinna; Höhne, Julius; Brawanski, Alexander; Zeman, Florian; Schebesch, Karl-Michael

2018-06-01

Space-occupying spinal metastases (SM), commonly diagnosed because of acute neurological deterioration, consequently lead to immediate decompression with tumor removal or debulking. In this study, we analyzed a series of patients with surgically treated spinal metastases and explicitly sought to determine individual predictors of functional outcome. 94 patients (26 women, 68 men; mean age 64.0 years) with spinal metastases, who had been surgically treated at our department, were included retrospectively. We reviewed the pre- and postoperative charts, surgical reports, radiographic data for demographics, duration of symptoms, histopathology, stage of systemic disease, co-morbidities, radiographic extension, surgical strategy, neurological performance (Frankel Grade Classification), and the Karnofsky Performance Index (KPI). Emergency surgery within <24 h after discharge had been conducted in 33% of patients. Prostate carcinoma (29.5%) and breast carcinoma (11.6%) were the most common histopathologies. Median KPI was 60% at admission that had significantly improved at discharge (KPI 70%; p = 0.01). The rate of complications without revision was 4.3%, the revision rate 4.2%. From admission to discharge, pain had been significantly reduced (p = 0.019) and motor deficits significantly improved (p = 0.003). KPI had been significantly improved during in-hospital treatment (median 60 vs 70, p = 0.010). In the multivariable analysis, predictors of poor outcome (KPI < 70) were male sex, multiple metastases, and pre-existing bowel and bladder dysfunction. Median follow up was 2 months. In our series, surgery for spinal metastases (laminectomy, tumor removal, and mass reduction) significantly reduced pain as well as sensory and motor deficits. We identified male sex, multiple metastases, and pre-existing bowel and bladder dysfunction as predictors of negative outcome. Copyright © 2018 Elsevier Ltd. All rights reserved.

Proactive Supply Chain Performance Management with Predictive Analytics

PubMed Central

Stefanovic, Nenad

2014-01-01

Today's business climate requires supply chains to be proactive rather than reactive, which demands a new approach that incorporates data mining predictive analytics. This paper introduces a predictive supply chain performance management model which combines process modelling, performance measurement, data mining models, and web portal technologies into a unique model. It presents the supply chain modelling approach based on the specialized metamodel which allows modelling of any supply chain configuration and at different level of details. The paper also presents the supply chain semantic business intelligence (BI) model which encapsulates data sources and business rules and includes the data warehouse model with specific supply chain dimensions, measures, and KPIs (key performance indicators). Next, the paper describes two generic approaches for designing the KPI predictive data mining models based on the BI semantic model. KPI predictive models were trained and tested with a real-world data set. Finally, a specialized analytical web portal which offers collaborative performance monitoring and decision making is presented. The results show that these models give very accurate KPI projections and provide valuable insights into newly emerging trends, opportunities, and problems. This should lead to more intelligent, predictive, and responsive supply chains capable of adapting to future business environment. PMID:25386605

Proactive supply chain performance management with predictive analytics.

PubMed

Stefanovic, Nenad

2014-01-01

Today's business climate requires supply chains to be proactive rather than reactive, which demands a new approach that incorporates data mining predictive analytics. This paper introduces a predictive supply chain performance management model which combines process modelling, performance measurement, data mining models, and web portal technologies into a unique model. It presents the supply chain modelling approach based on the specialized metamodel which allows modelling of any supply chain configuration and at different level of details. The paper also presents the supply chain semantic business intelligence (BI) model which encapsulates data sources and business rules and includes the data warehouse model with specific supply chain dimensions, measures, and KPIs (key performance indicators). Next, the paper describes two generic approaches for designing the KPI predictive data mining models based on the BI semantic model. KPI predictive models were trained and tested with a real-world data set. Finally, a specialized analytical web portal which offers collaborative performance monitoring and decision making is presented. The results show that these models give very accurate KPI projections and provide valuable insights into newly emerging trends, opportunities, and problems. This should lead to more intelligent, predictive, and responsive supply chains capable of adapting to future business environment.

Key Performance Indicators for the Assessment of Pediatric Pharmacotherapeutic Guidance

PubMed Central

Barrett, Jeffrey S.; Patel, Dimple; Jayaraman, Bhuvana; Narayan, Mahesh; Zuppa, Athena

2008-01-01

Given the paucity of actual guidance provided for managing pediatric drug therapy, prescribing caregivers must be able to draw on the limited published information in pediatrics and/or guidance provided in adults with some account for expected pediatric response. Guidance for managing drug therapy in children is clearly desirable. Our objectives were to construct key performance indicators (KPIs) for pediatric pharmacotherapy guidance to identify drugs where pharmacotherapy guidance would be most beneficial. A pilot survey to assess variation in caregiver appreciation for pediatric dosing guidance has also been constructed to provide a complementary subjective assessment. Three KPI categories, drug utilization (based on hospital admission and billing data collected from 2001 through 2006), medical need, and guidance outcome value along with a KPI composite score have been proposed. Low scores are favored with respect to prioritization for pharmacotherapy guidance. The pilot survey consisted of 15 questions to assess 1) physician knowledge regarding dosing guidance, 2) attitudes toward dose modification and patient individualization, 3) the accessibility, ease of use and appropriateness of existing data stores, and 4) frequency of dosing modification, consultation of dosing compendiums and estimate of success rate in dosing guidance. Pilot results suggest that dosing guidance is generally viewed as important and that the existing resources are insufficient to guide recommendations for all drugs. While the majority of respondents check more than one resource less than 25% of the time, at least 25% of the respondents check more than one resource 25–50% of the time. The majority viewed the relevance of dosing guidance very important to the management of drug therapy. The questionnaire is being extended to the primary care centers, the Kids First Network and specialty care centers. Results will guide the development of decision support systems (DSS) that provide patient-specific pharmacotherapy guidance as part of our pediatric knowledgebase initiative. For the top 25 most utilized agents at our institution over the last 6 years, KPI score ranged from 35 (dexamethasone) to 77 (cefazolin and ampicillin) with an average score of 55. Prototype DSS for tacrolimus and methotrexate are strongly supported by the KPI scoring which ranks their selection in the top 5% of drugs on formulary. KPI metrics provide an objective means of ranking agents for which pediatric pharmacotherapeutic guidance is clearly needed. PMID:23055875

Key performance indicators for the assessment of pediatric pharmacotherapeutic guidance.

PubMed

Barrett, Jeffrey S; Patel, Dimple; Jayaraman, Bhuvana; Narayan, Mahesh; Zuppa, Athena

2008-07-01

Given the paucity of actual guidance provided for managing pediatric drug therapy, prescribing caregivers must be able to draw on the limited published information in pediatrics and/or guidance provided in adults with some account for expected pediatric response. Guidance for managing drug therapy in children is clearly desirable. Our objectives were to construct key performance indicators (KPIs) for pediatric pharmacotherapy guidance to identify drugs where pharmacotherapy guidance would be most beneficial. A pilot survey to assess variation in caregiver appreciation for pediatric dosing guidance has also been constructed to provide a complementary subjective assessment. Three KPI categories, drug utilization (based on hospital admission and billing data collected from 2001 through 2006), medical need, and guidance outcome value along with a KPI composite score have been proposed. Low scores are favored with respect to prioritization for pharmacotherapy guidance. The pilot survey consisted of 15 questions to assess 1) physician knowledge regarding dosing guidance, 2) attitudes toward dose modification and patient individualization, 3) the accessibility, ease of use and appropriateness of existing data stores, and 4) frequency of dosing modification, consultation of dosing compendiums and estimate of success rate in dosing guidance. Pilot results suggest that dosing guidance is generally viewed as important and that the existing resources are insufficient to guide recommendations for all drugs. While the majority of respondents check more than one resource less than 25% of the time, at least 25% of the respondents check more than one resource 25-50% of the time. The majority viewed the relevance of dosing guidance very important to the management of drug therapy. The questionnaire is being extended to the primary care centers, the Kids First Network and specialty care centers. Results will guide the development of decision support systems (DSS) that provide patient-specific pharmacotherapy guidance as part of our pediatric knowledgebase initiative. For the top 25 most utilized agents at our institution over the last 6 years, KPI score ranged from 35 (dexamethasone) to 77 (cefazolin and ampicillin) with an average score of 55. Prototype DSS for tacrolimus and methotrexate are strongly supported by the KPI scoring which ranks their selection in the top 5% of drugs on formulary. KPI metrics provide an objective means of ranking agents for which pediatric pharmacotherapeutic guidance is clearly needed.

Overall Key Performance Indicator to Optimizing Operation of High-Pressure Homogenizers for a Reliable Quantification of Intracellular Components in Pichia pastoris.

PubMed

Garcia-Ortega, Xavier; Reyes, Cecilia; Montesinos, José Luis; Valero, Francisco

2015-01-01

The most commonly used cell disruption procedures may present lack of reproducibility, which introduces significant errors in the quantification of intracellular components. In this work, an approach consisting in the definition of an overall key performance indicator (KPI) was implemented for a lab scale high-pressure homogenizer (HPH) in order to determine the disruption settings that allow the reliable quantification of a wide sort of intracellular components. This innovative KPI was based on the combination of three independent reporting indicators: decrease of absorbance, release of total protein, and release of alkaline phosphatase activity. The yeast Pichia pastoris growing on methanol was selected as model microorganism due to it presents an important widening of the cell wall needing more severe methods and operating conditions than Escherichia coli and Saccharomyces cerevisiae. From the outcome of the reporting indicators, the cell disruption efficiency achieved using HPH was about fourfold higher than other lab standard cell disruption methodologies, such bead milling cell permeabilization. This approach was also applied to a pilot plant scale HPH validating the methodology in a scale-up of the disruption process. This innovative non-complex approach developed to evaluate the efficacy of a disruption procedure or equipment can be easily applied to optimize the most common disruption processes, in order to reach not only reliable quantification but also recovery of intracellular components from cell factories of interest.

Overall Key Performance Indicator to Optimizing Operation of High-Pressure Homogenizers for a Reliable Quantification of Intracellular Components in Pichia pastoris

PubMed Central

Garcia-Ortega, Xavier; Reyes, Cecilia; Montesinos, José Luis; Valero, Francisco

2015-01-01

The most commonly used cell disruption procedures may present lack of reproducibility, which introduces significant errors in the quantification of intracellular components. In this work, an approach consisting in the definition of an overall key performance indicator (KPI) was implemented for a lab scale high-pressure homogenizer (HPH) in order to determine the disruption settings that allow the reliable quantification of a wide sort of intracellular components. This innovative KPI was based on the combination of three independent reporting indicators: decrease of absorbance, release of total protein, and release of alkaline phosphatase activity. The yeast Pichia pastoris growing on methanol was selected as model microorganism due to it presents an important widening of the cell wall needing more severe methods and operating conditions than Escherichia coli and Saccharomyces cerevisiae. From the outcome of the reporting indicators, the cell disruption efficiency achieved using HPH was about fourfold higher than other lab standard cell disruption methodologies, such bead milling cell permeabilization. This approach was also applied to a pilot plant scale HPH validating the methodology in a scale-up of the disruption process. This innovative non-complex approach developed to evaluate the efficacy of a disruption procedure or equipment can be easily applied to optimize the most common disruption processes, in order to reach not only reliable quantification but also recovery of intracellular components from cell factories of interest. PMID:26284241

Impacting key performance indicators in an academic MR imaging department through process improvement.

PubMed

Recht, Michael; Macari, Michael; Lawson, Kirk; Mulholland, Tom; Chen, David; Kim, Danny; Babb, James

2013-03-01

The aim of this study was to evaluate all aspects of workflow in a large academic MRI department to determine whether process improvement (PI) efforts could improve key performance indicators (KPIs). KPI metrics in the investigators' MR imaging department include daily inpatient backlogs, on-time performance for outpatient examinations, examination volumes, appointment backlogs for pediatric anesthesia cases, and scan duration relative to time allotted for an examination. Over a 3-week period in April 2011, key members of the MR imaging department (including technologists, nurses, schedulers, physicians, and administrators) tracked all aspects of patient flow through the department, from scheduling to examination interpretation. Data were analyzed by the group to determine where PI could improve KPIs. Changes to MRI workflow were subsequently implemented, and KPIs were compared before (January 1, 2011, to April 30, 2011) and after (August 1, 2011, to December 31, 2011) using Mann-Whitney and Fisher's exact tests. The data analysis done during this PI led to multiple changes in the daily workflow of the MR department. In addition, a new sense of teamwork and empowerment was established within the MR staff. All of the measured KPIs showed statistically significant changes after the reengineering project. Intradepartmental PI efforts can significantly affect KPI metrics within an MR imaging department, making the process more patient centered. In addition, the process allowed significant growth without the need for additional equipment or personnel. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Novel de novo synthesized phosphate carrier compound ABA-PEG20k-Pi20 suppresses collagenase production in Enterococcus faecalis and prevents colonic anastomotic leak in an experimental model.

PubMed

Wiegerinck, M; Hyoju, S K; Mao, J; Zaborin, A; Adriaansens, C; Salzman, E; Hyman, N H; Zaborina, O; van Goor, H; Alverdy, J C

2018-04-16

Previous work has demonstrated that anastomotic leak can be caused by collagenolytic bacteria such as Enterococcus faecalis via an effect on wound collagen. In humans, E. faecalis is the organism cultured most commonly from a leaking anastomosis, and is not routinely eliminated by standard oral or intravenous antibiotics. Novel strategies are needed to contain the virulence of this pathogen when present on anastomotic tissues. Polyphosphorylated polymer ABA-PEG20k-Pi20 was tested in mice for its ability to prevent anastomotic leak caused by collagenolytic E. faecalis. The study design included a distal colonic resection and anastomosis followed by introduction of E. faecalis to anastomotic tissues via enema. Mice were assigned randomly to receive either ABA-PEG20-Pi20 or its unphosphorylated precursor ABA-PEG20k in their drinking water. The development of anastomotic leak was determined after the animals had been killed. Overnight incubation of two different E. faecalis collagenolytic strains with 2 mmol/l of ABA-PEG20k-Pi20 led to near complete inhibition of collagenase production (from 21 000 to 1000 and from 68 000 to 5000 units; P < 0·001; 6 samples per group) without suppressing bacterial growth. In mice drinking 1 per cent ABA-PEG20k-Pi20, the phosphate concentration in the distal colonic mucosa increased twofold and leak rates decreased from eight of 15 to three of 15 animals (P < 0·001). In mice drinking ABA-PEG20k-Pi20, the percentage of collagenolytic colonies among E. faecalis populations present at anastomotic tissue sites was decreased by 6-4800-fold (P = 0·008; 5 animals). These data indicate that oral intake of ABA-PEG20k-Pi20 may be an effective agent to contain the virulence of E. faecalis and may prevent anastomotic leak caused by this organism. Clinical relevance Progress in understanding the pathogenesis of anastomotic leak continues to point to intestinal bacteria as key causative agents. The presence of pathogens such as Enterococcus faecalis that predominate on anastomotic tissues despite antibiotic use, coupled with their ability to produce collagenase, appears to alter the process of healing that leads to leakage. Further antibiotic administration may seem logical, but carries the unwanted risk of eliminating the normal microbiome, which functions competitively to exclude and suppress the virulence of pathogens such as E. faecalis. Therefore, non-antibiotic strategies that can suppress the production of collagenase by E. faecalis without affecting its growth, or potentially normal beneficial microbiota, may have unique advantages. The findings of this study demonstrate that drinking a phosphate-based polymer can achieve the goal of preventing anastomotic leak by suppressing collagenase production in E. faecalis without affecting its growth. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

Determinants of ambulance response time: A study in Sabah, Malaysia

NASA Astrophysics Data System (ADS)

Chin, Su Na; Cheah, Phee Kheng; Arifin, Muhamad Yaakub; Wong, Boh Leng; Omar, Zaturrawiah; Yassin, Fouziah Md; Gabda, Darmesah

2017-04-01

Ambulance response time (ART) is one of the standard key performance indicators (KPI) in measuring the emergency medical services (EMS) delivery performances. When the mean time of ART of EMS system reaches the KPI target, it shows that the EMS system performs well. This paper considers the determinants of ART, using data sampled from 967 ambulance runs in a government hospital in Sabah. Multiple regression analysis with backward elimination was proposed for the identification of significant factors. Amongst the underlying factors, travel distance, age of patients, type of treatment and peak hours were identified to be significantly affecting ART. Identifying factors that influence ART helps the development of strategic improvement planning for reducing the ART.

Dark lump excitations in superfluid Fermi gases

NASA Astrophysics Data System (ADS)

Xu, Yan-Xia; Duan, Wen-Shan

2012-11-01

We study the linear and nonlinear properties of two-dimensional matter-wave pulses in disk-shaped superfluid Fermi gases. A Kadomtsev—Petviashvili I (KPI) solitary wave has been realized for superfluid Fermi gases in the limited cases of Bardeen—Cooper—Schrieffer (BCS) regime, Bose—Einstein condensate (BEC) regime, and unitarity regime. One-lump solution as well as one-line soliton solutions for the KPI equation are obtained, and two-line soliton solutions with the same amplitude are also studied in the limited cases. The dependence of the lump propagating velocity and the sound speed of two-dimensional superfluid Fermi gases on the interaction parameter are investigated for the limited cases of BEC and unitarity.

Identifying influential factors of business process performance using dependency analysis

NASA Astrophysics Data System (ADS)

Wetzstein, Branimir; Leitner, Philipp; Rosenberg, Florian; Dustdar, Schahram; Leymann, Frank

2011-02-01

We present a comprehensive framework for identifying influential factors of business process performance. In particular, our approach combines monitoring of process events and Quality of Service (QoS) measurements with dependency analysis to effectively identify influential factors. The framework uses data mining techniques to construct tree structures to represent dependencies of a key performance indicator (KPI) on process and QoS metrics. These dependency trees allow business analysts to determine how process KPIs depend on lower-level process metrics and QoS characteristics of the IT infrastructure. The structure of the dependencies enables a drill-down analysis of single factors of influence to gain a deeper knowledge why certain KPI targets are not met.

Design logistics performance measurement model of automotive component industry for srengthening competitiveness of dealing AEC 2015

NASA Astrophysics Data System (ADS)

Amran, T. G.; Janitra Yose, Mindy

2018-03-01

As the free trade Asean Economic Community (AEC) causes the tougher competition, it is important that Indonesia’s automotive industry have high competitiveness as well. A model of logistics performance measurement was designed as an evaluation tool for automotive component companies to improve their logistics performance in order to compete in AEC. The design of logistics performance measurement model was based on the Logistics Scorecard perspectives, divided into two stages: identifying the logistics business strategy to get the KPI and arranging the model. 23 KPI was obtained. The measurement result can be taken into consideration of determining policies to improve the performance logistics competitiveness.

New prognostic model for extranodal natural killer/T cell lymphoma, nasal type.

PubMed

Cai, Qingqing; Luo, Xiaolin; Zhang, Guanrong; Huang, Huiqiang; Huang, Hui; Lin, Tongyu; Jiang, Wenqi; Xia, Zhongjun; Young, Ken H

2014-09-01

Extranodal natural killer/T cell lymphoma, nasal type (ENKTL) is an aggressive disease with a poor prognosis, requiring risk stratification in affected patients. We designed a new prognostic model specifically for ENKTL to identify high-risk patients who need more aggressive therapy. We retrospectively reviewed 158 patients who were newly diagnosed with ENKTL. The estimated 5-year overall survival rate was 39.4 %. Independent prognostic factors included total protein (TP) <60 g/L, fasting blood glucose (FBG) >100 mg/dL, and Korean Prognostic Index (KPI) score ≥2. We constructed a new prognostic model by combining these prognostic factors: group 1 (64 cases (41.0 %)), no adverse factors; group 2 (58 cases (37.2 %)), one adverse factor; and group 3 (34 cases (21.8 %)), two or three adverse factors. The 5-year overall survival (OS) rates of these groups were 66.7, 23.0, and 5.9 %, respectively (p < 0.001). Our new prognostic model had a better prognostic value than did the KPI model alone (p < 0.001). Our proposed prognostic model for ENKTL, including the newly identified prognostic indicators, TP and FBG, demonstrated a balanced distribution of patients into different risk groups with better prognostic discrimination compared with the KPI model alone.

Contribution of Kunitz protease inhibitor and transmembrane domains to amyloid precursor protein homodimerization.

PubMed

Ben Khalifa, N; Tyteca, D; Courtoy, P J; Renauld, J C; Constantinescu, S N; Octave, J N; Kienlen-Campard, P

2012-01-01

The two major isoforms of the human amyloid precursor protein (APP) are APP695 and APP751. They differ by the insertion of a Kunitz-type protease inhibitor (KPI) sequence in the extracellular domain of APP751. APP-KPI isoforms are increased in Alzheimer's disease brains, and they could be associated with disease progression. Recent studies have shown that APP processing to Aβ is regulated by homodimerization, which involves both extracellular and juxtamembrane/transmembrane (JM/TM) regions. Our aim is to understand the mechanisms controlling APP dimerization and the contribution of the ectodomain and JM/TM regions to this process. We used bimolecular fluorescence complementation approaches coupled to fluorescence-activated cell sorting analysis to measure the dimerization level of different APP isoforms and APP C-terminal fragments (C99) mutated in their JM/TM region. APP751 was found to form significantly more homodimers than APP695. Mutation of dimerization motifs in the TM domain of APP or C99 did not significantly affect fluorescence complementation. These findings indicate that the KPI domain plays a major role in APP dimerization. They set the basis for further investigation of the relation between dimerization, metabolism and function of APP. Copyright © 2012 S. Karger AG, Basel.

Phylogenetic groups among Klebsiella pneumoniae isolates from Brazil: relationship with antimicrobial resistance and origin.

PubMed

de Melo, Maíra Espíndola Silva; Cabral, Adriane Borges; Maciel, Maria Amélia Vieira; da Silveira, Vera Magalhães; de Souza Lopes, Ana Catarina

2011-05-01

The objectives of this study were to determine the distribution of phylogenetic groups among Klebsiella pneumoniae isolates from Recife, Brazil and to assess the relationship between the groups and the isolation sites and resistance profile. Ninety four isolates of K. pneumoniae from hospital or community infections and from normal microbiota were analyzed by gyrA PCR-RFLP, antibiotic susceptibility, and adonitol fermentation. The results revealed the distinction of three phylogenetic groups, as it has also been reported in Europe, showing that these clusters are highly conserved within K. pneumoniae. Group KpI was dominantly represented by hospital and community isolates while groups KpII and KpIII displayed mainly normal microbiota isolates. The resistance to third generation cephalosporins, aztreonam, imipenem, amoxicillin/clavulanic acid, and streptomycin was only observed in KpI. The percentage of resistance was higher in KpI, followed by KpII and KpIII. The differences in the distribution of K. pneumoniae phylogenetic groups observed in this study suggest distinctive clinical and epidemiological characteristics among the three groups, which is important to understand the epidemiology of infections caused by this organism. This is the first study in Brazil on K. pneumoniae isolates from normal microbiota and community infections regarding the distribution of phylogenetic groups based on the gyrA gene.

Hemocyte-lineage marker proteins in a crustacean, the freshwater crayfish, Pacifastacus leniusculus.

PubMed

Wu, Chenglin; Söderhäll, Irene; Kim, Young-A; Liu, Haipeng; Söderhäll, Kenneth

2008-10-01

To identify proteins associated with development of different hemocyte types in the freshwater crayfish Pacifastacus leniusculus, 2-DE followed by MS analysis was carried out with hematopoietic tissue (Hpt) cells, semigranular cells (SGC) and granular cells (GC). Within the hemocyte lineages one two-domain Kazal proteinase inhibitor (KPI) was found to be specific for SGC, while a superoxide dismutase (SOD) was specific for GC at protein as well as at mRNA level. The proliferation cell nuclear antigen (PCNA) was detected at the mRNA level in Hpt cells only. We also provide evidence that SGC and GC most likely differentiate to maturation as separate lineages. We found that after laminarin or lipopolysaccharide (LPS) injection into crayfish, the transcript levels of PCNA and SOD increased in the Hpt cells, whereas the KPI transcript never was present in Hpt regardless of any challenge. RNA interference of PCNA in the Hpt cells led to that most of the cells did not spread or attach to the tissue culture dish. These results suggest that PCNA, KPI and SOD can be used as markers for Hpt cells, SGC and GC, respectively, and in conjunction with these results, a model is proposed how the Hpt responds to a microbial challenge by proliferation and release of Hpt cells.

Operations management tools to be applied for textile

NASA Astrophysics Data System (ADS)

Maralcan, A.; Ilhan, I.

2017-10-01

In this paper, basic concepts of process analysis such as flow time, inventory, bottleneck, labour cost and utilization are illustrated first. The effect of bottleneck on the results of a business are especially emphasized. In the next section, tools on productivity measurement; KPI (Key Performance Indicators) Tree, OEE (Overall Equipment Effectiveness) and Takt Time are introduced and exemplified. KPI tree is a diagram on which we can visualize all the variables of an operation which are driving financial results through cost and profit. OEE is a tool to measure a potential extra capacity of an equipment or an employee. Takt time is a tool to determine the process flow rate according to the customer demand. KPI tree is studied through the whole process while OEE is exemplified for a stenter frame machine which is the most important machine (and usually the bottleneck) and the most expensive investment in a finishing plant. Takt time is exemplified for the quality control department. Finally quality tools, six sigma, control charts and jidoka are introduced. Six sigma is a tool to measure process capability and by the way probability of a defect. Control chart is a powerful tool to monitor the process. The idea of jidoka (detect, stop and alert) is about alerting the people that there is a problem in the process.

Metal-oxide assisted surface treatment of polyimide gate insulators for high-performance organic thin-film transistors.

PubMed

Kim, Sohee; Ha, Taewook; Yoo, Sungmi; Ka, Jae-Won; Kim, Jinsoo; Won, Jong Chan; Choi, Dong Hoon; Jang, Kwang-Suk; Kim, Yun Ho

2017-06-14

We developed a facile method for treating polyimide-based organic gate insulator (OGI) surfaces with self-assembled monolayers (SAMs) by introducing metal-oxide interlayers, called the metal-oxide assisted SAM treatment (MAST). To create sites for surface modification with SAM materials on polyimide-based OGI (KPI) surfaces, the metal-oxide interlayer, here amorphous alumina (α-Al 2 O 3 ), was deposited on the KPI gate insulator using spin-coating via a rapid sol-gel reaction, providing an excellent template for the formation of a high-quality SAM with phosphonic acid anchor groups. The SAM of octadecylphosphonic acid (ODPA) was successfully treated by spin-coating onto the α-Al 2 O 3 -deposited KPI film. After the surface treatment by ODPA/α-Al 2 O 3 , the surface energy of the KPI thin film was remarkably decreased and the molecular compatibility of the film with an organic semiconductor (OSC), 2-decyl-7-phenyl-[1]benzothieno[3,2-b][1]benzothiophene (Ph-BTBT-C 10 ), was increased. Ph-BTBT-C 10 molecules were uniformly deposited on the treated gate insulator surface and grown with high crystallinity, as confirmed by atomic force microscopy (AFM) and X-ray diffraction (XRD) analysis. The mobility of Ph-BTBT-C 10 thin-film transistors (TFTs) was approximately doubled, from 0.56 ± 0.05 cm 2 V -1 s -1 to 1.26 ± 0.06 cm 2 V -1 s -1 , after the surface treatment. The surface treatment of α-Al 2 O 3 and ODPA significantly decreased the threshold voltage from -21.2 V to -8.3 V by reducing the trap sites in the OGI and improving the interfacial properties with the OSC. We suggest that the MAST method for OGIs can be applied to various OGI materials lacking reactive sites using SAMs. It may provide a new platform for the surface treatment of OGIs, similar to that of conventional SiO 2 gate insulators.

A Global Protein Kinase and Phosphatase Interaction Network in Yeast

PubMed Central

Breitkreutz, Ashton; Choi, Hyungwon; Sharom, Jeffrey R.; Boucher, Lorrie; Neduva, Victor; Larsen, Brett; Lin, Zhen-Yuan; Breitkreutz, Bobby-Joe; Stark, Chris; Liu, Guomin; Ahn, Jessica; Dewar-Darch, Danielle; Reguly, Teresa; Tang, Xiaojing; Almeida, Ricardo; Qin, Zhaohui Steve; Pawson, Tony; Gingras, Anne-Claude; Nesvizhskii, Alexey I.; Tyers, Mike

2011-01-01

The interactions of protein kinases and phosphatases with their regulatory subunits and substrates underpin cellular regulation. We identified a kinase and phosphatase interaction (KPI) network of 1844 interactions in budding yeast by mass spectrometric analysis of protein complexes. The KPI network contained many dense local regions of interactions that suggested new functions. Notably, the cell cycle phosphatase Cdc14 associated with multiple kinases that revealed roles for Cdc14 in mitogen-activated protein kinase signaling, the DNA damage response, and metabolism, whereas interactions of the target of rapamycin complex 1 (TORC1) uncovered new effector kinases in nitrogen and carbon metabolism. An extensive backbone of kinase-kinase interactions cross-connects the proteome and may serve to coordinate diverse cellular responses. PMID:20489023

EPA Monthly Key Performance Indicator Dashboards 2017

EPA Pesticide Factsheets

Each month, the Web Analytics Program posts updated Key Performance Indicator (KPI) dashboards that correspond to three Web performance goals: content consumption, content discovery, and audience engagement.

Prognostic significance of peripheral monocyte count in patients with extranodal natural killer/T-cell lymphoma.

PubMed

Huang, Jia-Jia; Li, Ya-Jun; Xia, Yi; Wang, Yu; Wei, Wen-Xiao; Zhu, Ying-Jie; Lin, Tong-Yu; Huang, Hui-Qiang; Jiang, Wen-Qi; Li, Zhi-Ming

2013-05-03

Extranodal natural killer/T-cell lymphoma (ENKL) has heterogeneous clinical manifestations and prognosis. This study aims to evaluate the prognostic impact of absolute monocyte count (AMC) in ENKL, and provide some immunologically relevant information for better risk stratification in patients with ENKL. Retrospective data from 163 patients newly diagnosed with ENKL were analyzed. The absolute monocyte count (AMC) at diagnosis was analyzed as continuous and dichotomized variables. Independent prognostic factors of survival were determined by Cox regression analysis. The AMC at diagnosis were related to overall survival (OS) and progression-free survival (PFS) in patients with ENKL. Multivariate analysis identified AMC as independent prognostic factors of survival, independent of International Prognostic Index (IPI) and Korean prognostic index (KPI). The prognostic index incorporating AMC and absolute lymphocyte count (ALC), another surrogate factor of immune status, could be used to stratify all 163 patients with ENKL into different prognostic groups. For patients who received chemotherapy followed by radiotherapy (102 cases), the three AMC/ALC index categories identified patients with significantly different survivals. When superimposed on IPI or KPI categories, the AMC/ALC index was better able to identify high-risk patients in the low-risk IPI or KPI category. The baseline peripheral monocyte count is shown to be an effective prognostic indicator of survival in ENKL patients. The prognostic index related to tumor microenvironment might be helpful to identify high-risk patients with ENKL.

Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in the treatment of stage IE/IIE extranodal natural killer/T cell lymphoma, nasal type: 13-year follow-up in 135 patients.

PubMed

Wang, Liang; Xia, Zhong-jun; Huang, Hui-qiang; Lu, Yue; Zhang, Yu-jing

2012-11-01

We conducted a retrospective study of 135 patients of stage IE/IIE extranodal natural killer/T cell lymphoma, nasal type (ENKTL) treated with CHOP as induction chemotherapy to find some valuable prognostic factors and analyze the usefulness of International Prognostic Index (IPI) and Korean Prognostic Index (KPI) in predicting prognosis. Most of the patients were in the low-risk group (IPI score 0-1). Complete remission (CR) after induction chemotherapy was achieved in 31.8 % of the patients, which increased to 69.6 % after radiotherapy. The 2-, 5-, and 10-year overall survival (OS) rates were 60, 48, and 43 %, respectively. Patients with better performance status (ECOG 0-1), normal serum LDH level, without local invasiveness, low KPI scores, and IPI score of 0 had significantly better overall survival (P < 0.05) in univariate analysis. Using multivariate analysis, we identified serum LDH level, ECOG PS score and local invasiveness to be independent prognostic factors. In conclusion, ENKTL is an aggressive lymphoma that shows heterogeneity. The IPI and KPI score systems should be improved further to classify patients into different groups, and should be validated in larger prospective trials. Due to the multi-drug resistance mechanism of ENKTL, CHOP is no longer the state of art and novel drugs should be incorporated into future treatments.

Fusion proteins comprising annexin V and Kunitz protease inhibitors are highly potent thrombogenic site-directed anticoagulants

PubMed Central

Chen, Hsiu-Hui; Vicente, Cristina P.; He, Li; Tollefsen, Douglas M.; Wun, Tze-Chein

2005-01-01

The anionic phospholipid, phosphatidyl-l-serine (PS), is sequestered in the inner layer of the plasma membrane in normal cells. Upon injury, activation, and apoptosis, PS becomes exposed on the surfaces of cells and sheds microparticles, which are procoagulant. Coagulation is initiated by formation of a tissue factor/factor VIIa complex on PS-exposed membranes and propagated through the assembly of intrinsic tenase (factor VIIIa/factor IXa), prothrombinase (factor Va/factor Xa), and factor XIa complexes on PS-exposed activated platelets. We constructed a novel series of recombinant anticoagulant fusion proteins by linking annexin V (ANV), a PS-binding protein, to the Kunitz-type protease inhibitor (KPI) domain of tick anticoagulant protein, an aprotinin mutant (6L15), amyloid β-protein precursor, or tissue factor pathway inhibitor. The resulting ANV-KPI fusion proteins were 6- to 86-fold more active than recombinant tissue factor pathway inhibitor and tick anticoagulant protein in an in vitro tissue factor–initiated clotting assay. The in vivo antithrombotic activities of the most active constructs were 3- to 10-fold higher than that of ANV in a mouse arterial thrombosis model. ANV-KPI fusion proteins represent a new class of anticoagulants that specifically target the anionic membrane-associated coagulation enzyme complexes present at sites of thrombogenesis and are potentially useful as antithrombotic agents. PMID:15677561

Amplitude analysis of the B+/--->phiK*(892)+/- decay.

PubMed

Aubert, B; Bona, M; Boutigny, D; Karyotakis, Y; Lees, J P; Poireau, V; Prudent, X; Tisserand, V; Zghiche, A; Garra Tico, J; Grauges, E; Lopez, L; Palano, A; Eigen, G; Stugu, B; Sun, L; Abrams, G S; Battaglia, M; Brown, D N; Button-Shafer, J; Cahn, R N; Groysman, Y; Jacobsen, R G; Kadyk, J A; Kerth, L T; Kolomensky, Yu G; Kukartsev, G; Lopes Pegna, D; Lynch, G; Mir, L M; Orimoto, T J; Ronan, M T; Tackmann, K; Wenzel, W A; del Amo Sanchez, P; Hawkes, C M; Watson, A T; Held, T; Koch, H; Lewandowski, B; Pelizaeus, M; Schroeder, T; Steinke, M; Walker, D; Asgeirsson, D J; Cuhadar-Donszelmann, T; Fulsom, B G; Hearty, C; Mattison, T S; McKenna, J A; Khan, A; Saleem, M; Teodorescu, L; Blinov, V E; Bukin, A D; Druzhinin, V P; Golubev, V B; Onuchin, A P; Serednyakov, S I; Skovpen, Yu I; Solodov, E P; Todyshev, K Yu; Bondioli, M; Curry, S; Eschrich, I; Kirkby, D; Lankford, A J; Lund, P; Mandelkern, M; Martin, E C; Stoker, D P; Abachi, S; Buchanan, C; Foulkes, S D; Gary, J W; Liu, F; Long, O; Shen, B C; Zhang, L; Paar, H P; Rahatlou, S; Sharma, V; Berryhill, J W; Campagnari, C; Cunha, A; Dahmes, B; Hong, T M; Kovalskyi, D; Richman, J D; Beck, T W; Eisner, A M; Flacco, C J; Heusch, C A; Kroseberg, J; Lockman, W S; Schalk, T; Schumm, B A; Seiden, A; Williams, D C; Wilson, M G; Winstrom, L O; Chen, E; Cheng, C H; Fang, F; Hitlin, D G; Narsky, I; Piatenko, T; Porter, F C; Andreassen, R; Mancinelli, G; Meadows, B T; Mishra, K; Sokoloff, M D; Blanc, F; Bloom, P C; Chen, S; Ford, W T; Hirschauer, J F; Kreisel, A; Nagel, M; Nauenberg, U; Olivas, A; Smith, J G; Ulmer, K A; Wagner, S R; Zhang, J; Gabareen, A M; Soffer, A; Toki, W H; Wilson, R J; Winklmeier, F; Zeng, Q; Altenburg, D D; Feltresi, E; Hauke, A; Jasper, H; Merkel, J; Petzold, A; Spaan, B; Wacker, K; Brandt, T; Klose, V; Kobel, M J; Lacker, H M; Mader, W F; Nogowski, R; Schubert, J; Schubert, K R; Schwierz, R; Sundermann, J E; Volk, A; Bernard, D; Bonneaud, G R; Latour, E; Lombardo, V; Thiebaux, Ch; Verderi, M; Clark, P J; Gradl, W; Muheim, F; Playfer, S; Robertson, A I; Xie, Y; Andreotti, M; Bettoni, D; Bozzi, C; Calabrese, R; Cecchi, A; Cibinetto, G; Franchini, P; Luppi, E; Negrini, M; Petrella, A; Piemontese, L; Prencipe, E; Santoro, V; Anulli, F; Baldini-Ferroli, R; Calcaterra, A; de Sangro, R; Finocchiaro, G; Pacetti, S; Patteri, P; Peruzzi, I M; Piccolo, M; Rama, M; Zallo, A; Buzzo, A; Contri, R; Lo Vetere, M; Macri, M M; Monge, M R; Passaggio, S; Patrignani, C; Robutti, E; Santroni, A; Tosi, S; Chaisanguanthum, K S; Morii, M; Wu, J; Dubitzky, R S; Marks, J; Schenk, S; Uwer, U; Bard, D J; Dauncey, P D; Flack, R L; Nash, J A; Nikolich, M B; Panduro Vazquez, W; Tibbetts, M; Behera, P K; Chai, X; Charles, M J; Mallik, U; Meyer, N T; Ziegler, V; Cochran, J; Crawley, H B; Dong, L; Eyges, V; Meyer, W T; Prell, S; Rosenberg, E I; Rubin, A E; Gao, Y Y; Gritsan, A V; Guo, Z J; Lae, C K; Denig, A G; Fritsch, M; Schott, G; Arnaud, N; Béquilleux, J; Davier, M; Grosdidier, G; Höcker, A; Lepeltier, V; Le Diberder, F; Lutz, A M; Pruvot, S; Rodier, S; Roudeau, P; Schune, M H; Serrano, J; Sordini, V; Stocchi, A; Wang, W F; Wormser, G; Lange, D J; Wright, D M; Bingham, I; Chavez, C A; Forster, I J; Fry, J R; Gabathuler, E; Gamet, R; Hutchcroft, D E; Payne, D J; Schofield, K C; Touramanis, C; Bevan, A J; George, K A; Di Lodovico, F; Menges, W; Sacco, R; Cowan, G; Flaecher, H U; Hopkins, D A; Paramesvaran, S; Salvatore, F; Wren, A C; Brown, D N; Davis, C L; Allison, J; Barlow, N R; Barlow, R J; Chia, Y M; Edgar, C L; Lafferty, G D; West, T J; Yi, J I; Anderson, J; Chen, C; Jawahery, A; Roberts, D A; Simi, G; Tuggle, J M; Blaylock, G; Dallapiccola, C; Hertzbach, S S; Li, X; Moore, T B; Salvati, E; Saremi, S; Cowan, R; Dujmic, D; Fisher, P H; Koeneke, K; Sciolla, G; Sekula, S J; Spitznagel, M; Taylor, F; Yamamoto, R K; Zhao, M; Zheng, Y; Mclachlin, S E; Patel, P M; Robertson, S H; Lazzaro, A; Palombo, F; Bauer, J M; Cremaldi, L; Eschenburg, V; Godang, R; Kroeger, R; Sanders, D A; Summers, D J; Zhao, H W; Brunet, S; Côté, D; Simard, M; Taras, P; Viaud, F B; Nicholson, H; De Nardo, G; Fabozzi, F; Lista, L; Monorchio, D; Sciacca, C; Baak, M A; Raven, G; Snoek, H L; Jessop, C P; LoSecco, J M; Benelli, G; Corwin, L A; Honscheid, K; Kagan, H; Kass, R; Morris, J P; Rahimi, A M; Regensburger, J J; Wong, Q K; Blount, N L; Brau, J; Frey, R; Igonkina, O; Kolb, J A; Lu, M; Rahmat, R; Sinev, N B; Strom, D; Strube, J; Torrence, E; Gagliardi, N; Gaz, A; Margoni, M; Morandin, M; Pompili, A; Posocco, M; Rotondo, M; Simonetto, F; Stroili, R; Voci, C; Ben-Haim, E; Briand, H; Calderini, G; Chauveau, J; David, P; Del Buono, L; de la Vaissière, Ch; Hamon, O; Leruste, Ph; Malclès, J; Ocariz, J; Perez, A; Gladney, L; Biasini, M; Covarelli, R; Manoni, E; Angelini, C; Batignani, G; Bettarini, S; Carpinelli, M; Cenci, R; Cervelli, A; Forti, F; Giorgi, M A; Lusiani, A; Marchiori, G; Mazur, M A; Morganti, M; Neri, N; Paoloni, E; Rizzo, G; Walsh, J J; Haire, M; Biesiada, J; Elmer, P; Lau, Y P; Lu, C; Olsen, J; Smith, A J S; Telnov, A V; Baracchini, E; Bellini, F; Cavoto, G; D'Orazio, A; del Re, D; Di Marco, E; Faccini, R; Ferrarotto, F; Ferroni, F; Gaspero, M; Jackson, P D; Li Gioi, L; Mazzoni, M A; Morganti, S; Piredda, G; Polci, F; Renga, F; Voena, C; Ebert, M; Hartmann, T; Schröder, H; Waldi, R; Adye, T; Castelli, G; Franek, B; Olaiya, E O; Ricciardi, S; Roethel, W; Wilson, F F; Aleksan, R; Emery, S; Escalier, M; Gaidot, A; Ganzhur, S F; Hamel de Monchenault, G; Kozanecki, W; Vasseur, G; Yèche, Ch; Zito, M; Chen, X R; Liu, H; Park, W; Purohit, M V; Wilson, J R; Allen, M T; Aston, D; Bartoldus, R; Bechtle, P; Berger, N; Claus, R; Coleman, J P; Convery, M R; Dingfelder, J C; Dorfan, J; Dubois-Felsmann, G P; Dunwoodie, W; Field, R C; Glanzman, T; Gowdy, S J; Graham, M T; Grenier, P; Hast, C; Hryn'ova, T; Innes, W R; Kaminski, J; Kelsey, M H; Kim, H; Kim, P; Kocian, M L; Leith, D W G S; Li, S; Luitz, S; Luth, V; Lynch, H L; MacFarlane, D B; Marsiske, H; Messner, R; Muller, D R; O'Grady, C P; Ofte, I; Perazzo, A; Perl, M; Pulliam, T; Ratcliff, B N; Roodman, A; Salnikov, A A; Schindler, R H; Schwiening, J; Snyder, A; Stelzer, J; Su, D; Sullivan, M K; Suzuki, K; Swain, S K; Thompson, J M; Va'vra, J; van Bakel, N; Wagner, A P; Weaver, M; Wisniewski, W J; Wittgen, M; Wright, D H; Yarritu, A K; Yi, K; Young, C C; Burchat, P R; Edwards, A J; Majewski, S A; Petersen, B A; Wilden, L; Ahmed, S; Alam, M S; Bula, R; Ernst, J A; Jain, V; Pan, B; Saeed, M A; Wappler, F R; Zain, S B; Bugg, W; Krishnamurthy, M; Spanier, S M; Eckmann, R; Ritchie, J L; Ruland, A M; Schilling, C J; Schwitters, R F; Izen, J M; Lou, X C; Ye, S; Bianchi, F; Gallo, F; Gamba, D; Pelliccioni, M; Bomben, M; Bosisio, L; Cartaro, C; Cossutti, F; Della Ricca, G; Lanceri, L; Vitale, L; Azzolini, V; Lopez-March, N; Martinez-Vidal, F; Milanes, D A; Oyanguren, A; Albert, J; Banerjee, Sw; Bhuyan, B; Hamano, K; Kowalewski, R; Nugent, I M; Roney, J M; Sobie, R J; Back, J J; Harrison, P F; Ilic, J; Latham, T E; Mohanty, G B; Pappagallo, M; Band, H R; Chen, X; Dasu, S; Flood, K T; Hollar, J J; Kutter, P E; Pan, Y; Pierini, M; Prepost, R; Wu, S L; Neal, H

2007-11-16

We perform an amplitude analysis of B+/--->phi(1020)K*(892)+/- decay with a sample of about 384 x 10(6) BB[over ] pairs recorded with the BABAR detector. Overall, twelve parameters are measured, including the fractions of longitudinal fL and parity-odd transverse f perpendicular amplitudes, branching fraction, strong phases, and six parameters sensitive to CP violation. We use the dependence on the Kpi invariant mass of the interference between the JP=1(-) and 0+ Kpi components to resolve the discrete ambiguity in the determination of the strong and weak phases. Our measurements of fL=0.49+/-0.05+/-0.03, f perpendicular=0.21+/-0.05+/-0.02, and the strong phases point to the presence of a substantial helicity-plus amplitude from a presently unknown source.

Eigenfunctions and Eigenvalues for a Scalar Riemann-Hilbert Problem Associated to Inverse Scattering

NASA Astrophysics Data System (ADS)

Pelinovsky, Dmitry E.; Sulem, Catherine

A complete set of eigenfunctions is introduced within the Riemann-Hilbert formalism for spectral problems associated to some solvable nonlinear evolution equations. In particular, we consider the time-independent and time-dependent Schrödinger problems which are related to the KdV and KPI equations possessing solitons and lumps, respectively. Non-standard scalar products, orthogonality and completeness relations are derived for these problems. The complete set of eigenfunctions is used for perturbation theory and bifurcation analysis of eigenvalues supported by the potentials under perturbations. We classify two different types of bifurcations of new eigenvalues and analyze their characteristic features. One type corresponds to thresholdless generation of solitons in the KdV equation, while the other predicts a threshold for generation of lumps in the KPI equation.

Observation of new charmless decays of bottom hadrons.

PubMed

Aaltonen, T; Adelman, J; Akimoto, T; Alvarez González, B; Amerio, S; Amidei, D; Anastassov, A; Annovi, A; Antos, J; Apollinari, G; Apresyan, A; Arisawa, T; Artikov, A; Ashmanskas, W; Attal, A; Aurisano, A; Azfar, F; Azzurri, P; Badgett, W; Barbaro-Galtieri, A; Barnes, V E; Barnett, B A; Bartsch, V; Bauer, G; Beauchemin, P-H; Bedeschi, F; Beecher, D; Behari, S; Bellettini, G; Bellinger, J; Benjamin, D; Beretvas, A; Beringer, J; Bhatti, A; Binkley, M; Bisello, D; Bizjak, I; Blair, R E; Blocker, C; Blumenfeld, B; Bocci, A; Bodek, A; Boisvert, V; Bolla, G; Bortoletto, D; Boudreau, J; Boveia, A; Brau, B; Bridgeman, A; Brigliadori, L; Bromberg, C; Brubaker, E; Budagov, J; Budd, H S; Budd, S; Burke, S; Burkett, K; Busetto, G; Bussey, P; Buzatu, A; Byrum, K L; Cabrera, S; Calancha, C; Campanelli, M; Campbell, M; Canelli, F; Canepa, A; Carls, B; Carlsmith, D; Carosi, R; Carrillo, S; Carron, S; Casal, B; Casarsa, M; Castro, A; Catastini, P; Cauz, D; Cavaliere, V; Cavalli-Sforza, M; Cerri, A; Cerrito, L; Chang, S H; Chen, Y C; Chertok, M; Chiarelli, G; Chlachidze, G; Chlebana, F; Cho, K; Chokheli, D; Chou, J P; Choudalakis, G; Chuang, S H; Chung, K; Chung, W H; Chung, Y S; Chwalek, T; Ciobanu, C I; Ciocci, M A; Clark, A; Clark, D; Compostella, G; Convery, M E; Conway, J; Cordelli, M; Cortiana, G; Cox, C A; Cox, D J; Crescioli, F; Cuenca Almenar, C; Cuevas, J; Culbertson, R; Cully, J C; Dagenhart, D; Datta, M; Davies, T; de Barbaro, P; De Cecco, S; Deisher, A; De Lorenzo, G; Dell'Orso, M; Deluca, C; Demortier, L; Deng, J; Deninno, M; Derwent, P F; di Giovanni, G P; Dionisi, C; Di Ruzza, B; Dittmann, J R; D'Onofrio, M; Donati, S; Dong, P; Donini, J; Dorigo, T; Dube, S; Efron, J; Elagin, A; Erbacher, R; Errede, D; Errede, S; Eusebi, R; Fang, H C; Farrington, S; Fedorko, W T; Feild, R G; Feindt, M; Fernandez, J P; Ferrazza, C; Field, R; Flanagan, G; Forrest, R; Frank, M J; Franklin, M; Freeman, J C; Furic, I; Gallinaro, M; Galyardt, J; Garberson, F; Garcia, J E; Garfinkel, A F; Genser, K; Gerberich, H; Gerdes, D; Gessler, A; Giagu, S; Giakoumopoulou, V; Giannetti, P; Gibson, K; Gimmell, J L; Ginsburg, C M; Giokaris, N; Giordani, M; Giromini, P; Giunta, M; Giurgiu, G; Glagolev, V; Glenzinski, D; Gold, M; Goldschmidt, N; Golossanov, A; Gomez, G; Gomez-Ceballos, G; Goncharov, M; González, O; Gorelov, I; Goshaw, A T; Goulianos, K; Gresele, A; Grinstein, S; Grosso-Pilcher, C; Grundler, U; Guimaraes da Costa, J; Gunay-Unalan, Z; Haber, C; Hahn, K; Hahn, S R; Halkiadakis, E; Han, B-Y; Han, J Y; Happacher, F; Hara, K; Hare, D; Hare, M; Harper, S; Harr, R F; Harris, R M; Hartz, M; Hatakeyama, K; Hays, C; Heck, M; Heijboer, A; Heinrich, J; Henderson, C; Herndon, M; Heuser, J; Hewamanage, S; Hidas, D; Hill, C S; Hirschbuehl, D; Hocker, A; Hou, S; Houlden, M; Hsu, S-C; Huffman, B T; Hughes, R E; Husemann, U; Hussein, M; Huston, J; Incandela, J; Introzzi, G; Iori, M; Ivanov, A; James, E; Jang, D; Jayatilaka, B; Jeon, E J; Jha, M K; Jindariani, S; Johnson, W; Jones, M; Joo, K K; Jun, S Y; Jung, J E; Junk, T R; Kamon, T; Kar, D; Karchin, P E; Kato, Y; Kephart, R; Keung, J; Khotilovich, V; Kilminster, B; Kim, D H; Kim, H S; Kim, H W; Kim, J E; Kim, M J; Kim, S B; Kim, S H; Kim, Y K; Kimura, N; Kirsch, L; Klimenko, S; Knuteson, B; Ko, B R; Kondo, K; Kong, D J; Konigsberg, J; Korytov, A; Kotwal, A V; Kreps, M; Kroll, J; Krop, D; Krumnack, N; Kruse, M; Krutelyov, V; Kubo, T; Kuhr, T; Kulkarni, N P; Kurata, M; Kwang, S; Laasanen, A T; Lami, S; Lammel, S; Lancaster, M; Lander, R L; Lannon, K; Lath, A; Latino, G; Lazzizzera, I; LeCompte, T; Lee, E; Lee, H S; Lee, S W; Leone, S; Lewis, J D; Lin, C-S; Linacre, J; Lindgren, M; Lipeles, E; Lister, A; Litvintsev, D O; Liu, C; Liu, T; Lockyer, N S; Loginov, A; Loreti, M; Lovas, L; Lucchesi, D; Luci, C; Lueck, J; Lujan, P; Lukens, P; Lungu, G; Lyons, L; Lys, J; Lysak, R; Macqueen, D; Madrak, R; Maeshima, K; Makhoul, K; Maki, T; Maksimovic, P; Malde, S; Malik, S; Manca, G; Manousakis-Katsikakis, A; Margaroli, F; Marino, C; Marino, C P; Martin, A; Martin, V; Martínez, M; Martínez-Ballarín, R; Maruyama, T; Mastrandrea, P; Masubuchi, T; Mathis, M; Mattson, M E; Mazzanti, P; McFarland, K S; McIntyre, P; McNulty, R; Mehta, A; Mehtala, P; Menzione, A; Merkel, P; Mesropian, C; Miao, T; Miladinovic, N; Miller, R; Mills, C; Milnik, M; Mitra, A; Mitselmakher, G; Miyake, H; Moggi, N; Moon, C S; Moore, R; Morello, M J; Morlock, J; Movilla Fernandez, P; Mülmenstädt, J; Mukherjee, A; Muller, Th; Mumford, R; Murat, P; Mussini, M; Nachtman, J; Nagai, Y; Nagano, A; Naganoma, J; Nakamura, K; Nakano, I; Napier, A; Necula, V; Nett, J; Neu, C; Neubauer, M S; Neubauer, S; Nielsen, J; Nodulman, L; Norman, M; Norniella, O; Nurse, E; Oakes, L; Oh, S H; Oh, Y D; Oksuzian, I; Okusawa, T; Orava, R; Osterberg, K; Griso, S Pagan; Palencia, E; Papadimitriou, V; Papaikonomou, A; Paramonov, A A; Parks, B; Pashapour, S; Patrick, J; Pauletta, G; Paulini, M; Paus, C; Peiffer, T; Pellett, D E; Penzo, A; Phillips, T J; Piacentino, G; Pianori, E; Pinera, L; Pitts, K; Plager, C; Pondrom, L; Poukhov, O; Pounder, N; Prakoshyn, F; Pronko, A; Proudfoot, J; Ptohos, F; Pueschel, E; Punzi, G; Pursley, J; Rademacker, J; Rahaman, A; Ramakrishnan, V; Ranjan, N; Redondo, I; Renton, P; Renz, M; Rescigno, M; Richter, S; Rimondi, F; Ristori, L; Robson, A; Rodrigo, T; Rodriguez, T; Rogers, E; Rolli, S; Roser, R; Rossi, M; Rossin, R; Roy, P; Ruiz, A; Russ, J; Rusu, V; Saarikko, H; Safonov, A; Sakumoto, W K; Saltó, O; Santi, L; Sarkar, S; Sartori, L; Sato, K; Savoy-Navarro, A; Schlabach, P; Schmidt, A; Schmidt, E E; Schmidt, M A; Schmidt, M P; Schmitt, M; Schwarz, T; Scodellaro, L; Scribano, A; Scuri, F; Sedov, A; Seidel, S; Seiya, Y; Semenov, A; Sexton-Kennedy, L; Sforza, F; Sfyrla, A; Shalhout, S Z; Shears, T; Shepard, P F; Shimojima, M; Shiraishi, S; Shochet, M; Shon, Y; Shreyber, I; Sidoti, A; Sinervo, P; Sisakyan, A; Slaughter, A J; Slaunwhite, J; Sliwa, K; Smith, J R; Snider, F D; Snihur, R; Soha, A; Somalwar, S; Sorin, V; Spalding, J; Spreitzer, T; Squillacioti, P; Stanitzki, M; St Denis, R; Stelzer, B; Stelzer-Chilton, O; Stentz, D; Strologas, J; Strycker, G L; Stuart, D; Suh, J S; Sukhanov, A; Suslov, I; Suzuki, T; Taffard, A; Takashima, R; Takeuchi, Y; Tanaka, R; Tecchio, M; Teng, P K; Terashi, K; Tesarek, R; Thom, J; Thompson, A S; Thompson, G A; Thomson, E; Tipton, P; Ttito-Guzmán, P; Tkaczyk, S; Toback, D; Tokar, S; Tollefson, K; Tomura, T; Tonelli, D; Torre, S; Torretta, D; Totaro, P; Tourneur, S; Trovato, M; Tsai, S-Y; Tu, Y; Turini, N; Ukegawa, F; Vallecorsa, S; van Remortel, N; Varganov, A; Vataga, E; Vázquez, F; Velev, G; Vellidis, C; Vidal, M; Vidal, R; Vila, I; Vilar, R; Vine, T; Vogel, M; Volobouev, I; Volpi, G; Wagner, P; Wagner, R G; Wagner, R L; Wagner, W; Wagner-Kuhr, J; Wakisaka, T; Wallny, R; Wang, S M; Warburton, A; Waters, D; Weinberger, M; Weinelt, J; Wester, W C; Whitehouse, B; Whiteson, D; Wicklund, A B; Wicklund, E; Wilbur, S; Williams, G; Williams, H H; Wilson, P; Winer, B L; Wittich, P; Wolbers, S; Wolfe, C; Wright, T; Wu, X; Würthwein, F; Xie, S; Yagil, A; Yamamoto, K; Yamaoka, J; Yang, U K; Yang, Y C; Yao, W M; Yeh, G P; Yoh, J; Yorita, K; Yoshida, T; Yu, G B; Yu, I; Yu, S S; Yun, J C; Zanello, L; Zanetti, A; Zhang, X; Zheng, Y; Zucchelli, S

2009-07-17

We search for new charmless decays of neutral b hadrons to pairs of charged hadrons, using 1 fb(-1) of data collected by the CDF II detector at the Fermilab Tevatron. We report the first observation of the Bs0-->K-pi+ decay and measure B(Bs0-->K-pi+)=(5.0+/-0.7(stat)+/-0.8(syst))x10(-6). We also report the first observation of charmless b-baryon decays, and measure B(Lambdab0-->ppi-)=(3.5+/-0.6(stat)+/-0.9(syst))x10(-6) and B(Lambdab0-->pK-)=(5.6+/-0.8(stat)+/-1.5(syst))x10(-6). No evidence is found for other modes, and we set the limit B(Bs0-->pi+pi;-)<1.2x10(-6) at 90% C.L.

A model-guided symbolic execution approach for network protocol implementations and vulnerability detection.

PubMed

Wen, Shameng; Meng, Qingkun; Feng, Chao; Tang, Chaojing

2017-01-01

Formal techniques have been devoted to analyzing whether network protocol specifications violate security policies; however, these methods cannot detect vulnerabilities in the implementations of the network protocols themselves. Symbolic execution can be used to analyze the paths of the network protocol implementations, but for stateful network protocols, it is difficult to reach the deep states of the protocol. This paper proposes a novel model-guided approach to detect vulnerabilities in network protocol implementations. Our method first abstracts a finite state machine (FSM) model, then utilizes the model to guide the symbolic execution. This approach achieves high coverage of both the code and the protocol states. The proposed method is implemented and applied to test numerous real-world network protocol implementations. The experimental results indicate that the proposed method is more effective than traditional fuzzing methods such as SPIKE at detecting vulnerabilities in the deep states of network protocol implementations.

An Alternative Nested Reading Frame May Participate in the Stress-Dependent Expression of a Plant Gene

PubMed Central

Sheshukova, Ekaterina V.; Komarova, Tatiana V.; Ershova, Natalia M.; Shindyapina, Anastasia V.; Dorokhov, Yuri L.

2017-01-01

Although plants as sessile organisms are affected by a variety of stressors in the field, the stress factors for the above-ground and underground parts of the plant and their gene expression profiles are not the same. Here, we investigated NbKPILP, a gene encoding a new member of the ubiquitous, pathogenesis-related Kunitz peptidase inhibitor (KPI)-like protein family, that we discovered in the genome of Nicotiana benthamiana and other representatives of the Solanaceae family. The NbKPILP gene encodes a protein that has all the structural elements characteristic of KPI but in contrast to the proven A. thaliana KPI (AtKPI), it does not inhibit serine peptidases. Unlike roots, NbKPILP mRNA and its corresponding protein were not detected in intact leaves, but abiotic and biotic stressors drastically affected NbKPILP mRNA accumulation. In search of the causes of suppressed NbKPILP mRNA accumulation in leaves, we found that the NbKPILP gene is “matryoshka,” containing an alternative nested reading frame (ANRF) encoding a 53-amino acid (aa) polypeptide (53aa-ANRF) which has an amphipathic helix (AH). We confirmed ANRF expression experimentally. A vector containing a GFP-encoding sequence was inserted into the NbKPILP gene in frame with 53aa-ANRF, resulting in a 53aa-GFP fused protein that localized in the membrane fraction of cells. Using the 5′-RACE approach, we have shown that the expression of ANRF was not explained by the existence of a cryptic promoter within the NbKPILP gene but was controlled by the maternal NbKPILP mRNA. We found that insertion of mutations destroying the 53aa-ANRF AH resulted in more than a two-fold increase of the NbKPILP mRNA level. The NbKPILP gene represents the first example of ANRF functioning as a repressor of a maternal gene in an intact plant. We proposed a model where the stress influencing the translation initiation promotes the accumulation of NbKPILP and its mRNA in leaves. PMID:29312392

An Alternative Nested Reading Frame May Participate in the Stress-Dependent Expression of a Plant Gene.

PubMed

Sheshukova, Ekaterina V; Komarova, Tatiana V; Ershova, Natalia M; Shindyapina, Anastasia V; Dorokhov, Yuri L

2017-01-01

Although plants as sessile organisms are affected by a variety of stressors in the field, the stress factors for the above-ground and underground parts of the plant and their gene expression profiles are not the same. Here, we investigated NbKPILP , a gene encoding a new member of the ubiquitous, pathogenesis-related Kunitz peptidase inhibitor (KPI)-like protein family, that we discovered in the genome of Nicotiana benthamiana and other representatives of the Solanaceae family. The NbKPILP gene encodes a protein that has all the structural elements characteristic of KPI but in contrast to the proven A. thaliana KPI (AtKPI), it does not inhibit serine peptidases. Unlike roots, NbKPILP mRNA and its corresponding protein were not detected in intact leaves, but abiotic and biotic stressors drastically affected NbKPILP mRNA accumulation. In search of the causes of suppressed NbKPILP mRNA accumulation in leaves, we found that the NbKPILP gene is "matryoshka," containing an alternative nested reading frame (ANRF) encoding a 53-amino acid (aa) polypeptide (53aa-ANRF) which has an amphipathic helix (AH). We confirmed ANRF expression experimentally. A vector containing a GFP-encoding sequence was inserted into the NbKPILP gene in frame with 53aa-ANRF, resulting in a 53aa-GFP fused protein that localized in the membrane fraction of cells. Using the 5'-RACE approach, we have shown that the expression of ANRF was not explained by the existence of a cryptic promoter within the NbKPILP gene but was controlled by the maternal NbKPILP mRNA. We found that insertion of mutations destroying the 53aa-ANRF AH resulted in more than a two-fold increase of the NbKPILP mRNA level. The NbKPILP gene represents the first example of ANRF functioning as a repressor of a maternal gene in an intact plant. We proposed a model where the stress influencing the translation initiation promotes the accumulation of NbKPILP and its mRNA in leaves.

Search for D0-D(-)0 mixing and a measurement of the doubly Cabibbo-suppressed decay rate in D0-->Kpi decays.

PubMed

Aubert, B; Barate, R; Boutigny, D; Gaillard, J-M; Hicheur, A; Karyotakis, Y; Lees, J P; Robbe, P; Tisserand, V; Zghiche, A; Palano, A; Pompili, A; Chen, J C; Qi, N D; Rong, G; Wang, P; Zhu, Y S; Eigen, G; Ofte, I; Stugu, B; Abrams, G S; Borgland, A W; Breon, A B; Brown, D N; Button-Shafer, J; Cahn, R N; Charles, E; Day, C T; Gill, M S; Gritsan, A V; Groysman, Y; Jacobsen, R G; Kadel, R W; Kadyk, J; Kerth, L T; Kolomensky, Yu G; Kral, J F; Kukartsev, G; LeClerc, C; Levi, M E; Lynch, G; Mir, L M; Oddone, P J; Orimoto, T J; Pripstein, M; Roe, N A; Romosan, A; Ronan, M T; Shelkov, V G; Telnov, A V; Wenzel, W A; Harrison, T J; Hawkes, C M; Knowles, D J; Penny, R C; Watson, A T; Watson, N K; Deppermann, T; Goetzen, K; Koch, H; Lewandowski, B; Pelizaeus, M; Peters, K; Schmuecker, H; Steinke, M; Barlow, N R; Bhimji, W; Boyd, J T; Chevalier, N; Cottingham, W N; Mackay, C; Wilson, F F; Hearty, C; Mattison, T S; McKenna, J A; Thiessen, D; Kyberd, P; McKemey, A K; Blinov, V E; Bukin, A D; Golubev, V B; Ivanchenko, V N; Kravchenko, E A; Onuchin, A P; Serednyakov, S I; Skovpen, Yu I; Solodov, E P; Yushkov, A N; Best, D; Chao, M; Kirkby, D; Lankford, A J; Mandelkern, M; McMahon, S; Mommsen, R K; Roethel, W; Stoker, D P; Buchanan, C; Hadavand, H K; Hill, E J; MacFarlane, D B; Paar, H P; Rahatlou, Sh; Schwanke, U; Sharma, V; Berryhill, J W; Campagnari, C; Dahmes, B; Kuznetsova, N; Levy, S L; Long, O; Lu, A; Mazur, M A; Richman, J D; Verkerke, W; Beringer, J; Eisner, A M; Grothe, M; Heusch, C A; Lockman, W S; Schalk, T; Schmitz, R E; Schumm, B A; Seiden, A; Turri, M; Walkowiak, W; Williams, D C; Wilson, M G; Albert, J; Chen, E; Dorsten, M P; Dubois-Felsmann, G P; Dvoretskii, A; Hitlin, D G; Narsky, I; Porter, F C; Ryd, A; Samuel, A; Yang, S; Jayatilleke, S; Mancinelli, G; Meadows, B T; Sokoloff, M D; Barillari, T; Blanc, F; Bloom, P; Clark, P J; Ford, W T; Nauenberg, U; Olivas, A; Rankin, P; Roy, J; Smith, J G; van Hoek, W C; Zhang, L; Harton, J L; Hu, T; Soffer, A; Toki, W H; Wilson, R J; Zhang, J; Altenburg, D; Brandt, T; Brose, J; Colberg, T; Dickopp, M; Dubitzky, R S; Hauke, A; Lacker, H M; Maly, E; Müller-Pfefferkorn, R; Nogowski, R; Otto, S; Schubert, K R; Schwierz, R; Spaan, B; Wilden, L; Bernard, D; Bonneaud, G R; Brochard, F; Cohen-Tanugi, J; Thiebaux, Ch; Vasileiadis, G; Verderi, M; Khan, A; Lavin, D; Muheim, F; Playfer, S; Swain, J E; Tinslay, J; Bozzi, C; Piemontese, L; Sarti, A; Treadwell, E; Anulli, F; Baldini-Ferroli, R; Calcaterra, A; de Sangro, R; Falciai, D; Finocchiaro, G; Patteri, P; Peruzzi, I M; Piccolo, M; Zallo, A; Buzzo, A; Contri, R; Crosetti, G; Lo Vetere, M; Macri, M; Monge, M R; Passaggio, S; Pastore, F C; Patrignani, C; Robutti, E; Santroni, A; Tosi, S; Bailey, S; Morii, M; Grenier, G J; Lee, S-J; Mallik, U; Cochran, J; Crawley, H B; Lamsa, J; Meyer, W T; Prell, S; Rosenberg, E I; Yi, J; Davier, M; Grosdidier, G; Höcker, A; Laplace, S; Le Diberder, F; Lepeltier, V; Lutz, A M; Petersen, T C; Plaszczynski, S; Schune, M H; Tantot, L; Wormser, G; Bionta, R M; Brigljević, V; Cheng, C H; Lange, D J; Wright, D M; Bevan, A J; Fry, J R; Gabathuler, E; Gamet, R; Kay, M; Payne, D J; Sloane, R J; Touramanis, C; Aspinwall, M L; Bowerman, D A; Dauncey, P D; Egede, U; Eschrich, I; Morton, G W; Nash, J A; Sanders, P; Taylor, G P; Back, J J; Bellodi, G; Harrison, P F; Shorthouse, H W; Strother, P; Vidal, P B; Cowan, G; Flaecher, H U; George, S; Green, M G; Kurup, A; Marker, C E; McMahon, T R; Ricciardi, S; Salvatore, F; Vaitsas, G; Winter, M A; Brown, D; Davis, C L; Allison, J; Barlow, R J; Forti, A C; Hart, P A; Jackson, F; Lafferty, G D; Lyon, A J; Weatherall, J H; Williams, J C; Farbin, A; Jawahery, A; Kovalskyi, D; Lae, C K; Lillard, V; Roberts, D A; Blaylock, G; Dallapiccola, C; Flood, K T; Hertzbach, S S; Kofler, R; Koptchev, V B; Moore, T B; Staengle, H; Willocq, S; Cowan, R; Sciolla, G; Taylor, F; Yamamoto, R K; Mangeol, D J J; Milek, M; Patel, P M; Lazzaro, A; Palombo, F; Bauer, J M; Cremaldi, L; Eschenburg, V; Godang, R; Kroeger, R; Reidy, J; Sanders, D A; Summers, D J; Zhao, H W; Hast, C; Taras, P; Nicholson, H; Cartaro, C; Cavallo, N; De Nardo, G; Fabozzi, F; Gatto, C; Lista, L; Paolucci, P; Piccolo, D; Sciacca, C; Baak, M A; Raven, G; LoSecco, J M; Gabriel, T A; Brau, B; Pulliam, T; Brau, J; Frey, R; Iwasaki, M; Potter, C T; Sinev, N B; Strom, D; Torrence, E; Colecchia, F; Dorigo, A; Galeazzi, F; Margoni, M; Morandin, M; Posocco, M; Rotondo, M; Simonetto, F; Stroili, R; Tiozzo, G; Voci, C; Benayoun, M; Briand, H; Chauveau, J; David, P; de la Vaissière, Ch; Del Buono, L; Hamon, O; Leruste, Ph; Ocariz, J; Pivk, M; Roos, L; Stark, J; T'Jampens, S; Manfredi, P F; Re, V; Gladney, L; Guo, Q H; Panetta, J; Angelini, C; Batignani, G; Bettarini, S; Bondioli, M; Bucci, F; Calderini, G; Carpinelli, M; Forti, F; Giorgi, M A; Lusiani, A; Marchiori, G; Martinez-Vidal, F; Morganti, M; Neri, N; Paoloni, E; Rama, M; Rizzo, G; Sandrelli, F; Walsh, J; Haire, M; Judd, D; Paick, K; Wagoner, D E; Danielson, N; Elmer, P; Lu, C; Miftakov, V; Olsen, J; Smith, A J S; Varnes, E W; Bellini, F; Cavoto, G; del Re, D; Faccini, R; Ferrarotto, F; Ferroni, F; Gaspero, M; Leonardi, E; Mazzoni, M A; Morganti, S; Pierini, M; Piredda, G; Safai Tehrani, F; Serra, M; Voena, C; Christ, S; Wagner, G; Waldi, R; Adye, T; De Groot, N; Franek, B; Geddes, N I; Gopal, G P; Olaiya, E O; Xella, S M; Aleksan, R; Emery, S; Gaidot, A; Ganzhur, S F; Giraud, P-F; Hamel de Monchenault, G; Kozanecki, W; Langer, M; London, G W; Mayer, B; Schott, G; Vasseur, G; Yeche, Ch; Zito, M; Purohit, M V; Weidemann, A W; Yumiceva, F X; Aston, D; Bartoldus, R; Berger, N; Boyarski, A M; Buchmueller, O L; Convery, M R; Coupal, D P; Dong, D; Dorfan, J; Dujmic, D; Dunwoodie, W; Field, R C; Glanzman, T; Gowdy, S J; Grauges-Pous, E; Hadig, T; Halyo, V; Hryn'ova, T; Innes, W R; Jessop, C P; Kelsey, M H; Kim, P; Kocian, M L; Langenegger, U; Leith, D W G S; Luitz, S; Luth, V; Lynch, H L; Marsiske, H; Menke, S; Messner, R; Muller, D R; O'Grady, C P; Ozcan, V E; Perazzo, A; Perl, M; Petrak, S; Ratcliff, B N; Robertson, S H; Roodman, A; Salnikov, A A; Schindler, R H; Schwiening, J; Simi, G; Snyder, A; Soha, A; Stelzer, J; Su, D; Sullivan, M K; Tanaka, H A; Va'vra, J; Wagner, S R; Weaver, M; Weinstein, A J R; Wisniewski, W J; Wright, D H; Young, C C; Burchat, P R; Meyer, T I; Roat, C; Ahmed, S; Ernst, J A; Bugg, W; Krishnamurthy, M; Spanier, S M; Eckmann, R; Kim, H; Ritchie, J L; Schwitters, R F; Izen, J M; Kitayama, I; Lou, X C; Ye, S; Bianchi, F; Bona, M; Gallo, F; Gamba, D; Borean, C; Bosisio, L; Della Ricca, G; Dittongo, S; Grancagnolo, S; Lanceri, L; Poropat, P; Vitale, L; Vuagnin, G; Panvini, R S; Banerjee, Sw; Brown, C M; Fortin, D; Jackson, P D; Kowalewski, R; Roney, J M; Band, H R; Dasu, S; Datta, M; Eichenbaum, A M; Hu, H; Johnson, J R; Liu, R; Lodovico, F Di; Mohapatra, A K; Pan, Y; Prepost, R; Sekula, S J; von Wimmersperg-Toeller, J H; Wu, J; Wu, S L; Yu, Z; Neal, H

2003-10-24

We present results of a search for D0-D(-)0 mixing and a measurement of R(D), the ratio of doubly Cabibbo-suppressed decays to Cabibbo-favored decays, using D0-->K+pi- decays from 57.1 fb(-1) of data collected near sqrt[s]=10.6 GeV with the BABAR detector at the PEP-II collider. At the 95% confidence level, allowing for CP violation, we find the mixing parameters x('2)<0.0022 and -0.056

The Alpha consensus meeting on cryopreservation key performance indicators and benchmarks: proceedings of an expert meeting.

PubMed

2012-08-01

This proceedings report presents the outcomes from an international workshop designed to establish consensus on: definitions for key performance indicators (KPIs) for oocyte and embryo cryopreservation, using either slow freezing or vitrification; minimum performance level values for each KPI, representing basic competency; and aspirational benchmark values for each KPI, representing best practice goals. This report includes general presentations about current practice and factors for consideration in the development of KPIs. A total of 14 KPIs were recommended and benchmarks for each are presented. No recommendations were made regarding specific cryopreservation techniques or devices, or whether vitrification is 'better' than slow freezing, or vice versa, for any particular stage or application, as this was considered to be outside the scope of this workshop. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Platelet amyloid precursor protein isoform expression in Alzheimer's disease: evidence for peripheral marker.

PubMed

Vignini, A; Sartini, D; Morganti, S; Nanetti, L; Luzzi, S; Provinciali, L; Mazzanti, L; Emanuelli, M

2011-01-01

Alzheimer's disease (AD) is a chronic neurodegenerative disorder characterized by a progressive cognitive and memory decline. Among peripheral markers of AD, great interest has been focused on the amyloid precursor protein (APP). In this regard, platelets represent an important peripheral source of APP since it has been demonstrated that the three major isoforms, that are constituted of 770, 751 and 695 aa residues, are inserted in the membrane of resting platelets. APP 751 and APP 770 contain a Kunitz-type serine protease inhibitor domain (APP KPI) and APP 695 lacks this domain. To address this issue, we first examined the platelet APP isoform mRNAs prospectively as biomarker for the diagnosis of AD by means of real-time quantitative PCR, and then evaluated the correlation between APP mRNA expression levels and cognitive impairment of enrolled subjects. Differential gene expression measurements in the AD patient group (n=18) revealed a significant up-regulation of APP TOT (1.52-fold), APP KPI (1.32-fold), APP 770 (1.33-fold) and APP 751 (1.26-fold) compared to controls (n=22). Moreover, a statistically significant positive correlation was found between APP mRNA levels (TOT, KPI, 770 and 751) and cognitive impairment. Since AD definitive diagnosis still relies on pathological evaluation at autopsy, the present results are consistent with the hypothesis that platelet APP could be considered a potential reliable peripheral marker for studying AD and could contribute to define a signature for the presence of AD pathology.

Light-Induced Surface Reactions at the Bismuth Vanadate/Potassium Phosphate Interface.

PubMed

Favaro, Marco; Abdi, Fatwa F; Lamers, Marlene; Crumlin, Ethan J; Liu, Zhi; van de Krol, Roel; Starr, David E

2018-01-18

Bismuth vanadate has recently drawn significant research attention as a light-absorbing photoanode due to its performance for photoelectrochemical water splitting. In this study, we use in situ ambient pressure X-ray photoelectron spectroscopy with "tender" X-rays (4.0 keV) to investigate a polycrystalline bismuth vanadate (BiVO 4 ) electrode in contact with an aqueous potassium phosphate (KPi) solution at open circuit potential under both dark and light conditions. This is facilitated by the creation of a 25 to 30 nm thick electrolyte layer using the "dip-and-pull" method. We observe that under illumination bismuth phosphate forms on the BiVO 4 surface leading to an increase of the surface negative charge. The bismuth phosphate layer may act to passivate surface states observed in photoelectrochemical measurements. The repulsive interaction between the negatively charged surface under illumination and the phosphate ions in solution causes a shift in the distribution of ions in the thin aqueous electrolyte film, which is observed as an increase in their photoelectron signals. Interestingly, we find that such changes at the BiVO 4 /KPi electrolyte interface are reversible upon returning to dark conditions. By measuring the oxygen 1s photoelectron peak intensities from the phosphate ions and liquid water as a function of time under dark and light conditions, we determine the time scales for the forward and reverse reactions. Our results provide direct evidence for light-induced chemical modification of the BiVO 4 /KPi electrolyte interface.

Prognostic significance of peripheral monocyte count in patients with extranodal natural killer/T-cell lymphoma

PubMed Central

2013-01-01

Background Extranodal natural killer/T-cell lymphoma (ENKL) has heterogeneous clinical manifestations and prognosis. This study aims to evaluate the prognostic impact of absolute monocyte count (AMC) in ENKL, and provide some immunologically relevant information for better risk stratification in patients with ENKL. Methods Retrospective data from 163 patients newly diagnosed with ENKL were analyzed. The absolute monocyte count (AMC) at diagnosis was analyzed as continuous and dichotomized variables. Independent prognostic factors of survival were determined by Cox regression analysis. Results The AMC at diagnosis were related to overall survival (OS) and progression-free survival (PFS) in patients with ENKL. Multivariate analysis identified AMC as independent prognostic factors of survival, independent of International Prognostic Index (IPI) and Korean prognostic index (KPI). The prognostic index incorporating AMC and absolute lymphocyte count (ALC), another surrogate factor of immune status, could be used to stratify all 163 patients with ENKL into different prognostic groups. For patients who received chemotherapy followed by radiotherapy (102 cases), the three AMC/ALC index categories identified patients with significantly different survivals. When superimposed on IPI or KPI categories, the AMC/ALC index was better able to identify high-risk patients in the low-risk IPI or KPI category. Conclusion The baseline peripheral monocyte count is shown to be an effective prognostic indicator of survival in ENKL patients. The prognostic index related to tumor microenvironment might be helpful to identify high-risk patients with ENKL. PMID:23638998

Who needs inpatient detox? Development and implementation of a hospitalist protocol for the evaluation of patients for alcohol detoxification.

PubMed

Stephens, John R; Liles, E Allen; Dancel, Ria; Gilchrist, Michael; Kirsch, Jonathan; DeWalt, Darren A

2014-04-01

Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates. To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol's implementation. Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation. Patients presenting for alcohol detoxification. Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification. Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation. We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation (p = 0.037). There was no difference in readmission rate or length of stay. Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions.

Pharmaceutical care for patients with COPD in Belgium and views on protocol implementation.

PubMed

Tommelein, Eline; Tollenaere, Kathleen; Mehuys, Els; Boussery, Koen

2014-08-01

A protocol-based pharmaceutical care program (the PHARMACOP-protocol) focusing on patient counselling during prescription filling has shown to be effective in patients with chronic obstructive pulmonary disease (COPD). However, implementation of this protocol in daily practice has not yet been studied. To describe current implementation level of the items included in the PHARMACOP-protocol in Belgian community pharmacies and to evaluate pharmacists' perspectives on the implementation of this protocol in daily practice. A cross-sectional study was conducted from April to June 2012, in randomly selected community pharmacies in Flanders. Pharmacists were questionned using structured interviews. 125 pharmacies were contacted and 80 managing pharmacists (64 %) participated. In >70 % of pharmacies, 4/7 protocol items for first prescriptions and 3/5 protocol items for follow-up prescriptions were already routinely implemented. For first and follow-up prescriptions, respectively 39 (49 %) and 34 pharmacists (43 %) stated they would need to spend at least 5 min extra to offer optimal patient counselling. Most mentioned barriers preventing protocol implementation included lack of time (80 %), no integration in pharmacy software (61 %) and too much administrative burden (58 %). Approximately 50 % of the PHARMACOP-protocol items are currently routinely provided in Belgian community pharmacies. Nearly all interviewed pharmacists are willing to implement the protocol fully or partially in daily practice.

A cascadable circular concentrator with parallel compressed structure for increasing the energy density

NASA Astrophysics Data System (ADS)

Ku, Nai-Lun; Chen, Yi-Yung; Hsieh, Wei-Che; Whang, Allen Jong-Woei

2012-02-01

Due to the energy crisis, the principle of green energy gains popularity. This leads the increasing interest in renewable energy such as solar energy. Thus, how to collect the sunlight for indoor illumination becomes our ultimate target. With the environmental awareness increasing, we use the nature light as the light source. Then we start to devote the development of solar collecting system. The Natural Light Guiding System includes three parts, collecting, transmitting and lighting part. The idea of our solar collecting system design is a concept for combining the buildings with a combination of collecting modules. Therefore, we can use it anyplace where the sunlight can directly impinges on buildings with collecting elements. In the meantime, while collecting the sunlight with high efficiency, we can transmit the sunlight into indoor through shorter distance zone by light pipe where we needs the light. We proposed a novel design including disk-type collective lens module. With the design, we can let the incident light and exit light be parallel and compressed. By the parallel and compressed design, we make every output light become compressed in the proposed optical structure. In this way, we can increase the ratio about light compression, get the better efficiency and let the energy distribution more uniform for indoor illumination. By the definition of "KPI" as an performance index about light density as following: lm/(mm)2, the simulation results show that the proposed Concentrator is 40,000,000 KPI much better than the 800,000 KPI measured from the traditional ones.

PI3K-mediated PDGFRα signaling regulates survival and proliferation in skeletal development through p53-dependent intracellular pathways

PubMed Central

Fantauzzo, Katherine A.; Soriano, Philippe

2014-01-01

Previous studies have identified phosphatidylinositol 3-kinase (PI3K) as the main downstream effector of PDGFRα signaling during murine skeletal development. Autophosphorylation mutant knock-in embryos in which PDGFRα is unable to bind PI3K (PdgfraPI3K/PI3K) exhibit skeletal defects affecting the palatal shelves, shoulder girdle, vertebrae, and sternum. To identify proteins phosphorylated by Akt downstream from PI3K-mediated PDGFRα signaling, we immunoprecipitated Akt phosphorylation substrates from PDGF-AA-treated primary mouse embryonic palatal mesenchyme (MEPM) lysates and analyzed the peptides by nanoliquid chromatography coupled to tandem mass spectrometry (nano-LC-MS/MS). Our analysis generated a list of 56 proteins, including 10 that regulate cell survival and proliferation. We demonstrate that MEPM cell survival is impaired in the presence of a PI3K inhibitor and that PdgfraPI3K/PI3K-derived MEPMs do not proliferate in response to PDGF-AA treatment. Several of the identified Akt phosphorylation targets, including Ybox1, mediate cell survival through regulation of p53. We show that Ybox1 binds both the Trp53 promoter and the p53 protein and that expression of Trp53 is significantly decreased upon PDGF-AA treatment in MEPMs. Finally, we demonstrate that introduction of a Trp53-null allele attenuates the vertebral defects found in PdgfraPI3K/PI3K neonates. Our findings identify p53 as a novel effector downstream from PI3K-engaged PDGFRα signaling that regulates survival and proliferation during skeletal development in vivo. PMID:24788519

Rate Constants of PSII Photoinhibition and its Repair, and PSII Fluorescence Parameters in Field Plants in Relation to their Growth Light Environments.

PubMed

Miyata, Kazunori; Ikeda, Hiroshi; Nakaji, Masayoshi; Kanel, Dhana Raj; Terashima, Ichiro

2015-09-01

The extent of photoinhibition of PSII is determined by a balance between the rate of photodamage to PSII and that of repair of the damaged PSII. It has already been indicated that the rate constants of photodamage (kpi) and repair (krec) of the leaves differ depending on their growth light environment. However, there are no studies using plants in the field. We examined these rate constants and fluorescence parameters of several field-grown plants to determine inter-relationships between these values and the growth environment. The kpi values were strongly related to the excess energy, EY, of the puddle model and non-regulated energy dissipation, Y(NO), of the lake model, both multiplied by the photosynthetically active photon flux density (PPFD) level during the photoinhibitory treatment. In contrast, the krec values corrected against in situ air temperature were very strongly related to the daily PPFD level. The plants from the fields showed higher NPQ than the chamber-grown plants, probably because these field plants acclimated to stronger lightflecks than the averaged growth PPFD. Comparing chamber-grown plants and the field plants, we showed that kpi is determined by the incident light level and the photosynthetic capacities such as in situ rate of PSII electron transport and non-photochemical quenching (NPQ) [e.g. Y(NO)×PPFD] and that krec is mostly determined by the growth light and temperature levels. © The Author 2015. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A Model Based Security Testing Method for Protocol Implementation

PubMed Central

Fu, Yu Long; Xin, Xiao Long

2014-01-01

The security of protocol implementation is important and hard to be verified. Since the penetration testing is usually based on the experience of the security tester and the specific protocol specifications, a formal and automatic verification method is always required. In this paper, we propose an extended model of IOLTS to describe the legal roles and intruders of security protocol implementations, and then combine them together to generate the suitable test cases to verify the security of protocol implementation. PMID:25105163

A model based security testing method for protocol implementation.

PubMed

Fu, Yu Long; Xin, Xiao Long

2014-01-01

The security of protocol implementation is important and hard to be verified. Since the penetration testing is usually based on the experience of the security tester and the specific protocol specifications, a formal and automatic verification method is always required. In this paper, we propose an extended model of IOLTS to describe the legal roles and intruders of security protocol implementations, and then combine them together to generate the suitable test cases to verify the security of protocol implementation.

Key Performance Indicators for Primary Schools.

ERIC Educational Resources Information Center

Strand, Steve

Focusing mostly on their application for primary schools, this document describes the educational key performance indicators (KPI) employed by the Wendsworth, England, Local Educational Authority (LEA). Indicators are divided into 3 areas, educational context, resource development, and outcomes. Contextual indicators include pupil mobility, home…

The Effect of Altitude and Travel on Rugby Union Performance: Analysis of the 2012 Super Rugby Competition.

PubMed

George, Tina M; Olsen, Peter D; Kimber, Nick E; Shearman, Jeremy P; Hamilton, Jamie G; Hamlin, Michael J

2015-12-01

The aim of this study was to investigate whether playing rugby at altitude or after travel (domestic and international) disadvantaged teams. In a retrospective longitudinal study, all matches (N = 125) played in the 2012 Super Rugby Competition were analyzed for key performance indicators (KPI) from coded game data provided by OPTA sports data company. Matches were played in a home-away format in New Zealand, South Africa, and Australia. Teams based at sea level but playing at altitude (1,271-1,753 m) were more likely to miss tackles (mean ± 90% confidence interval, 1.4 ± 1.7) and score fewer points in the first half compared with games at sea level. In the second half of games, sea level teams at altitude were very likely to make fewer gain lines (-4.0 ± 2.7) compared with the second half of games at sea level. The decreased ability to break the defensive line, which may be the result of altitude-induced fatigue, could reduce the likelihood of scoring points and winning a game. Travel also had an effect on KPI, where international travel resulted in more missed tackles (1.7 ± 1.3) and less frequent gain lines (-3.0 ± 1.9) in the first half relative to matches at home; overall, away teams (domestic and international) scored 4 less points in the second half compared with home teams. In conclusion, playing away from home in another country, particularly at altitude, can have a detrimental effect on KPI, which may affect the overall performance and the chances of winning matches.

Predictive value of pretreatment positron emission tomography/computed tomography in patients with newly diagnosed extranodal natural killer/T-cell lymphoma.

PubMed

Bai, Bing; Huang, Hui-Qiang; Cai, Qi-Chun; Fan, Wei; Wang, Xiao-Xiao; Zhang, Xu; Lin, Ze-Xiao; Gao, Yan; Xia, Yun-Fei; Guo, Ying; Cai, Qing-Qing; Jiang, Wen-Qi; Lin, Tong-Yu

2013-03-01

The role of (18)Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in extranodal natural killer/T-cell lymphoma (ENKL) is not well established. This study aimed to investigate the prognostic role of the pretreatment maximum standardized uptake value (SUV(max)) on PET/CT in patients with newly diagnosed ENKL. Among 364 consecutive patients with newly diagnosed ENKL, 81 patients were included and reviewed. The impact of SUV(max) on survival and the relationship between SUV(max) and other clinicopathological parameters were analyzed. The median SUV(max) was 14.6 (range 2.0-45.4). The optimal cutoff value of SUV(max) to predict overall survival (OS) was 15. Patients with high SUV(max) (SUVmax >15) were associated with bulky disease (P < 0.001), local invasion (P = 0.030), high score of Korean Prognostic Index (KPI, P = 0.046), resistance to primary treatment (P = 0.014), poor OS (P < 0.001), and unfavorable progression-free survival (P < 0.001). With a median follow-up of 25.0 months, the median OS was 63.0 months (range 2.0-99.0 months). Multivariate analyses revealed the following independent prognostic factors for OS: age >60 years (P = 0.001), stage III-IV (P = 0.023), SUV(max) >15 (P = 0.020), and bulky disease (>5 cm) (P = 0.002). By using the SUV(max), patients in most subgroups stratified by the KPI or the International Prognostic Index (IPI) were further discriminated in OS with significant statistical difference. Our results suggest the pretreatment SUV(max) is predictive of prognosis in patients with newly diagnosed ENKL. The SUV(max) may provide additional prognostic information for IPI and KPI.

The Role of Factor XIa (FXIa) Catalytic Domain Exosite Residues in Substrate Catalysis and Inhibition by the Kunitz Protease Inhibitor Domain of Protease Nexin 2*

PubMed Central

Su, Ya-Chi; Miller, Tara N.; Navaneetham, Duraiswamy; Schoonmaker, Robert T.; Sinha, Dipali; Walsh, Peter N.

2011-01-01

To select residues in coagulation factor XIa (FXIa) potentially important for substrate and inhibitor interactions, we examined the crystal structure of the complex between the catalytic domain of FXIa and the Kunitz protease inhibitor (KPI) domain of a physiologically relevant FXIa inhibitor, protease nexin 2 (PN2). Six FXIa catalytic domain residues (Glu98, Tyr143, Ile151, Arg3704, Lys192, and Tyr5901) were subjected to mutational analysis to investigate the molecular interactions between FXIa and the small synthetic substrate (S-2366), the macromolecular substrate (factor IX (FIX)) and inhibitor PN2KPI. Analysis of all six Ala mutants demonstrated normal Km values for S-2366 hydrolysis, indicating normal substrate binding compared with plasma FXIa; however, all except E98A and K192A had impaired values of kcat for S-2366 hydrolysis. All six Ala mutants displayed deficient kcat values for FIX hydrolysis, and all were inhibited by PN2KPI with normal values of Ki except for K192A, and Y5901A, which displayed increased values of Ki. The integrity of the S1 binding site residue, Asp189, utilizing p-aminobenzamidine, was intact for all FXIa mutants. Thus, whereas all six residues are essential for catalysis of the macromolecular substrate (FIX), only four (Tyr143, Ile151, Arg3704, and Tyr5901) are important for S-2366 hydrolysis; Glu98 and Lys192 are essential for FIX but not S-2366 hydrolysis; and Lys192 and Tyr5901 are required for both inhibitor and macromolecular substrate interactions. PMID:21778227

Identification of a female spawn-associated Kazal-type inhibitor from the tropical abalone Haliotis asinina.

PubMed

Wang, Tianfang; Nuurai, Parinyaporn; McDougall, Carmel; York, Patrick S; Bose, Utpal; Degnan, Bernard M; Cummins, Scott F

2016-07-01

Abalone (Haliotis) undergoes a period of reproductive maturation, followed by the synchronous release of gametes, called broadcast spawning. Field and laboratory studies have shown that the tropical species Haliotis asinina undergoes a two-week spawning cycle, thus providing an excellent opportunity to investigate the presence of endogenous spawning-associated peptides. In female H. asinina, we have isolated a peptide (5145 Da) whose relative abundance in hemolymph increases substantially just prior to spawning and is still detected using reverse-phase high-performance liquid chromatography chromatograms up to 1-day post-spawn. We have isolated this peptide from female hemolymph as well as samples prepared from the gravid female gonad, and demonstrated through comparative sequence analysis that it contains features characteristic of Kazal-type proteinase inhibitors (KPIs). Has-KPI is expressed specifically within the gonad of adult females. A recombinant Has-KPI was generated using a yeast expression system. The recombinant Has-KPI does not induce premature spawning of female H. asinina when administered intramuscularly. However it displays homomeric aggregations and interaction with at least one mollusc-type neuropeptide (LRDFVamide), suggesting a role for it in regulating neuropeptide endocrine communication. This research provides new understanding of a peptide that can regulate reproductive processes in female abalone, which has the potential to lead to the development of greater control over abalone spawning. The findings also highlight the need to further explore abalone reproduction to clearly define a role for novel spawning-associated peptide in sexual maturation and spawning. Copyright © 2016 European Peptide Society and John Wiley & Sons, Ltd. Copyright © 2016 European Peptide Society and John Wiley & Sons, Ltd.

Constant False Alarm Rate (CFAR) Autotrend Evaluation Report

DTIC Science & Technology

2011-12-01

represent a level of uncertainty in the performance analysis. The performance analysis produced the following Key Performance Indicators ( KPIs ) as...Identity KPI Key Performance Indicator MooN M-out-of-N MSPU Modernized Signal Processor Unit NFF No Fault Found PAT Parameter Allocation Table PD

Dalitz plot analysis of the decay D(+)-->K(-)pi(+)pi(+) and indication of a low-mass scalar Kpi resonance.

PubMed

Aitala, E M; Amato, S; Anjos, J C; Appel, J A; Ashery, D; Banerjee, S; Bediaga, I; Blaylock, G; Bracker, S B; Burchat, P R; Burnstein, R A; Carter, T; Carvalho, H S; Copty, N K; Cremaldi, L M; Darling, C; Denisenko, K; Devmal, S; Fernandez, A; Fox, G F; Gagnon, P; Göbel, C; Gounder, K; Halling, A M; Herrera, G; Hurvits, G; James, C; Kasper, P A; Kwan, S; Langs, D C; Leslie, J; Lundberg, B; Magnin, J; Massafferri, A; MayTal-Beck, S; Meadows, B; de Mello Neto, J R T; Mihalcea, D; Milburn, R H; de Miranda, J M; Napier, A; Nguyen, A; d'Oliveira, A B; O'Shaughnessy, K; Peng, K C; Perera, L P; Purohit, M V; Quinn, B; Radeztsky, S; Rafatian, A; Reay, N W; Reidy, J J; dos Reis, A C; Rubin, H A; Sanders, D A; Santha, A K S; Santoro, A F S; Schwartz, A J; Sheaff, M; Sidwell, R A; Slaughter, A J; Sokoloff, M D; Solano Salinas, C J; Stanton, N R; Stefanski, R J; Stenson, K; Summers, D J; Takach, S; Thorne, K; Tripathi, A K; Watanabe, S; Weiss-Babai, R; Wiener, J; Witchey, N; Wolin, E; Yang, S M; Yi, D; Yoshida, S; Zaliznyak, R; Zhang, C

2002-09-16

We study the Dalitz plot of the decay D(+)-->K(-)pi(+)pi(+) with a sample of 15090 events from Fermilab experiment E791. Modeling the decay amplitude as the coherent sum of known Kpi resonances and a uniform nonresonant term, we do not obtain an acceptable fit. If we allow the mass and width of the K(*)(0)(1430) to float, we obtain values consistent with those from PDG but the chi(2) per degree of freedom of the fit is still unsatisfactory. A good fit is found when we allow for the presence of an additional scalar resonance, with mass 797+/-19+/-43 MeV/c(2) and width 410+/-43+/-87 MeV/c(2). The mass and width of the K(*)(0)(1430) become 1459+/-7+/-5 MeV/c(2) and 175+/-12+/-12 MeV/c(2), respectively. Our results provide new information on the scalar sector in hadron spectroscopy.

The Automation System Censor Speech for the Indonesian Rude Swear Words Based on Support Vector Machine and Pitch Analysis

NASA Astrophysics Data System (ADS)

Endah, S. N.; Nugraheni, D. M. K.; Adhy, S.; Sutikno

2017-04-01

According to Law No. 32 of 2002 and the Indonesian Broadcasting Commission Regulation No. 02/P/KPI/12/2009 & No. 03/P/KPI/12/2009, stated that broadcast programs should not scold with harsh words, not harass, insult or demean minorities and marginalized groups. However, there are no suitable tools to censor those words automatically. Therefore, researches to develop a system of intelligent software to censor the words automatically are needed. To conduct censor, the system must be able to recognize the words in question. This research proposes the classification of speech divide into two classes using Support Vector Machine (SVM), first class is set of rude words and the second class is set of properly words. The speech pitch values as an input in SVM, it used for the development of the system for the Indonesian rude swear word. The results of the experiment show that SVM is good for this system.

SPP: A data base processor data communications protocol

NASA Technical Reports Server (NTRS)

Fishwick, P. A.

1983-01-01

The design and implementation of a data communications protocol for the Intel Data Base Processor (DBP) is defined. The protocol is termed SPP (Service Port Protocol) since it enables data transfer between the host computer and the DBP service port. The protocol implementation is extensible in that it is explicitly layered and the protocol functionality is hierarchically organized. Extensive trace and performance capabilities have been supplied with the protocol software to permit optional efficient monitoring of the data transfer between the host and the Intel data base processor. Machine independence was considered to be an important attribute during the design and implementation of SPP. The protocol source is fully commented and is included in Appendix A of this report.

The hidden KPI registration accuracy.

PubMed

Shorrosh, Paul

2011-09-01

Determining the registration accuracy rate is fundamental to improving revenue cycle key performance indicators. A registration quality assurance (QA) process allows errors to be corrected before bills are sent and helps registrars learn from their mistakes. Tools are available to help patient access staff who perform registration QA manually.

Examining the Relationships between KPI Technology Factor and ICT/Enterprise Alignment

ERIC Educational Resources Information Center

Taylor, Carolyn

2013-01-01

"Fortune" Global 500 Corporations understand that achieving alignment between information and communication technology and enterprise is a major issue. There is much evidence that supports the notion that strategic alignment of information and communication technology (ICT) and enterprise are drivers of economic growth. Addressing…

Impact of a pharmacist-driven warfarin management protocol on achieving therapeutic International Normalized Ratios.

PubMed

Downing, Amanda; Mortimer, Molly; Hiers, Jill

2016-03-01

Warfarin is a high alert medication and a challenge to dose and monitor. Pharmacist-driven warfarin management has been shown to decrease the time international normalized ratio (INR) is out of range, which may reduce undesired outcomes. The purpose of this study is to assess the effect of the implementation of a pharmacist-driven warfarin management protocol on the achievement of therapeutic INRs. A warfarin management protocol was developed using evidence based literature and similar protocols from other institutions. Pharmacists utilized the protocol to provide patient specific warfarin dosing upon provider referral. To evaluate the protocol's impact, a retrospective chart review pre- and post-implementation was completed for admitted patients receiving warfarin. Three hundred twenty-seven charts were reviewed for pre- and post-implementation data. INRs within therapeutic range increased from 27.8% before protocol implementation to 38.5% after implementation. There was also a reduction in subtherapeutic INRs (55.3% pre to 39% post) and supratherapeutic INRs 5 or above (3.7% pre to 2.6% post). Supratherapeutic INRs between 3 and 5 did increase from 13.2% before protocol implementation to 19.9% in the pharmacist managed group. In addition to reducing the time to achievement of therapeutic INRs by 0.5 days, implementation of the protocol resulted in an increased the number of patients with at least one therapeutic INR during admission (35% pre to 40% post). The implementation of a pharmacist-driven warfarin dosing protocol increased therapeutic INRs, and decreased the time to therapeutic range, as well as the proportion of subtherapeutic INRs and supratherapeutic INRs 5 or greater. Additional benefits of the protocol include documentation of Joint Commission National Patient Safety Goal compliance, promotion of interdisciplinary collaboration and increased continuity of care. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

An Investigation into Specifying Service Level Agreements for Provisioning Cloud Computing Services

DTIC Science & Technology

2012-12-01

IT .................................................................................................... Information Technology KPI ...the service delivery be measured? 3. Key Performance Indicators ( KPIs ): Describe the KPIs and the responsible party for producing the KPIs . 4...level objectives (SLOs) that are evaluated according to measurable Key Performance Indicators ( KPIs ). Automatic SLA protection enables further

Application of the canonical operator to the description of self-focusing soliton-like solutions of the Kadomtsev-Petviashvili equation

NASA Astrophysics Data System (ADS)

Maslov, V. P.; Shafarevich, A. I.

2011-12-01

A description for the asymptotic soliton-like solution of the Kadomtsev-Petviashvili I equation (KPI equation) in terms of the canonical operator is suggested. This solution can smoothly be continued to the vicinity of the focal point.

Darboux transformation and explicit solutions for some (2+1)-dimensional equations

NASA Astrophysics Data System (ADS)

Wang, Yan; Shen, Lijuan; Du, Dianlou

2007-06-01

Three systems of (2+1)-dimensional soliton equations and their decompositions into the (1+1)-dimensional soliton equations are proposed. These equations include KPI, CKP, MKPI. With the help of Darboux transformation of (1+1)-dimensional equations, we get the explicit solutions of the (2+1)-dimensional equations.

U.S. EPA, Pesticide Product Label, SEVIN 5% DUST, 11/19/1981

EPA Pesticide Factsheets

2011-04-21

... "e;;t~~i~:i'·:,~r:.;~. eT~;:': i:, .O~~~:~J It;;;'"lh~''I~;.rP:~,~: t;~~ ';JI.~~ n>nl~ .nd "',"'nlll frU'1 m"lh KPI>I .. d( 1',",41 r.11 and .""rv II) to 14 ...

KPI Graduate Executive Summary Report, Summer 2000-Winter 2001.

ERIC Educational Resources Information Center

Sheridan Coll. (Ontario).

Summarizes findings from the Key Performance Indicator Satisfaction Survey administered by Sheridan College in the summer 2000, fall 2000, and winter 2001 terms. This survey was administered in compliance with the Ontario government's efforts to increase the accountability of the Colleges of Applied Arts and Technology through the measurement of…

A Performance Evaluation of NACK-Oriented Protocols as the Foundation of Reliable Delay- Tolerant Networking Convergence Layers

NASA Technical Reports Server (NTRS)

Iannicca, Dennis; Hylton, Alan; Ishac, Joseph

2012-01-01

Delay-Tolerant Networking (DTN) is an active area of research in the space communications community. DTN uses a standard layered approach with the Bundle Protocol operating on top of transport layer protocols known as convergence layers that actually transmit the data between nodes. Several different common transport layer protocols have been implemented as convergence layers in DTN implementations including User Datagram Protocol (UDP), Transmission Control Protocol (TCP), and Licklider Transmission Protocol (LTP). The purpose of this paper is to evaluate several stand-alone implementations of negative-acknowledgment based transport layer protocols to determine how they perform in a variety of different link conditions. The transport protocols chosen for this evaluation include Consultative Committee for Space Data Systems (CCSDS) File Delivery Protocol (CFDP), Licklider Transmission Protocol (LTP), NACK-Oriented Reliable Multicast (NORM), and Saratoga. The test parameters that the protocols were subjected to are characteristic of common communications links ranging from terrestrial to cis-lunar and apply different levels of delay, line rate, and error.

IONAC-Lite

NASA Technical Reports Server (NTRS)

Torgerson, Jordan L.; Clare, Loren P.; Pang, Jackson

2011-01-01

The Interplanetary Overlay Net - working Protocol Accelerator (IONAC) described previously in The Inter - planetary Overlay Networking Protocol Accelerator (NPO-45584), NASA Tech Briefs, Vol. 32, No. 10, (October 2008) p. 106 (http://www.techbriefs.com/component/ content/article/3317) provides functions that implement the Delay Tolerant Networking (DTN) bundle protocol. New missions that require high-speed downlink-only use of DTN can now be accommodated by the unidirectional IONAC-Lite to support high data rate downlink mission applications. Due to constrained energy resources, a conventional software implementation of the DTN protocol can provide only limited throughput for any given reasonable energy consumption rate. The IONAC-Lite DTN Protocol Accelerator is able to reduce this energy consumption by an order of magnitude and increase the throughput capability by two orders of magnitude. In addition, a conventional DTN implementation requires a bundle database with a considerable storage requirement. In very high downlink datarate missions such as near-Earth radar science missions, the storage space utilization needs to be maximized for science data and minimized for communications protocol-related storage needs. The IONAC-Lite DTN Protocol Accelerator is implemented in a reconfigurable hardware device to accomplish exactly what s needed for high-throughput DTN downlink-only scenarios. The following are salient features of the IONAC-Lite implementation: An implementation of the Bundle Protocol for an environment that requires a very high rate bundle egress data rate. The C&DH (command and data handling) subsystem is also expected to be very constrained so the interaction with the C&DH processor and the temporary storage are minimized. Fully pipelined design so that bundle processing database is not required. Implements a lookup table-based approach to eliminate multi-pass processing requirement imposed by the Bundle Protocol header s length field structure and the SDNV (self-delimiting numeric value) data field formatting. 8-bit parallel datapath to support high data-rate missions. Reduced resource utilization implementation for missions that do not require custody transfer features. There was no known implementation of the DTN protocol in a field programmable gate array (FPGA) device prior to the current implementation. The combination of energy and performance optimization that embodies this design makes the work novel.

Implementation of Siemens USS protocol into LabVIEW.

PubMed

Hosek, P; Diblik, M

2011-10-01

This article gives basic overview of the USS protocol as a communication interface to drive Siemens frequency inverters. It presents our implementation of this protocol into LabVIEW, as there was permanent demand from the community of the users to have native LabVIEW implementation of the USS protocol. It also states encountered problems and their solutions. Copyright © 2011 Society for Laboratory Automation and Screening. Published by Elsevier Inc. All rights reserved.

Verification and validation of a reliable multicast protocol

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1995-01-01

This paper describes the methods used to specify and implement a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally by two complementary teams using a combination of formal and informal techniques in an attempt to ensure the correctness of the protocol implementation. The first team, called the Design team, initially specified protocol requirements using a variant of SCR requirements tables and implemented a prototype solution. The second team, called the V&V team, developed a state model based on the requirements tables and derived test cases from these tables to exercise the implementation. In a series of iterative steps, the Design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation through testing. Test cases derived from state transition paths in the formal model formed the dialogue between teams during development and served as the vehicles for keeping the model and implementation in fidelity with each other. This paper describes our experiences in developing our process model, details of our approach, and some example problems found during the development of RMP.

Radiation safety protocol using real-time dose reporting reduces patient exposure in pediatric electrophysiology procedures.

PubMed

Patel, Akash R; Ganley, Jamie; Zhu, Xiaowei; Rome, Jonathan J; Shah, Maully; Glatz, Andrew C

2014-10-01

Radiation exposure during pediatric catheterization is significant. We sought to describe radiation exposure and the effectiveness of radiation safety protocols in reducing exposure during catheter ablations with electrophysiology studies in children and patients with congenital heart disease. We additionally sought to identify at-risk patients. We retrospectively reviewed all interventional electrophysiology procedures performed from April 2009 to September 2011 (6 months preceding intervention, 12 months following implementation of initial radiation safety protocol, and 8 months following implementation of modified protocol). The protocols consisted of low pulse rate fluoroscopy settings, operator notification of skin entrance dose every 1,000 mGy, adjusting cameras by >5 at every 1,000 mGy, and appropriate collimation. The cohort consisted of 291 patients (70 pre-intervention, 137 after initial protocol implementation, 84 after modified protocol implementation) at a median age of 14.9 years with congenital heart disease present in 11 %. Diagnoses included atrioventricular nodal reentrant tachycardia (25 %), atrioventricular reentrant tachycardia (61 %), atrial tachycardias (12 %), and ventricular tachycardia (2 %). There were no differences between groups based on patient, arrhythmia, and procedural characteristics. Following implementation of the protocols, there were significant reductions in all measures of radiation exposure: fluoroscopy time (17.8 %), dose area product (80.2 %), skin entry dose (81.0 %), and effective dose (76.9 %), p = 0.0001. Independent predictors of increased radiation exposure included larger patient weight, longer fluoroscopy time, and lack of radiation safety protocol. Implementation of a radiation safety protocol for pediatric and congenital catheter ablations can drastically reduce radiation exposure to patients without affecting procedural success.

The reliable multicast protocol application programming interface

NASA Technical Reports Server (NTRS)

Montgomery , Todd; Whetten, Brian

1995-01-01

The Application Programming Interface for the Berkeley/WVU implementation of the Reliable Multicast Protocol is described. This transport layer protocol is implemented as a user library that applications and software buses link against.

Evaluation of the Telecommunications Protocol Processing Subsystem Using Reconfigurable Interoperable Gate Array

NASA Technical Reports Server (NTRS)

Pang, Jackson; Liddicoat, Albert; Ralston, Jesse; Pingree, Paula

2006-01-01

The current implementation of the Telecommunications Protocol Processing Subsystem Using Reconfigurable Interoperable Gate Arrays (TRIGA) is equipped with CFDP protocol and CCSDS Telemetry and Telecommand framing schemes to replace the CPU intensive software counterpart implementation for reliable deep space communication. We present the hardware/software co-design methodology used to accomplish high data rate throughput. The hardware CFDP protocol stack implementation is then compared against the two recent flight implementations. The results from our experiments show that TRIGA offers more than 3 orders of magnitude throughput improvement with less than one-tenth of the power consumption.

a Radical Collaborative Approach: Developing a Model for Learning Theory, Human-Based Computation and Participant Motivation in a Rock-Art Heritage Application

NASA Astrophysics Data System (ADS)

Haubt, R.

2016-06-01

This paper explores a Radical Collaborative Approach in the global and centralized Rock-Art Database project to find new ways to look at rock-art by making information more accessible and more visible through public contributions. It looks at rock-art through the Key Performance Indicator (KPI), identified with the latest Australian State of the Environment Reports to help develop a better understanding of rock-art within a broader Cultural and Indigenous Heritage context. Using a practice-led approach the project develops a conceptual collaborative model that is deployed within the RADB Management System. Exploring learning theory, human-based computation and participant motivation the paper develops a procedure for deploying collaborative functions within the interface design of the RADB Management System. The paper presents the results of the collaborative model implementation and discusses considerations for the next iteration of the RADB Universe within an Agile Development Approach.

Key Performance Indicators in Radiology: You Can't Manage What You Can't Measure.

PubMed

Harvey, H Benjamin; Hassanzadeh, Elmira; Aran, Shima; Rosenthal, Daniel I; Thrall, James H; Abujudeh, Hani H

2016-01-01

Quality assurance (QA) is a fundamental component of every successful radiology operation. A radiology QA program must be able to efficiently and effectively monitor and respond to quality problems. However, as radiology QA has expanded into the depths of radiology operations, the task of defining and measuring quality has become more difficult. Key performance indicators (KPIs) are highly valuable data points and measurement tools that can be used to monitor and evaluate the quality of services provided by a radiology operation. As such, KPIs empower a radiology QA program to bridge normative understandings of health care quality with on-the-ground quality management. This review introduces the importance of KPIs in health care QA, a framework for structuring KPIs, a method to identify and tailor KPIs, and strategies to analyze and communicate KPI data that would drive process improvement. Adopting a KPI-driven QA program is both good for patient care and allows a radiology operation to demonstrate measurable value to other health care stakeholders. Copyright © 2015 Mosby, Inc. All rights reserved.

Xrootd in dCache - design and experiences

NASA Astrophysics Data System (ADS)

Behrmann, Gerd; Ozerov, Dmitry; Zangerl, Thomas

2011-12-01

dCache is a well established distributed storage solution used in both high energy physics computing and other disciplines. An overview of the implementation of the xrootd data access protocol within dCache is presented. The performance of various access mechanisms is studied and compared and it is concluded that our implementation is as perfomant as other protocols. This makes dCache a compelling alternative to the Scalla software suite implementation of xrootd, with added value from broad protocol support, including the IETF approved NFS 4.1 protocol.

An implementation of the SNR high speed network communication protocol (Receiver part)

NASA Astrophysics Data System (ADS)

Wan, Wen-Jyh

1995-03-01

This thesis work is to implement the receiver pan of the SNR high speed network transport protocol. The approach was to use the Systems of Communicating Machines (SCM) as the formal definition of the protocol. Programs were developed on top of the Unix system using C programming language. The Unix system features that were adopted for this implementation were multitasking, signals, shared memory, semaphores, sockets, timers and process control. The problems encountered, and solved, were signal loss, shared memory conflicts, process synchronization, scheduling, data alignment and errors in the SCM specification itself. The result was a correctly functioning program which implemented the SNR protocol. The system was tested using different connection modes, lost packets, duplicate packets and large data transfers. The contributions of this thesis are: (1) implementation of the receiver part of the SNR high speed transport protocol; (2) testing and integration with the transmitter part of the SNR transport protocol on an FDDI data link layered network; (3) demonstration of the functions of the SNR transport protocol such as connection management, sequenced delivery, flow control and error recovery using selective repeat methods of retransmission; and (4) modifications to the SNR transport protocol specification such as corrections for incorrect predicate conditions, defining of additional packet types formats, solutions for signal lost and processes contention problems etc.

D meson hadronic decays at CLEO-c

NASA Astrophysics Data System (ADS)

Yang, Fan

The CLEO-c experiment is the best arena in which to study most D meson decay phenomena. Precise measurements of hadronic deecays of D mesons allow us to better constrain parameters of the Standard Model. We study the inclusive decays of D+s mesons, using data collected near the D*+sD-s peak production energy Ecm = 4170 MeV by the CLEO-c detector. We report the inclusive yields of D+s decays to K+X, K-X, K0SX , pi+X, pi-X, pi 0X, etaX, eta'X , φX, oX and f0(980)X, and also decays into pairs of kaons, D+s → KK¯X. Using these measurements, we obtain an overview of D+s decays. The measurements of inclusive decays of D+s mesons indicate that the inclusive o yield, Ds → oX, is substantial. Using the same D*+sD-s data sample, we search for D+s exclusive hadronic decays involving o. We report the first observation of D+s → pi+pi0o decay and first upper limits on D+s → pi+etao, D+s → K+pi0o, D+s → K+o, and D+s → K+etao decays. Our measurement of D+s → pi+o decay is consistent with other experiments. Using the data collected on psi(3770) resonance and near the D*+sD-s peak production energy by the CLEO-c detector, we study the decays of charmed mesons D0, D +, and Ds to pairs of light pseudoscalar mesons P. We report branching fractions of Cabibbo-favored, singly-Cabibbo-suppressed, and doubly-Cabibbo-suppressed decays. We normalize against the Cabibbo-favored D modes, D 0 → K-pi+, D+ → K-pi +pi+, and D+s → K+ K0S. These measurements of D → PP decays allow the testing of flavor symmetry and the extraction of key amplitudes.

The effects of different pre-game motivational interventions on athlete free hormonal state and subsequent performance in professional rugby union matches.

PubMed

Cook, Christian J; Crewther, Blair T

2012-07-16

We examined the effect of different pre-match motivational interventions on athlete free testosterone (T) and cortisol (C) concentrations and subsequent match performance in professional rugby union. Male participants (n=12) playing at a senior or academy level in rugby union were recruited and each completed three interventions (15 min each) before a competitive game; 1) watching a video clip of successful skill execution by the player with positive coach feedback [VPCF1]; 2) watching a video clip of successful skill execution by an opposing player with cautionary coach feedback [VCCF], 3) the player left alone to self-motivate [SM1]. The first and last interventions were retested [VPCF2 and SM2]. Salivary free T and C measures were taken pre-intervention and pre-game. Within each game, players were rated by coaching staff on a key performance indicator (KPI) from identified skills and an overall performance indicator (OPI), where 1 = best performance to 5 = worst performance. The VPCF1 and VPCF2 interventions both promoted significant T responses (11.8% to 12.5%) before each game and more so than SM1, SM2 and VCCF. The VCCF approach produced the largest C response (17.6%) and this differed from all other treatments. The VPCF interventions were also associated with better game KPI (1.5 to 1.8) and OPI ratings (1.7 to 1.8) than SM1, SM2 and/or VCCF. Across all treatments, greater individual T responses and lower C responses were associated with better KPI and OPI outcomes. In conclusion, the pre-game presentation of motivational strategies to athletes involving specific video footage and coach feedback produced different outcomes on two indicators of match performance, which were also associated with changes in free hormonal state. Copyright © 2012 Elsevier Inc. All rights reserved.

Serum C-reactive protein (CRP) as a simple and independent prognostic factor in extranodal natural killer/T-cell lymphoma, nasal type.

PubMed

Li, Ya-Jun; Li, Zhi-Ming; Xia, Yi; Huang, Jia-Jia; Huang, Hui-Qiang; Xia, Zhong-Jun; Lin, Tong-Yu; Li, Su; Cai, Xiu-Yu; Wu-Xiao, Zhi-Jun; Jiang, Wen-Qi

2013-01-01

C-reactive protein (CRP) is a biomarker of the inflammatory response, and it shows significant prognostic value for several types of solid tumors. The prognostic significance of CRP for lymphoma has not been fully examined. We evaluated the prognostic role of baseline serum CRP levels in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL). We retrospectively analyzed 185 patients with newly diagnosed ENKTL. The prognostic value of the serum CRP level was evaluated for the low-CRP group (CRP≤10 mg/L) versus the high-CRP group (CRP>10 mg/L). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were evaluated and compared with the newly developed prognostic model. Patients in the high-CRP group tended to display increased adverse clinical characteristics, lower rates of complete remission (P<0.001), inferior progression-free survival (PFS, P = 0.001), and inferior overall survival (OS, P<0.001). Multivariate analysis demonstrated that elevated serum CRP levels, age >60 years, hypoalbuminemia, and elevated lactate dehydrogenase levels were independent adverse predictors of OS. Based on these four independent predictors, we constructed a new prognostic model that identified 4 groups with varying OS: group 1, no adverse factors; group 2, 1 factor; group 3, 2 factors; and group 4, 3 or 4 factors (P<0.001). The novel prognostic model was found to be superior to both the IPI in discriminating patients with different outcomes in the IPI low-risk group and the KPI in distinguishing between the low- and intermediate-low-risk groups, the intermediate-low- and high-intermediate-risk groups, and the high-intermediate- and high-risk groups. Our results suggest that pretreatment serum CRP levels represent an independent predictor of clinical outcome for patients with ENKTL. The prognostic value of the new prognostic model is superior to both IPI and KPI.

Serum C-Reactive Protein (CRP) as a Simple and Independent Prognostic Factor in Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type

PubMed Central

Xia, Yi; Huang, Jia-Jia; Huang, Hui-Qiang; Xia, Zhong-Jun; Lin, Tong-Yu; Li, Su; Cai, Xiu-Yu; Wu-Xiao, Zhi-Jun; Jiang, Wen-Qi

2013-01-01

Background C-reactive protein (CRP) is a biomarker of the inflammatory response, and it shows significant prognostic value for several types of solid tumors. The prognostic significance of CRP for lymphoma has not been fully examined. We evaluated the prognostic role of baseline serum CRP levels in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL). Methods We retrospectively analyzed 185 patients with newly diagnosed ENKTL. The prognostic value of the serum CRP level was evaluated for the low-CRP group (CRP≤10 mg/L) versus the high-CRP group (CRP>10 mg/L). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were evaluated and compared with the newly developed prognostic model. Results Patients in the high-CRP group tended to display increased adverse clinical characteristics, lower rates of complete remission (P<0.001), inferior progression-free survival (PFS, P = 0.001), and inferior overall survival (OS, P<0.001). Multivariate analysis demonstrated that elevated serum CRP levels, age >60 years, hypoalbuminemia, and elevated lactate dehydrogenase levels were independent adverse predictors of OS. Based on these four independent predictors, we constructed a new prognostic model that identified 4 groups with varying OS: group 1, no adverse factors; group 2, 1 factor; group 3, 2 factors; and group 4, 3 or 4 factors (P<0.001). The novel prognostic model was found to be superior to both the IPI in discriminating patients with different outcomes in the IPI low-risk group and the KPI in distinguishing between the low- and intermediate-low-risk groups, the intermediate-low- and high-intermediate-risk groups, and the high-intermediate- and high-risk groups. Conclusions Our results suggest that pretreatment serum CRP levels represent an independent predictor of clinical outcome for patients with ENKTL. The prognostic value of the new prognostic model is superior to both IPI and KPI. PMID:23724031

Toward fidelity between specification and implementation

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.; Morrison, Jeff; Wu, Yunqing

1994-01-01

This paper describes the methods used to specify and implement a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally by two complementary teams using a combination of formal and informal techniques in an attempt to ensure the correctness of the protocol implementation. The first team, called the Design team, initially specified protocol requirements using a variant of SCR requirements tables and implemented a prototype solution. The second team, called the V&V team, developed a state model based on the requirements tables and derived test cases from these tables to exercise the implementation. In a series of iterative steps, the Design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation through testing. Test cases derived from state transition paths in the formal model formed the dialogue between teams during development and served as the vehicles for keeping the model and implementation in fidelity with each other. This paper describes our experiences in developing our process model, details of our approach, and some example problems found during the development of RMP.

Tiered protocol implementation improves treatment of hypoglycaemia in a neurosciences critical care and surgical intensive care unit.

PubMed

Van Berkel, Megan A; MacDermott, Jennifer; Dungan, Kathleen M; Cook, Charles H; Murphy, Claire V

2017-12-01

Although studies demonstrate techniques to limit hypoglycaemia in critically ill patients, there are limited data supporting methods to improve management of existing hypoglycaemia. Assess the impact and sustainability of a computerised, three tiered, nurse driven protocol for hypoglycaemia treatment. Retrospective pre and post protocol study. Neurosciences and surgical intensive care units at a tertiary academic medical centre. Patients with a hypoglycaemic episode were included during a pre-protocol or post-protocol implementation period. An additional six-month cohort was evaluated to assess sustainability. Fifty-four patients were included for evaluation (35 pre- and 19 post-protocol); 122 patients were included in the sustainability cohort. Hypoglycaemia treatment significantly improved in the post-protocol cohort (20% vs. 52.6%, p=0.014); with additional improvement to 79.5% in the sustainability cohort. Time to follow-up blood glucose was decreased after treatment from 122 [Q1-Q3: 46-242] minutes pre-protocol to 25 [Q1-Q3: 9-48] minutes post protocol (p<0.0001). This reduction was maintained in the sustainability cohort [median of 29min (Q1-Q3: 20-51)]. Implementation of a nurse-driven, three-tiered protocol for treatment of hypoglyacemia significantly improved treatment rates, as well as reduced time to recheck blood glucose measurement. These benefits were sustained during a six-month period after protocol implementation. Copyright © 2017 Elsevier Ltd. All rights reserved.

An Approach to Verification and Validation of a Reliable Multicasting Protocol

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1994-01-01

This paper describes the process of implementing a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally using a combination of formal and informal techniques in an attempt to ensure the correctness of its implementation. Our development process involved three concurrent activities: (1) the initial construction and incremental enhancement of a formal state model of the protocol machine; (2) the initial coding and incremental enhancement of the implementation; and (3) model-based testing of iterative implementations of the protocol. These activities were carried out by two separate teams: a design team and a V&V team. The design team built the first version of RMP with limited functionality to handle only nominal requirements of data delivery. In a series of iterative steps, the design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation. This was done by generating test cases based on suspected errant or offnominal behaviors predicted by the current model. If the execution of a test was different between the model and implementation, then the differences helped identify inconsistencies between the model and implementation. The dialogue between both teams drove the co-evolution of the model and implementation. Testing served as the vehicle for keeping the model and implementation in fidelity with each other. This paper describes (1) our experiences in developing our process model; and (2) three example problems found during the development of RMP.

An approach to verification and validation of a reliable multicasting protocol

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1995-01-01

This paper describes the process of implementing a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally using a combination of formal and informal techniques in an attempt to ensure the correctness of its implementation. Our development process involved three concurrent activities: (1) the initial construction and incremental enhancement of a formal state model of the protocol machine; (2) the initial coding and incremental enhancement of the implementation; and (3) model-based testing of iterative implementations of the protocol. These activities were carried out by two separate teams: a design team and a V&V team. The design team built the first version of RMP with limited functionality to handle only nominal requirements of data delivery. In a series of iterative steps, the design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation. This was done by generating test cases based on suspected errant or off-nominal behaviors predicted by the current model. If the execution of a test was different between the model and implementation, then the differences helped identify inconsistencies between the model and implementation. The dialogue between both teams drove the co-evolution of the model and implementation. Testing served as the vehicle for keeping the model and implementation in fidelity with each other. This paper describes (1) our experiences in developing our process model; and (2) three example problems found during the development of RMP.

System for Configuring Modular Telemetry Transponders

NASA Technical Reports Server (NTRS)

Varnavas, Kosta A. (Inventor); Sims, William Herbert, III (Inventor)

2014-01-01

A system for configuring telemetry transponder cards uses a database of error checking protocol data structures, each containing data to implement at least one CCSDS protocol algorithm. Using a user interface, a user selects at least one telemetry specific error checking protocol from the database. A compiler configures an FPGA with the data from the data structures to implement the error checking protocol.

Prosthesis Prescription Protocol of the Arm (PPP-Arm): The implementation of a national prosthesis prescription protocol.

PubMed

Wijdenes, Paula; Brouwers, Michael; van der Sluis, Corry K

2018-02-01

In order to create more uniformity in the prescription of upper limb prostheses by Dutch rehabilitation teams, the development and implementation of a Prosthesis Prescription Protocol of the upper limb (PPP-Arm) was initiated. The aim was to create a national digital protocol to structure, underpin, and evaluate the prescription of upper limb prostheses for clients with acquired or congenital arm defects. Prosthesis Prescription Protocol of the Arm (PPP-Arm) was developed on the basis of the International Classification of Functioning and consisted of several layers. All stakeholders (rehabilitation teams, orthopedic workshops, patients, and insurance companies) were involved in development and implementation. A national project coordinator and knowledge brokers in each team were essential for the project. PPP-Arm was successfully developed and implemented in nine Dutch rehabilitation teams. The protocol improved team collaboration, structure, and completeness of prosthesis prescriptions and treatment uniformity and might be interesting for other countries as well. Clinical relevance A national protocol to prescribe upper limb prostheses can be helpful to create uniformity in treatment of patients with upper limb defects. Such a protocol improves quality of care for all patients in the country.

A new multi-symplectic scheme for the generalized Kadomtsev-Petviashvili equation

NASA Astrophysics Data System (ADS)

Li, Haochen; Sun, Jianqiang

2012-09-01

We propose a new scheme for the generalized Kadomtsev-Petviashvili (KP) equation. The multi-symplectic conservation property of the new scheme is proved. Back error analysis shows that the new multi-symplectic scheme has second order accuracy in space and time. Numerical application on studying the KPI equation and the KPII equation are presented in detail.

Quantifying Faculty Productivity in Japan: Development and Application of the Achievement-Motivated Key Performance Indicator. Research & Occasional Paper Series: CSHE.8.16

ERIC Educational Resources Information Center

Aida, Misako; Watanabe, Satoshi P.

2016-01-01

Universities throughout the world are trending toward more performance based methods to capture their strengths, weaknesses and productivity. Hiroshima University has developed an integrated objective measure for quantifying multifaceted faculty activities, namely the "Achievement-Motivated Key Performance Indicator" (A-KPI), in order to…

An electronic specimen collection protocol schema (eSCPS). Document architecture for specimen management and the exchange of specimen collection protocols between biobanking information systems.

PubMed

Eminaga, O; Semjonow, A; Oezguer, E; Herden, J; Akbarov, I; Tok, A; Engelmann, U; Wille, S

2014-01-01

The integrity of collection protocols in biobanking is essential for a high-quality sample preparation process. However, there is not currently a well-defined universal method for integrating collection protocols in the biobanking information system (BIMS). Therefore, an electronic schema of the collection protocol that is based on Extensible Markup Language (XML) is required to maintain the integrity and enable the exchange of collection protocols. The development and implementation of an electronic specimen collection protocol schema (eSCPS) was performed at two institutions (Muenster and Cologne) in three stages. First, we analyzed the infrastructure that was already established at both the biorepository and the hospital information systems of these institutions and determined the requirements for the sufficient preparation of specimens and documentation. Second, we designed an eSCPS according to these requirements. Finally, a prospective study was conducted to implement and evaluate the novel schema in the current BIMS. We designed an eSCPS that provides all of the relevant information about collection protocols. Ten electronic collection protocols were generated using the supplementary Protocol Editor tool, and these protocols were successfully implemented in the existing BIMS. Moreover, an electronic list of collection protocols for the current studies being performed at each institution was included, new collection protocols were added, and the existing protocols were redesigned to be modifiable. The documentation time was significantly reduced after implementing the eSCPS (5 ± 2 min vs. 7 ± 3 min; p = 0.0002). The eSCPS improves the integrity and facilitates the exchange of specimen collection protocols in the existing open-source BIMS.

Bundle Security Protocol for ION

NASA Technical Reports Server (NTRS)

Burleigh, Scott C.; Birrane, Edward J.; Krupiarz, Christopher

2011-01-01

This software implements bundle authentication, conforming to the Delay-Tolerant Networking (DTN) Internet Draft on Bundle Security Protocol (BSP), for the Interplanetary Overlay Network (ION) implementation of DTN. This is the only implementation of BSP that is integrated with ION.

Fast, efficient error reconciliation for quantum cryptography

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

Buttler, W.T.; Lamoreaux, S.K.; Torgerson, J.R.

2003-05-01

We describe an error-reconciliation protocol, which we call Winnow, based on the exchange of parity and Hamming's 'syndrome' for N-bit subunits of a large dataset. The Winnow protocol was developed in the context of quantum-key distribution and offers significant advantages and net higher efficiency compared to other widely used protocols within the quantum cryptography community. A detailed mathematical analysis of the Winnow protocol is presented in the context of practical implementations of quantum-key distribution; in particular, the information overhead required for secure implementation is one of the most important criteria in the evaluation of a particular error-reconciliation protocol. The increasemore » in efficiency for the Winnow protocol is largely due to the reduction in authenticated public communication required for its implementation.« less

Evaluating Protocol Lifecycle Time Intervals in HIV/AIDS Clinical Trials

PubMed Central

Schouten, Jeffrey T.; Dixon, Dennis; Varghese, Suresh; Cope, Marie T.; Marci, Joe; Kagan, Jonathan M.

2014-01-01

Background Identifying efficacious interventions for the prevention and treatment of human diseases depends on the efficient development and implementation of controlled clinical trials. Essential to reducing the time and burden of completing the clinical trial lifecycle is determining which aspects take the longest, delay other stages, and may lead to better resource utilization without diminishing scientific quality, safety, or the protection of human subjects. Purpose In this study we modeled time-to-event data to explore relationships between clinical trial protocol development and implementation times, as well as identify potential correlates of prolonged development and implementation. Methods We obtained time interval and participant accrual data from 111 interventional clinical trials initiated between 2006 and 2011 by NIH’s HIV/AIDS Clinical Trials Networks. We determined the time (in days) required to complete defined phases of clinical trial protocol development and implementation. Kaplan-Meier estimates were used to assess the rates at which protocols reached specified terminal events, stratified by study purpose (therapeutic, prevention) and phase group (pilot/phase I, phase II, and phase III/ IV). We also examined several potential correlates to prolonged development and implementation intervals. Results Even though phase grouping did not determine development or implementation times of either therapeutic or prevention studies, overall we observed wide variation in protocol development times. Moreover, we detected a trend toward phase III/IV therapeutic protocols exhibiting longer developmental (median 2 ½ years) and implementation times (>3years). We also found that protocols exceeding the median number of days for completing the development interval had significantly longer implementation. Limitations The use of a relatively small set of protocols may have limited our ability to detect differences across phase groupings. Some timing effects present for a specific study phase may have been masked by combining protocols into phase groupings. Presence of informative censoring, such as withdrawal of some protocols from development if they began showing signs of lost interest among investigators, complicates interpretation of Kaplan-Meier estimates. Because this study constitutes a retrospective examination over an extended period of time, it does not allow for the precise identification of relative factors impacting timing. Conclusions Delays not only increase the time and cost to complete clinical trials, but they also diminish their usefulness by failing to answer research questions in time. We believe that research analyzing the time spent traversing defined intervals across the clinical trial protocol development and implementation continuum can stimulate business process analyses and reengineering efforts that could lead to reductions in the time from clinical trial concept to results, thereby accelerating progress in clinical research. PMID:24980279

Performance management of Clostridium difficile infection in hospitals - The carrot or stick approach?

PubMed

Fitzpatrick, Fidelma; Riordan, Mary O

2016-02-01

Public and political pressure for healthcare quality indicator monitoring, specifically healthcare-associated infection (HAI) has intensified the debate regarding the merits of public reporting and target setting as policy approaches. This paper reviews the evidence for these approaches with a focus on HAI, including Clostridium difficile infection (CDI). Healthcare key performance indicators (KPIs) and associated targets have been used widely with little evaluation. While targets are associated with some HAI reductions including CDI, as their control is multi-factorial, it is likely that reductions are due to numerous, concurrent control measures. Targets may help tackle organizational-wide issues that require high level management engagement and have contributed to the increased access and influence of infection control teams. HAI public reporting has also gained traction and is mandatory in many countries despite little scientific evaluation. CDI is one of the KPIs used but there is little consensus as to the best KPI for public reporting. Countries without public reporting have also seen improvements. Using indicator-based strategies rather than evidence-based ones risk improving the KPI but not necessarily quality of care. 'Bottom-up' approaches focussing on quality improvement and innovation generated by front line staff are seen as a lever for sustainable change. Positive deviance, where the resourcefulness and problem solving abilities of staff is harnessed, enables 'bottom-up' changes with process and outcome improvements. As implementation of best practice in healthcare is dependent on behavioural and cultural change, it is most likely that a combination of 'top-down' and 'bottom-up' approaches are required for sustainable improvement. This combined approach was used to improve staff influenza vaccination rates. Regulation may initially direct the spot-light onto infection control needs but true sustainable HAI reduction will only be fostered with concurrent cultural and behavioural shifts in practice and ownership of the HAI burden across clinical, policy and management domains. It will be interesting if this approach will be increasingly used by policy makers, however, irrespective it is clear that there is a need for rigorous evaluation of our HAI policy approaches from this point forward. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prototype development and implementation of picture archiving and communications systems based on ISO-OSI standard

NASA Astrophysics Data System (ADS)

Martinez, Ralph; Nam, Jiseung

1992-07-01

Picture Archiving and Communication Systems (PACS) is an integration of digital image formation in a hospital, which encompasses various imaging equipment, image viewing workstations, image databases, and a high speed network. The integration requires a standardization of communication protocols to connect devices from different vendors. The American College of Radiology and the National Electrical Manufacturers Association (ACR- NEMA) standard Version 2.0 provides a point-to-point hardware interface, a set of software commands, and a consistent set of data formats for PACS. But, it is inadequate for PACS networking environments, because of its point-to-point nature and its inflexibility to allow other services and protocols in the future. Based on previous experience of PACS developments in The University of Arizona, a new communication protocol for PACS networks and an approach were proposed to ACR-NEMA Working Group VI. The defined PACS protocol is intended to facilitate the development of PACS''s capable of interfacing with other hospital information systems. Also, it is intended to allow the creation of diagnostic information data bases which can be interrogated by a variety of distributed devices. A particularly important goal is to support communications in a multivendor environment. The new protocol specifications are defined primarily as a combination of the International Organization for Standardization/Open Systems Interconnection (ISO/OSI), TCP/IP protocols, and the data format portion of ACR-NEMA standard. This paper addresses the specification and implementation of the ISO-based protocol into a PACS prototype. The protocol specification, which covers Presentation, Session, Transport, and Network layers, is summarized briefly. The protocol implementation is discussed based on our implementation efforts in the UNIX Operating System Environment. At the same time, results of performance comparison between the ISO and TCP/IP implementations are presented to demonstrate the implementation of defined protocol. The testing of performance analysis is done by prototyping PACS on available platforms, which are Micro VAX II, DECstation and SUN Workstation.

Internet Protocol Implementation Guide.

DTIC Science & Technology

1982-08-01

RD-R153 624 INTERNET PROTOCOL IMPLEMENTATION GIDE(U) SRI 1/2 INTERNATIONAL MENLO PARK CA NETWORK INFORMATION CENTER AUG 82 DCA2e-83-C-8e25 N... INTERNET PROTOCOL S IMPLEMENTATION GUIDE August 1982 DTICFL. !.ECTE .-" MAY 1 31985 ;z B Q.. Network Information Center SRI International Menlo Park...this is more information than the receiving Internet * module needs. The specified procedure is to take the return route recorded in the first

Adherence to, and outcomes of, a galactomannan screening protocol in high-risk hematology patients.

PubMed

Harricharan, S; Biederman, K; Bombassaro, A M; Lazo-Langner, A; Elsayed, S; Fulford, A; Delport, J A; Xenocostas, A

2018-04-01

A twice-weekly galactomannan (gm) screening protocol was implemented in high-risk hematology inpatients. Study objectives were to determine adherence to the protocol, use of selected resources, and patient outcomes. This retrospective cohort study compared outcomes of interest before and after implementation of gm screening. Adults undergoing matched related allogeneic hematopoietic stem-cell transplantation or induction chemotherapy for acute leukemia were eligible. Patients could be enrolled more than once and were evaluated as episodes. Adherence to the gm protocol was assessed in post-implementation episodes. Use of broad-spectrum antifungals (bsafs), consultations (infectious diseases, respirology), and diagnostic procedures (computed tomography imaging, bronchoalveolar lavage) were compared between phases, as were the patient outcomes of all-cause mortality and clinical success (alive and not taking a bsaf). Of 182 episodes consecutively screened, 70 per phase were enrolled. Clinical characteristics and duration of assessment were similar for the phases. Full or partial adherence to the protocol was observed in 61 post-implementation episodes (87%), with full adherence in 40 episodes (57%). More episodes in the pre-implementation phase than in the post-implementation phase involved receipt of bsafs, consultations, and diagnostics (27% vs. 7%, p = 0.02; 46% vs. 26%, p = 0.014; and 46% vs. 31%, p = 0.083 respectively). Although mortality was similar in the two phases, clinical success at the final assessment was observed in fewer pre-implementation than post-implementation episodes (79% vs. 98%, p < 0.001). Implementation of a gm screening protocol was feasible and associated with significantly fewer episodes involving receipt of bsafs and consultations, and with significantly more episodes showing clinical success.

Implementation of Symptom Protocols for Nurses Providing Telephone‐Based Cancer Symptom Management: A Comparative Case Study

PubMed Central

Green, Esther; Ballantyne, Barbara; Tarasuk, Joy; Skrutkowski, Myriam; Carley, Meg; Chapman, Kim; Kuziemsky, Craig; Kolari, Erin; Sabo, Brenda; Saucier, Andréanne; Shaw, Tara; Tardif, Lucie; Truant, Tracy; Cummings, Greta G.; Howell, Doris

2016-01-01

ABSTRACT Background The pan‐Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence‐informed protocols for symptom management. Aim To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone‐based symptom support to cancer patients. Methods A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases. Results At baseline, >85% nurses rated protocols positively but barriers were identified (64‐80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self‐management. Twenty‐two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p < .01). Protocol adaptations addressed barriers (e.g., health records approval, creating pocket versions, distributing with telephone messages). Chart audits revealed that protocols used were documented for 11% to 47% of patient calls. Sustained use requires organizational alignment and ongoing leadership support. Linking Evidence to Action Protocol uptake was similar to trials that have evaluated tailored interventions to improve professional practice by overcoming identified barriers. Collaborating with knowledge users facilitated interpretation of findings, aided protocol adaptation, and supported implementation. Protocol implementation in nursing requires a tailored approach. A multifaceted intervention approach increased nurses’ use of evidence‐informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses’ confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally. PMID:27243574

Effective School-Community Relations as a Key Performance Indicator for the Secondary School Administrator in Aba South District, Nigeria

ERIC Educational Resources Information Center

Abraham, Nath. M.; Ememe, Ogbonna N.

2012-01-01

This study investigates Effective School-Community Relations as a key Performance Indicator (KPI) of Secondary Schools Administrator in Aba South District, Nigeria. Descriptive survey method was adopted. All the 248 teachers made up the population and sample in a purposive sampling technique representing 100% of the entire population as sample. A…

The Effect of the Dynamic Skills Protocol RTI Model on Reading Achievement in an Elementary School and the Predictive Validity of Phonics Screening Measures Implemented in the Model

ERIC Educational Resources Information Center

Laben, Joyce

2012-01-01

With the implementation of RTI, educators are attempting to find models that are the best fit for their schools. The problem solving and standard protocol models are the two most common. This study of 65 students examines a new model, the dynamic skills protocol implemented in an elementary school starting in their fourth quarter of kindergarten…

Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh.

PubMed

Kortz, Teresa Bleakly; Axelrod, David M; Chisti, Mohammod J; Kache, Saraswati

2017-01-01

Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay. This was a retrospective cohort study of children 1-59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation. 404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol) in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72). The adjusted odds ratio (AOR) for post-protocol mortality was 1.55 (95% CI, 0.88-2.71). The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04-5.85), as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43-14.29) and having a longer median length of stay (AOR 1.81, 95% CI 1.10-2.96). There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4) or antibiotic administration between the cohorts (pre- 16.08% vs. post- 12.43%, p = 0.42). Implementation of a pediatric sepsis protocol did not improve all-cause mortality or length of stay and may have been associated with increased fluid overload and heart failure during the study period in a large, non-governmental hospital in Bangladesh. Similar rates of early antibiotic administration may indicate poor protocol compliance. Though evidenced-based protocols are a potential cost-effective strategy to improve outcomes, future studies should focus on optimal implementation of context-relevant sepsis protocols in limited resource settings.

Student Non-Suicidal Self-Injury: A Protocol for School Counselors

ERIC Educational Resources Information Center

Stargell, Nicole A.; Zoldan, Chelsey A.; Kress, Victoria E.; Walker-Andrews, Laura M.; Whisenhunt, Julia L.

2018-01-01

Schools have a demonstrated need for student non-suicidal self-injury protocols and school counselors play an important role in the development and implementation of such procedures. This article presents an overview of school counselor considerations related to developing and implementing a self-injury protocol. It provides an example of a…

Implementation of a protocol to reduce occurrence of retained sponges after vaginal delivery.

PubMed

Lutgendorf, Monica A; Schindler, Lynnett L; Hill, James B; Magann, Everett F; O'Boyle, John D

2011-06-01

Retained sponges (gossypiboma) following vaginal delivery are an uncommon occurrence. Although significant morbidity from such an event is unlikely, there are many reported adverse effects, including symptoms of malodorous discharge, loss of confidence in providers and the medical system, and legal claims. To report a protocol intended to reduce the occurrence of retained sponges following vaginal delivery. After identification of limitations with existing delivery room protocols, we developed a sponge count protocol to reduce occurrence of retained vaginal sponges. We report our experience at Naval Medical Center Portsmouth, a large tertiary care military treatment facility with our efforts to implement a sponge count protocol to reduce retained sponges following vaginal delivery. With appropriate pre-implementation training, protocols which incorporate post-delivery vaginal sweep and sponge counts are well accepted by the health care team and can be incorporated into the delivery room routine.

[Effect of a multidisciplinar protocol on the clinical results obtained after bariatric surgery].

PubMed

Cánovas Gaillemin, B; Sastre Martos, J; Moreno Segura, G; Llamazares Iglesias, O; Familiar Casado, C; Abad de Castro, S; López Pardo, R; Sánchez-Cabezudo Muñoz, M A

2011-01-01

Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. Retrospective comparative study of the outcomes in patients previously operated (51 patients) and after the implementation of the protocol (66 patients). The following data were gathered: anthropometry, pre-and post-surgery comorbidities, post-surgical nutritional and surgical complications, validated Quality of Life questionnaire, and dietary habits. Withdrawals (l7.6%) and alcoholism (5.8%) were higher in patients pre- versus post-implementation of the protocol (4.5% vs. 3%, respectively), the differences being statistically significant. The mortality rate was 2% in the pre-protocol group and 0% in the postprotocol group. The dietary habits were better in the post-protocol group, the pre-protocol group presenting a higher percentage of feeding-behavior disorders (5.1%) although not reaching a statistical significance. The improvement in quality of life was higher in the post-protocol group for all items, but only reaching statistical significance in sexual activity (p = 0.004). In the pre-protocol group, 70.5% of the patients had more than one nutritional complication vs. 32.8% in the post-protocol group (p < 0.05). There were no differences regarding the percentage of weight in excess lost at two years (> 50% in 81.3% in the pre-protocol group vs. 74.8% in the pos-protocol group) or the comorbidities. Bariatric surgery achieves excellent outcomes in weight loss, comorbidities, and quality of life, but presents nutritional, surgical, and psychiatric complications that require a protocol-based and multidisciplinary approach. Our protocol improves the outcomes regarding the withdrawal rates, feeding-behavior disorders, dietary habits, nutritional complications, and quality of life.

Development, implementation, and experimentation of parametric routing protocol for sensor networks

NASA Astrophysics Data System (ADS)

Nassr, Matthew S.; Jun, Jangeun; Eidenbenz, Stephan J.; Frigo, Janette R.; Hansson, Anders A.; Mielke, Angela M.; Smith, Mark C.

2006-09-01

The development of a scalable and reliable routing protocol for sensor networks is traced from a theoretical beginning to positive simulation results to the end of verification experiments in large and heavily loaded networks. Design decisions and explanations as well as implementation hurdles are presented to give a complete picture of protocol development. Additional software and hardware is required to accurately test the performance of our protocol in field experiments. In addition, the developed protocol is tested in TinyOS on Mica2 motes against well-established routing protocols frequently used in sensor networks. Our protocol proves to outperform the standard (MINTRoute) and the trivial (Gossip) in a variety of different scenarios.

Minimizing variance in pediatric gastrostomy: does standardized perioperative feeding plan decrease cost and improve outcomes?

PubMed

Sunstrom, Rachel; Hamilton, Nicholas; Fialkowski, Elizabeth; Lofberg, Katrine; McKee, Julie; Sims, Thomas; Krishnaswami, Sanjay; Azarow, Kenneth

2016-05-01

A protocol for laparoscopic gastrostomy placement was implemented which specified perioperative antibiotics, feeding regimens, and discharge criteria. Our hypothesis was that hospital cost could be decreased, whereas at the same time improving or maintaining patient outcomes. Data were collected on consecutive patients beginning 6 months after implementation of our protocol. We recorded surgeon compliance, patient outcomes (as defined by 30-day NSQIP complication rates), and cost of initial hospitalization, which was then compare to a 6-month historical control period. Our control group n = 26 and protocol group n = 39. Length of stay was shorter in the protocol group (P ≤ .05 by nonparametric analysis). The complication rate was similar in both groups (23% control vs 15% protocol, P = .43). Initial hospital costs were not different. Surgeon compliance to protocol was 82%. A standard protocol is achievable for gastrostomy tube management. After implementation of our protocol, we were able to show a significant decrease in length of stay, whereas maintaining quality. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementation of an Intensive Care Unit-Specific Alcohol Withdrawal Syndrome Management Protocol Reduces the Need for Mechanical Ventilation.

PubMed

Heavner, Jason J; Akgün, Kathleen M; Heavner, Mojdeh S; Eng, Claire C; Drew, Matthew; Jackson, Peter; Pritchard, David; Honiden, Shyoko

2018-05-25

Alcohol use disorders are prevalent and put patients at risk for developing alcohol withdrawal syndrome (AWS). Treatment of AWS with a symptom-triggered protocol standardizes management and may avoid AWS-related complications. The objective of this study was to evaluate whether implementation of an intensive care unit (ICU)-specific, symptom-triggered protocol for management of AWS was associated with improved clinical outcomes and, in particular, would reduce the risk of patients with AWS requiring mechanical ventilation. Retrospective pre-post-protocol implementation study. Thirty-six-bed, closed medical ICU (MICU) at a large, tertiary care, teaching hospital in an urban setting. A total of 233 adults admitted to the MICU with any diagnosis of alcohol use disorders based on International Classification of Diseases, Ninth Revision codes and who received at least one dose of any benzodiazepine; of these patients, 139 were in the pre-protocol era (August 2009-January 2010 and August 2010-January 2011), and 94 were in the post-protocol era (August 2012-January 2013), after implementation of the Yale Alcohol Withdrawal Protocol (YAWP) in April 2012. The YAWP pairs a modified Minnesota Detoxification Scale with an order set that includes benzodiazepine dosing regimens and suggests adjuvant therapies. AWS was the primary reason for ICU admission (107/233 patients [45.9%]) and did not significantly vary between eras (P=0.2). Of the 233 patients included, 81.1% were male and 67.0% were white, which did not significantly differ by study era. Severity of illness at MICU admission did not significantly differ between patients in the pre-protocol and post-protocol eras (median [interquartile range] Acute Physiology and Chronic Health Evaluation [APACHE] II scores of 12 [9-17] and 12.5 [7-16], respectively, p=0.4). Median lorazepam-equivalent dose per MICU day, duration of benzodiazepine infusion, and use of adjuvant therapy were not significantly different between eras. MICU intubation was less common in the post-protocol era (36/139 patients [25.9%] pre-protocol vs 8/94 patients [8.5%] post-protocol, p=0.0009). ICU-related pneumonia was also decreased in the post-protocol era (30/139 patients [21.6%] pre-protocol vs 10/94 patients [10.6%] post-protocol, p=0.03). After adjusting for demographics, adjuvant therapies, and Acute Physiology and Chronic Health Evaluation II scores, protocol implementation was associated with a decreased odds of MICU intubation (odds ratio 0.13; 95% confidence interval 0.04-0.39). Implementation of YAWP was associated with a decreased risk of MICU intubation in patients at risk for AWS. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Cost savings using a protocol approach to manage anemia in a hemodialysis unit.

PubMed

Charlesworth, Emily C; Richardson, Robert M; Battistella, Marisa

2014-01-01

National guidelines recommend using anemia management protocols to guide treatment. The objective of this study was to determine if an anemia management protocol would improve hemoglobin (Hgb) indices in hemodialysis patients and to measure whether the protocol would reduce the use and cost of darbepoetin alfa (DBO) and intravenous (IV) iron in hemodialysis patients. An anemia management protocol was created and implemented for hemodialysis patients at our institution. A retrospective observational review of the use of DBO and IV iron as well as changes in Hgb, transferrin saturation and ferritin in 174 patients was conducted 6 months before and after implementation of the anemia protocol. The number of Hgb measurements in the target range increased from 44.3 to 46.0% (p = 0.48) after protocol implementation. The mean weekly dose of DBO was reduced from 34.56 ± 31.12 to 31.11 ± 28.64 μg post-protocol implementation (p = 0.011), which translated to a cost savings of USD 41,649 over 6 months. The mean monthly IV iron dose also decreased from 139.56 ± 98.83 to 97.65 ± 79.05 mg (p < 0.005), a cost savings of USD 18,594 over the same time period. The use of an anemia management protocol resulted in the deprescribing of DBO and iron agents while increasing the number of patients in the target Hgb range, which led to significant cost savings in the treatment of anemia.

Maximizing Interhospital Transfer Resources for Neurosurgical Patients.

PubMed

Schnurman, Zane; Chin, Robert; Fishkin, Edward R; Huang, Paul P

2017-08-01

Delays in patient transfers are associated with worse outcomes for some neurosurgical conditions. One of the primary causes of transfer delay is lack of neurosurgery intensive care unit bed availability. In the present study, we characterize the results of implementing an interhospital transfer protocol to reduce unnecessary transfers and improve bed availability. A transfer protocol was implemented in July 2012 at the Bellevue Hospital Department of Neurosurgery that screened for and prevented transfer of low-risk patients who were unlikely to require specialized inpatient neurosurgical care. The impact of this protocol was assessed with prospectively recorded data on all potential interhospital transfers from May 2011 through June 2016. Of the 1978 calls (regarding 1886 individual patients), 402 occurred before the implementation of the transfer protocol and 1576 occurred after. Before the protocol, 84.1% of transfer requests were accepted, but 15.2% were subsequently denied for bed unavailability. After the protocol, a smaller share of transfer requests were accepted after protocol screening (71.8%, P < 0.001), but only 1.9% (P < 0.001) were subsequently denied because of bed unavailability. The diagnosis demographics changed significantly (P < 0.001), with a larger share of arriving transfers suffering from aneurysms or tumors after the protocol and a smaller share suffering from stenosis/disc disease without neurological symptoms. The transfer protocol implemented in the present study allowed transfer determination based on the need for specialized neurosurgical care rather than chance unavailability of beds. Developing interhospital transfer protocols may be an effective strategy to efficiently allocate limited hospital resources and improve transfer systems. Copyright © 2017 Elsevier Inc. All rights reserved.

Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes.

PubMed

Timpa, Joseph G; O'Meara, L Carlisle; Goldberg, Kellen G; Phillips, Jay P; Crawford, Jack H; Jackson, Kimberly W; Alten, Jeffrey A

2016-03-01

Perioperative transfusion of blood products is associated with increased morbidity and mortality after pediatric cardiac surgery. We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass (CPB) surgery. A multidisciplinary team evaluated baseline data from 99 consecutive CPB patients, focusing on the variability in transfusion management and bleeding outcomes, to create a standardized bleeding and transfusion management protocol. A total of 62 subsequent patients were evaluated after implementation of the protocol: 17 with single pass hemoconcentrated (SPHC) blood transfusion and 45 with modified ultrafiltration (MUF). Implementation of the protocol with SPHC blood led to significant decrease in transfusion of every blood product in the cardiovascular operating room and first 6 hours in cardiovascular intensive care unit ([CVICU] p < .05). Addition of MUF to the protocol led to further decrease in transfusion of all blood products compared to preprotocol. Patients <2 months old had 49% decrease in total blood product administration: 155 mL/kg preprotocol, 117 mL/kg protocol plus SPHC, and 79 mL/kg protocol plus MUF (p < .01). There were significant decreases in postoperative bleeding in the first hour after CVICU admission: 6 mL/kg preprotocol, 3.8 mL/kg protocol plus SPHC, and 2 mL/kg protocol plusMUF (p = .02). There was also significantly decreased incidence of severe postoperative bleeding (>10 mL/kg) in the first CVICU hour for protocol plus MUF patients (p < .01). Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product transfusion and improves some bleeding outcomes.

Moving Triadic Gaze Intervention Into Practice: Measuring Clinician Attitude and Implementation Fidelity

PubMed Central

Olswang, Lesley B.; Greenslade, Kathryn; Pinder, Gay Lloyd; Dowden, Patricia; Madden, Jodi

2017-01-01

Purpose This research investigated a first step in implementing the dynamic assessment (DA) component of Triadic Gaze Intervention (Olswang, Feuerstein, Pinder, & Dowden, 2013; Olswang et al., 2014), an evidence-based protocol for teaching early signals of communication to young children with physical disabilities. Clinician attitudes about adopting external evidence into practice and implementation fidelity in DA protocol delivery were examined following training. Method Seven early intervention clinicians from multiple disciplines were trained to deliver the four essential elements of the DA protocol: (a) provide communication opportunity, (b) recognize child's potentially communicative signal, (c) shape child's signal toward triadic gaze, and (d) reinforce with play. Clinician attitude regarding adopting evidence into practice was measured at baseline and follow-up, with the Evidence-Based Practice Attitude Scale (Aarons, 2004). Implementation fidelity in delivering the protocol was measured for adherence (accuracy) and competence (quality) during trial implementation. Results Clinicians' attitudes about trying new evidence that at first was perceived as incongruent with their practice improved over the course of the research. Clinicians demonstrated strong adherence to the DA protocol; however, competence varied across clinicians and appeared related to child performance. Conclusions The results provided insight into moving Triadic Gaze Intervention into practice and yielded valuable information regarding the implementation process, with implications for future research. PMID:28525577

Interdisciplinary development and implementation of communication checklist for postoperative management of pediatric airway patients.

PubMed

Kim, Sang W; Maturo, Stephen; Dwyer, Danielle; Monash, Bradley; Yager, Phoebe H; Zanger, Kerstin; Hartnick, Christopher J

2012-01-01

The authors describe their multidisciplinary experience in applying the Institute of Health Improvement methodology to develop a protocol and checklist to reduce communication error during transfer of care for postoperative pediatric surgical airway patients. Preliminary outcome data following implementation of the protocol and checklist are also presented. Prospective study from July 1, 2009, to February 1, 2011. Tertiary care center. Subjects. One hundred twenty-six pediatric airway patients who required coordinated care between Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital. Two sentinel events involving airway emergencies demonstrated a critical need for a standardized, comprehensive instrument that would ensure safe transfer of care. After development and implementation of the protocol and checklist, an initial pilot period on the first set of 9 pediatric airway patients was reassessed. Subsequent prospective 11-month follow-up data of 93 pediatric airway patients were collected and analyzed. A multidisciplinary pediatric team developed and implemented a formalized, postoperative checklist and transfer protocol. After implementation of the checklist and transfer protocol, prospective analysis showed no adverse events from miscommunication during transfer of care over the subsequent 11-month period involving 93 pediatric airway patients. There has been very little written in the quality and safety patient literature about coordinating effective transfer of care between the pediatric surgical and medical subspecialty realms. After design and implementation of a simple, electronically based transfer-of-care checklist and protocol, the number of postsurgical pediatric airway information transfer and communication errors decreased significantly.

Performance Analysis of Hospital Information System of the National Health Insurance Corporation Ilsan Hospital

PubMed Central

Han, Jung Mi; Boo, Eun Hee; Kim, Jung A; Yoon, Soo Jin; Kim, Seong Woo

2012-01-01

Objectives This study evaluated the qualitative and quantitative performances of the newly developed information system which was implemented on November 4, 2011 at the National Health Insurance Corporation Ilsan Hospital. Methods Registration waiting time and changes in the satisfaction scores for the key performance indicators (KPI) before and after the introduction of the system were compared; and the economic effects of the system were analyzed by using the information economics approach. Results After the introduction of the system, the waiting time for registration was reduced by 20%, and the waiting time at the internal medicine department was reduced by 15%. The benefit-to-cost ratio was increased to 1.34 when all intangible benefits were included in the economic analysis. Conclusions The economic impact and target satisfaction rates increased due to the introduction of the new system. The results were proven by the quantitative and qualitative analyses carried out in this study. This study was conducted only seven months after the introduction of the system. As such, a follow-up study should be carried out in the future when the system stabilizes. PMID:23115744

Factors Impacting Student Service Utilization at Ontario Colleges: Key Performance Indicators as a Measure of Success: A Niagara College View

ERIC Educational Resources Information Center

Veres, David

2015-01-01

Student success in Ontario College is significantly influenced by the utilization of student services. At Niagara College there has been a significant investment in student services as a strategy to support student success. Utilizing existing KPI data, this quantitative research project is aimed at measuring factors that influence both the use of…

Verknüpfung von DQ-Indikatoren mit KPIs und Auswirkungen auf das Return on Investment

NASA Astrophysics Data System (ADS)

Block, Frank

Häufig ist nicht klar, welche Beziehungen zwischen Datenqualitätsindikatoren (DQI, Definition folgt weiter unten) und Key Performance Indicators (KPI, s. Abschnitt 1.3 für weitere Details) eines Unternehmens oder einer Organisation bestehen. Dies ist insbesondere deshalb von Bedeutung, da die Kenntnis dieser Beziehungen maßgeblich die Ausprägung eines Datenqualitätsprojekts beeinflusst.

LETTER TO THE EDITOR: Solving the Kadomtsev - Petviashvili equation with initial data not vanishing at large distances

NASA Astrophysics Data System (ADS)

Boiti, M.; Pempinelli, F.; Pogrebkov, A.

1997-06-01

We consider, in the framework of the inverse scattering method, the solution of the Kadomtsev - Petviashvili equation in its version called KPI. The spectral theory is extended to the case in which the initial data 0266-5611/13/3/001/img1 are not vanishing along a finite number of directions at large distances on the plane.

Line Crack Subject to Shear.

DTIC Science & Technology

1977-07-01

91). f ex(ý- ,2 in ýx+x’)? dx’ = (T/)112 cp- 2 A)sinti x I~ ~ JCPIX ois r(x+x’)I (I/p Cos(- Fx (3.16) 12 = fexp(_py,2--yy, )dy’ . 1 /P1/2k~pY 24... Astro .& Engr. Sc. Providence, Rhode Island 02912 Purdue University Lafayette, Indiana 47907 Prof. R.S. Rivlin Center fe. the Application of Mathematics

Time-Frequency Variability of Kuroshio Meanders in Tokara Strait

NASA Astrophysics Data System (ADS)

Nakamura, H.; Yamashiro, T.; Nishina, A.; Ichikawa, H.

2006-12-01

The Kuroshio path in the northern Okinawa Trough, Japan, located between the continental slope and Tokara Strait, exhibits meandering motions with largest displacements in the East China Sea; these motions have dominant periods in the broad range of 30-90 days. Understanding the dynamic nature of such meanders is crucial to predicting small and large meanders of the Kuroshio path off the south coast of Japan. Previous numerical simulations suggest that the Kuroshio path meanders in the northern Okinawa Trough become nonstationary in variance because of changes in background states of the Kuroshio in the northern Okinawa Trough, but a detailed analysis based on observed data has yet to be performed. The purpose of the present study is to provide a detailed description of the time-frequency variability of Kuroshio path meanders observed in Tokara Strait. Three Kuroshio indicators were subjected to wavelet analysis for the period 1984-2004: the Kuroshio Position Index (KPI) in Tokara Strait, Kuroshio Volume Transport (KVT) in Tokara Strait, and the basal current velocity of the Kuroshio on the continental slope in the northern Okinawa Trough. The 30-90 day variance of the KPI shows a season-fixed nature, with larger amplitudes in the period December-July. The amplitude of the variance in this phenomenon is also modulated by interannual variations, with small variance recorded during 1989-1992, large variance during 1993-1998, and a return to small variance from 1999-2003. This interannual variation is positively correlated with that of the KVT. The largest variance of the KPI during February-April precedes the largest volume transport in April-May by about 1 month, suggesting that eddy vorticity flux strengthens the mean current field. Previous numerical simulations reproduce the recirculation gyre as a cyclonic eddy in the area between the continental slope and Tokara Strait; this gyre is analogous to the northern recirculation gyre associated with the eastward jet. On the basis of data from a moored current-meter situated on the continental slope, the genesis of the 30-90 day meanders within Tokara Strait is ascribed to nonlinear energy transfer from 8-25 day meanders on the continental slope.

EPICO 4.0. 'Total quality' in the management of invasive candidiasis in critically ill patients by analysing the integrated process.

PubMed

Zaragoza, Rafael; Ferrer, Ricard; Llinares, Pedro; Maseda, Emilio; Rodríguez, Alejandro; Grau, Santiago; Quindós, Guillermo

A high quality integrated process in the clinical setting of non-neutropenic critically ill patients at risk for invasive candidiasis is a necessary tool to improve the management of these patients. To identify the key points on invasive candidiasis in order to develop a set of recommendations with a high level of consensus required for the creation of a total quality integrated process for the management of non-neutropenic critically ill patients at risk of invasive candidiasis. After a thorough review of the literature of the previous five years, a Spanish prospective questionnaire, which measured consensus by the Delphi technique, was anonymously conducted by e-mail, including 31 national multidisciplinary experts with extensive experience in invasive fungal infections, from six national scientific societies. The experts included a specialist in intensive care medicine, anesthetists, microbiologists, pharmacologists, and specialists in infectious diseases that responded 27 questions prepared by the coordination group. The educational objectives considered six processes that included knowledge of the local epidemiology, the creation and development of multidisciplinary teams, the definitions of the process, protocols, and indicators (KPI), an educational phase, hospital implementation, and the measurement of outcomes. The level of agreement among experts in each category to be selected should exceed 70%. In a second phase, after drawing up the recommendations of the selected processes, a face to face meeting with more than 60 specialists was held. The specialists were asked to validate the pre-selected recommendations. Firstly, 20 recommendations from all the sections were pre-selected: Knowledge of local epidemiology (3 recommendations), creation and development of multidisciplinary teams (3), definition of the process, protocols and indicators (1), educational phase (3), hospital implementation (3), and measurement of outcomes (7). After the second phase, 18 recommendations were validated, and it was concluded that the minimum team or core necessary for the development of an efficient program in the use of antifungal drugs in non-neutropenic critically ill patients must consist of a specialist in infectious diseases, a clinical pharmacist, a microbiologist, a specialist in intensive care medicine, a specialist in anesthesia and recovery, and an administrator or member of the medical management team, and, in order to be cost-effective, it should be implemented in hospitals with over 200 beds. In addition, it is recommended to apply a consensual check list for the evaluation of the diagnostic process and treatment of invasive candidiasis in patients that have started an antifungal treatment. The management of external knowledge and individual learning stand out as active educational strategies. The main strategies for measuring patient safety outcomes are the analysis of the results achieved, and learning activities; assess, review and refine the deployment of the processes; quality control; epidemiological surveillance and applied research; benchmarking; and basic research. The results of the integrated process should be annually disseminated outside the hospital. Optimizing the management of invasive candidiasis requires the application of the knowledge and skills detailed in our recommendations. These recommendations, based on the Delphi methodology, facilitate the creation of a total quality integrated process in critically-ill patients at risk for invasive candidiasis. Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints

PubMed Central

Martins, João Soares; Zwi, Anthony B; Hobday, Karen; Bonaparte, Fernando; Kelly, Paul M

2012-01-01

Background Timor-Leste changed its malaria treatment protocol in 2007, replacing the first-line for falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. This study explored the factors affecting the implementation of the revised treatment protocol, with an emphasis on identifying key constraints. Methods A mixed method approach drew on both qualitative and quantitative data. The study included data from District Health Services in seven districts, community health centres in 14 sub-districts, four hospitals, five private clinics, one private pharmacy and the country's autonomous medical store. In-depth interviews with 36 key informants, five group interviews and 15 focus group discussions were conducted. A survey was also undertaken at community health centres and hospitals to assess the availability of a physical copy of the Malaria Treatment Protocol, as well as the availability and utilization of artemether-lumefantrine and sulphadoxine-pyrimethamine. Results Many factors impeded the implementation of the new malaria protocol. These included: inadequate introduction and training around the revised treatment protocol; unclear phasing out of sulphadoxine-pyrimethamine and phasing in of the revised treatment, artemether-lumefantrine, and the rapid diagnostic test (RDT); lack of supervision; lack of adherence to the revised guidelines by foreign health workers; lack of access to the new drug by the private sector; obstacles in the procurement process; and the use of trade names rather than generic drug description. Insufficient understanding of the rapid diagnostic test and the untimely supply of drugs further hampered implementation. Conclusion To effectively implement a revised malaria treatment protocol, barriers should be identified during the policy formulation process and those emerging during implementation should be recognized promptly and addressed. PMID:22460007

Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh

PubMed Central

Axelrod, David M.; Chisti, Mohammod J.; Kache, Saraswati

2017-01-01

Background Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay. Materials and methods This was a retrospective cohort study of children 1–59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation. Results 404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol) in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72). The adjusted odds ratio (AOR) for post-protocol mortality was 1.55 (95% CI, 0.88–2.71). The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04–5.85), as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43–14.29) and having a longer median length of stay (AOR 1.81, 95% CI 1.10–2.96). There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4) or antibiotic administration between the cohorts (pre- 16.08% vs. post- 12.43%, p = 0.42). Conclusions Implementation of a pediatric sepsis protocol did not improve all-cause mortality or length of stay and may have been associated with increased fluid overload and heart failure during the study period in a large, non-governmental hospital in Bangladesh. Similar rates of early antibiotic administration may indicate poor protocol compliance. Though evidenced-based protocols are a potential cost-effective strategy to improve outcomes, future studies should focus on optimal implementation of context-relevant sepsis protocols in limited resource settings. PMID:28753618

Standardized patient walkthroughs in the National Drug Abuse Treatment Clinical Trials Network: common challenges to protocol implementation.

PubMed

Fussell, Holly E; Kunkel, Lynn E; McCarty, Dennis; Lewy, Colleen S

2011-09-01

Training research staff to implement clinical trials occurring in community-based addiction treatment programs presents unique challenges. Standardized patient walkthroughs of study procedures may enhance training and protocol implementation. Examine and discuss cross-site and cross-study challenges of participant screening and data collection procedures identified during standardized patient walkthroughs of multi-site clinical trials. Actors portrayed clients and "walked through" study procedures with protocol research staff. The study completed 57 walkthroughs during implementation of 4 clinical trials. Observers and walkthrough participants identified three areas of concern (consent procedures, screening and assessment processes, and protocol implementation) and made suggestions for resolving the concerns. Standardized patient walkthroughs capture issues with study procedures previously unidentified with didactic training or unscripted rehearsals. Clinical trials within the National Drug Abuse Treatment Clinical Trials Network are conducted in addiction treatment centers that vary on multiple dimensions. Based on walkthrough observations, the national protocol team and local site leadership modify standardized operating procedures and resolve cross-site problems prior to recruiting study participants. The standardized patient walkthrough improves consistency across study sites and reduces potential site variation in study outcomes.

Evaluating an Organizational Protocol to Implement Effective Leadership Meetings

ERIC Educational Resources Information Center

Anderson, Erika

2009-01-01

The problem on which this study focused was the need to organize and implement effective leadership meetings that led to improved professional collaboration. The purpose was to evaluate the use of a protocol in organizing and implementing such meetings. The research questions were framed around the four levels of the Kirkpatrick (1996) evaluation…

Corporate dashboard for payphone service

NASA Astrophysics Data System (ADS)

Siraj, Fadzilah; Shadan, Hezlin

2015-12-01

Making assured that managements are kept abreast of what is happening in the company is not an easy task. The quantity of data generated by the business process is astonishing large and non-centralized. The challenge facing business organizations is how to extract, load, transform data, and then deliver useful information to key decision makers. The major challenge for the payphone industries is in making a good decision, particularly to increase quality of service, customer satisfaction while achieving high revenue. With current practice, the process is very time consuming and therefore, a systematic and informative corporate dashboard needs to be provided especially for managerial level in supporting their decision making process. This paper proposed a dashboard application design that provides a single-screen display of relevant information such as the phone performance and coin collection reports, as well as generated revenue to enable faster and more effective decision making. The development of the dashboard is divided into requirement, design and implementation phases. The implementation using real data has demonstrated the potential use of the dashboard. The evaluation results indicate that the dashboard can be used as a tool that can support payphone operation works and decision process by providing the analytical analysis of the KPI report and the performance status. In addition, the results can be used as a guideline for the dashboard developer to understand the process and focuses on the key elements and the principle in designing the effective dashboard.

Implementation of lung cancer CT screening in the Nordic countries.

PubMed

Pedersen, Jesper Holst; Sørensen, Jens Benn; Saghir, Zaigham; Fløtten, Øystein; Brustugun, Odd Terje; Ashraf, Haseem; Strand, Trond-Eirik; Friesland, Signe; Koyi, Hirsh; Ek, Lars; Nyrén, Sven; Bergman, Per; Jekunen, Antti; Nieminen, Eeva-Maija; Gudbjartsson, Tomas

2017-10-01

We review the current knowledge of CT screening for lung cancer and present an expert-based, joint protocol for the proper implementation of screening in the Nordic countries. Experts representing all the Nordic countries performed literature review and concensus for a joint protocol for lung cancer screening. Areas of concern and caution are presented and discussed. We suggest to perform CT screening pilot studies in the Nordic countries in order to gain experience and develop specific and safe protocols for the implementation of such a program.

Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis.

PubMed

Ali, Ather; Kahn, Janet; Rosenberger, Lisa; Perlman, Adam I

2012-10-04

Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials. The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists' clinical judgment and maintaining consistency with a prior pilot study. The manualized protocol addressed identical specified body regions with distinct 30- and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30- and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated. The massage protocol was manualized, using standard techniques, and made flexible for individual practitioner and subject needs. The protocol has been applied in two randomized clinical trials. This manualized Swedish massage protocol has real-world utility and can be readily utilized both in the research and clinical settings. Clinicaltrials.gov NCT00970008 (18 August 2009).

High-Performance CCSDS Encapsulation Service Implementation in FPGA

NASA Technical Reports Server (NTRS)

Clare, Loren P.; Torgerson, Jordan L.; Pang, Jackson

2010-01-01

The Consultative Committee for Space Data Systems (CCSDS) Encapsulation Service is a convergence layer between lower-layer space data link framing protocols, such as CCSDS Advanced Orbiting System (AOS), and higher-layer networking protocols, such as CFDP (CCSDS File Delivery Protocol) and Internet Protocol Extension (IPE). CCSDS Encapsulation Service is considered part of the data link layer. The CCSDS AOS implementation is described in the preceding article. Recent advancement in RF modem technology has allowed multi-megabit transmission over space links. With this increase in data rate, the CCSDS Encapsulation Service needs to be optimized to both reduce energy consumption and operate at a high rate. CCSDS Encapsulation Service has been implemented as an intellectual property core so that the aforementioned problems are solved by way of operating the CCSDS Encapsulation Service inside an FPGA. The CCSDS En capsula tion Service in FPGA implementation consists of both packetizing and de-packetizing features

The Impact of a Management Protocol on the Outcomes of Child Abuse in Hospitalized Children in Hong Kong

ERIC Educational Resources Information Center

Lee, Anselm C. W.; Li, C. H.; So, K. T.

2006-01-01

Objective: To study the outcomes of children hospitalized for suspected child abuse before and after the implementation of a management protocol in a hospital in Hong Kong. Study period: Two 2-year periods before (1994-1995) and after (2002-2003) the implementation of the protocol in 1998. Methods: This is a retrospective hospital chart review in…

A Unified Algebraic and Logic-Based Framework Towards Safe Routing Implementations

DTIC Science & Technology

2015-08-13

Software - defined Networks ( SDN ). We developed a declarative platform for implementing SDN protocols using declarative...and debugging several SDN applications. Example-based SDN synthesis. Recent emergence of software - defined networks offers an opportunity to design...domain of Software - defined Networks ( SDN ). We developed a declarative platform for implementing SDN protocols using declarative networking

Blind Data Attack on BGP Routers

DTIC Science & Technology

2017-03-01

implement blind attack protection, leaving long -standing connections, such as Border Gateway Protocol (BGP) sessions, vulnerable to exploitation. This...protection measures should a discovered vulnerability reduce attack complexity. 14. SUBJECT TERMS BGP, TCP, blind attack, blind data attack 15. NUMBER OF...implementations may not properly implement blind attack protection, leaving long -standing connections, such as BorderGateway Protocol (BGP) sessions

[Atosiban treatment for preterm labor--financial considerations and savings by implementing clinical guidelines].

PubMed

Hadar, Eran; Mansur, Nariman; Ambar, Irit; Hod, Moshe

2011-06-01

Preterm delivery is a significant cause of neonatal morbidity and mortality. Pregnant women, with symptoms and signs consistent with preterm labor, can be treated with various tocolytic drugs. Atosiban is one of many drugs indicated to arrest imminent preterm labor. Various studies show that the efficacy of atosiban is similar to other tocolytic drugs. The main advantage of atosiban is a relativeLy low incidence of adverse maternal reactions. Its considerable shortcoming is the financial cost, compared to other available drugs. In view of its cost, we have decided to implement a strict protocol to direct the use of atosiban, with the intent to reduce costs, without hampering quality of care. The protocol was implemented from July 2009, and it outlines the medical and procedural terms to use atosiban. We compared similar time periods before and after implementation of the protocol. The outcomes compared included: treatment success, rates of preterm deliveries and financial costs. Within the timeframe that the protocol was implemented, we have been able to demonstrate a 40% reduction in atosiban related costs, compared to a parallel period, when the clinical guidelines were not implemented. This translates into savings of about NIS 40,000 (New Israeli Shekel) (approximately $10,000). This was achieved without an increase in the rate of preterm deliveries. Implementing and enforcing a simple protocol of supervision on the use of atosiban enables a considerable reduction of financial costs related to atosiban, without hampering medical care.

Successful implementation of a neonatal pain and sedation protocol at 2 NICUs.

PubMed

Deindl, Philipp; Unterasinger, Lukas; Kappler, Gregor; Werther, Tobias; Czaba, Christine; Giordano, Vito; Frantal, Sophie; Berger, Angelika; Pollak, Arnold; Olischar, Monika

2013-07-01

To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs. The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5-5.9] mg/kg versus intervention group dose of 2.7 [0.4-57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2-10] vs 6 [2-13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P < .001; nurses: 17% vs 55%; P < .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation. Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes.

WE-E-304-00: Implementing SBRT Protocols

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

NONE

2015-06-15

SBRT is having a dramatic impact on radiation therapy of early-stage, locally advanced cancers. A number of national protocols have been and are being developed to assess the clinical efficacy of SBRT for various anatomical sites, such as lung and spine. Physics credentialing for participating and implementation of trial protocols involve a broad spectrum of requirements from image guidance, motion management, to planning technology and dosimetric constrains. For radiation facilities that do not have extensive experiences in SBRT treatment and protocol credentialing, these complex processes of credentialing and implementation could be very challenging and, sometimes, may lead to ineffective evenmore » unsuccessful execution of these processes. In this proposal, we will provide comprehensive review of some current SBRT protocols, explain the requirements and their underline rationales, illustrate representative failed and successful experiences, related to SBRT credentialing, and discuss strategies for effective SBRT credentialing and implementation. Learning Objectives: Understand requirements and challenges of SBRT credentailing and implentation Discuss processes and strategies of effective SBRT credentailing Discuss practical considerations, potential pitfalls and solutions of SBRT implentation.« less

WE-E-304-02: Implementing SBRT Protocols: A NRG CIRO Perspective

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

Xiao, Y.

2015-06-15

SBRT is having a dramatic impact on radiation therapy of early-stage, locally advanced cancers. A number of national protocols have been and are being developed to assess the clinical efficacy of SBRT for various anatomical sites, such as lung and spine. Physics credentialing for participating and implementation of trial protocols involve a broad spectrum of requirements from image guidance, motion management, to planning technology and dosimetric constrains. For radiation facilities that do not have extensive experiences in SBRT treatment and protocol credentialing, these complex processes of credentialing and implementation could be very challenging and, sometimes, may lead to ineffective evenmore » unsuccessful execution of these processes. In this proposal, we will provide comprehensive review of some current SBRT protocols, explain the requirements and their underline rationales, illustrate representative failed and successful experiences, related to SBRT credentialing, and discuss strategies for effective SBRT credentialing and implementation. Learning Objectives: Understand requirements and challenges of SBRT credentailing and implentation Discuss processes and strategies of effective SBRT credentailing Discuss practical considerations, potential pitfalls and solutions of SBRT implentation.« less

Improving heart failure disease management in skilled nursing facilities: lessons learned.

PubMed

Dolansky, Mary A; Hitch, Jeanne A; Piña, Ileana L; Boxer, Rebecca S

2013-11-01

The purpose of the study was to design and evaluate an improvement project that implemented HF management in four skilled nursing facilities (SNFs). Kotter's Change Management principles were used to guide the implementation. In addition, half of the facilities had an implementation coach who met with facility staff weekly for 4 months and monthly for 5 months. Weekly and monthly audits were performed that documented compliance with eight key aspects of the protocol. Contextual factors were captured using field notes. Adherence to the HF management protocols was variable ranging from 17% to 82%. Facilitators of implementation included staff who championed the project, an implementation coach, and physician involvement. Barriers were high staff turnover and a hierarchal culture. Opportunities exist to integrate HF management protocols to improve SNF care.

How to implement a clinical pathway for intensive glucose regulation in acute coronary syndromes.

PubMed

de Mulder, Maarten; Zwaan, Esther; Wielinga, Yvonne; Stam, Frank; Umans, Victor A W M

2009-06-01

Hyperglycemia upon admission of myocardial infarction patients predicts inferior clinical outcomes. Current strategies investigating hyperglycemia correction mostly use glucose-driven protocols. Implementation of these often labor-intensive protocols might be facilitated with the approach of a clinical pathway. Therefore, we evaluated the implementation of our glucose-driven protocol.We adapted a protocol for use in our coronary care unit (CCU), which was implemented according to the steps of a clinical pathway. To compensate for carbohydrates in meals we additionally developed a regimen of subcutaneous insulin.Protocol adherence was facilitated with a Web-based insulin calculator. All hyperglycemic patients admitted to the CCU were eligible for treatment according to this protocol.In a 4-month period, 643 glucose measurements were obtained in hyperglycemic patients admitted to our CCU. Patients were treated intensively with IV insulin for 35 hours and had 23 glucose measurements in this time span on average. This regimen achieved a median glucose of 6.2 mmol/L. Severe hypoglycemia occurred in only 1.1% of measurements and was without severe clinical side effects.Introduction of new intensive insulin protocol according to the steps of a clinical pathway is safe and feasible. The presence of a clinical pathway coordinator and sound communication are important conditions for successful introduction, which can be further aided with a computerized calculator.

Inverse scattering transform for the time dependent Schrödinger equation with applications to the KPI equation

NASA Astrophysics Data System (ADS)

Zhou, Xin

1990-03-01

For the direct-inverse scattering transform of the time dependent Schrödinger equation, rigorous results are obtained based on an opertor-triangular-factorization approach. By viewing the equation as a first order operator equation, similar results as for the first order n x n matrix system are obtained. The nonlocal Riemann-Hilbert problem for inverse scattering is shown to have solution.

Lump solutions of the BKP equation

NASA Astrophysics Data System (ADS)

Gilson, C. R.; Nimmo, J. J. C.

1990-07-01

Rational solutions of the BKP equation which decay to zero in all directions in the plane are obtained. These solutions are analogous to the lump solutions of the KPI equation. Properties of the single lump solution are described and the form of the N-lump solution is given. It is shown that single lump solutions are only non-singular for spectral parameters lying in certain regions of the complex plane.

Fasting blood glucose is a novel prognostic indicator for extranodal natural killer/T-cell lymphoma, nasal type

PubMed Central

Cai, Q; Luo, X; Liang, Y; Rao, H; Fang, X; Jiang, W; Lin, T; Lin, T; Huang, H

2013-01-01

Background: Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL) is an aggressive disease with poor prognosis, requiring risk stratification. However, the prognosis of ENKTL is not fully defined and needs supplementation. We hypothesised that fasting blood glucose (FBG) may be a new prognostic factor for ENKTL. Methods: We retrospectively analysed 130 patients newly diagnosed with ENKTL. Results: Both univariate analysis and multivariate analysis revealed that FBG >100 mg dl−1 was associated with a poor outcome. Patients with FBG >100 mg dl−1 at diagnosis had more adverse clinical features, achieved lower complete remission rates (P=0.003) and had worse overall survival (P<0.001) and progression-free survival (P<0.001) compared with low-FBG patients. Measurement of FBG was helpful in differentiating between low-risk patients using the International Prognostic Index (IPI) and Prognosis Index for peripheral T-cell lymphoma (PIT) scoring and patients in a different category using the Korean Prognostic Index (KPI) scores with different survival outcomes (P<0.05). Conclusion: Our data suggest that measuring FBG levels at diagnosis is a novel, independent predictor of prognosis in ENKTL and helps to distinguish low-risk patients with poor survival, and this holds true in patients considered low-risk by IPI, PIT and KPI. PMID:23299534

Homogenous UV/periodate process in treatment of p-nitrophenol aqueous solutions under mild operating conditions.

PubMed

Saien, Javad; Fallah Vahed Bazkiaei, Marzieh

2018-07-01

Aqueous solutions of p-nitrophenol (PNP) were treated with UV-activated potassium periodate (UV/KPI) in an efficient photo-reactor. Either periodate or UV alone had little effect; however, their combination led to a significant degradation and mineralization. The response surface methodology was employed for design of experiments and optimization. The optimum conditions for treatment of 30 mg/L of the substrate were determined as [KPI] = 386.3 mg/L, pH = 6.2 and T = 34.6°C, under which 79.5% degradation was achieved after 60 min. Use of 25 and 40 kHz ultrasound waves caused the degradation to enhance to 88.3% and 92.3%, respectively. The intermediates were identified by gas chromatography-mass spectroscopy analysis, leading to propose the reaction pathway. The presence of water conventional bicarbonate, chloride, sulfate and nitrate anions caused unfavorable effects in efficiency. Meanwhile, the kinetic study showed that PNP degradation follows a pseudo-first-order reaction and the activation energy was determined. The irradiation energy consumption required for one order of magnitude degradation was estimated as 11.18 kWh/m 3 . Accordingly, comparison with the previously reported processes showed the superiority of PNP treatment with the employed process.

The Xpress Transfer Protocol (XTP): A tutorial (expanded version)

NASA Technical Reports Server (NTRS)

Sanders, Robert M.; Weaver, Alfred C.

1990-01-01

The Xpress Transfer Protocol (XTP) is a reliable, real-time, light weight transfer layer protocol. Current transport layer protocols such as DoD's Transmission Control Protocol (TCP) and ISO's Transport Protocol (TP) were not designed for the next generation of high speed, interconnected reliable networks such as fiber distributed data interface (FDDI) and the gigabit/second wide area networks. Unlike all previous transport layer protocols, XTP is being designed to be implemented in hardware as a VLSI chip set. By streamlining the protocol, combining the transport and network layers and utilizing the increased speed and parallelization possible with a VLSI implementation, XTP will be able to provide the end-to-end data transmission rates demanded in high speed networks without compromising reliability and functionality. This paper describes the operation of the XTP protocol and in particular, its error, flow and rate control; inter-networking addressing mechanisms; and multicast support features, as defined in the XTP Protocol Definition Revision 3.4.

High-Performance CCSDS AOS Protocol Implementation in FPGA

NASA Technical Reports Server (NTRS)

Clare, Loren P.; Torgerson, Jordan L.; Pang, Jackson

2010-01-01

The Consultative Committee for Space Data Systems (CCSDS) Advanced Orbiting Systems (AOS) space data link protocol provides a framing layer between channel coding such as LDPC (low-density parity-check) and higher-layer link multiplexing protocols such as CCSDS Encapsulation Service, which is described in the following article. Recent advancement in RF modem technology has allowed multi-megabit transmission over space links. With this increase in data rate, the CCSDS AOS protocol implementation needs to be optimized to both reduce energy consumption and operate at a high rate.

Variability of DKA Management Among Pediatric Emergency Room and Critical Care Providers: A Call for More Evidence-Based and Cost-Effective Care?

PubMed

Clark, Matthew G; Dalabih, Abdallah

2014-09-01

Management protocols have been shown to be effective in the pediatric emergency medicine (PEM) and pediatric critical care (PCC) settings. Treatment protocols define clear goals which are achieved with consistency in implementation. Over the last decade, many new recommendations have been proposed on managing diabetic ketoacidosis (DKA). Although no perfect set of guidelines exist, many institutions are developing DKA treatment protocols. We sought to determine the variability between institutions in implementation of these protocols.

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

PubMed

Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

2015-01-01

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.

Treatment outcomes after implementation of an adapted WHO protocol for severe sepsis and septic shock in Haiti.

PubMed

Papali, Alfred; Eoin West, T; Verceles, Avelino C; Augustin, Marc E; Nathalie Colas, L; Jean-Francois, Carl H; Patel, Devang M; Todd, Nevins W; McCurdy, Michael T

2017-10-01

The World Health Organization (WHO) has developed a simplified algorithm specific to resource-limited settings for the treatment of severe sepsis emphasizing early fluids and antibiotics. However, this protocol's clinical effectiveness is unknown. We describe patient outcomes before and after implementation of an adapted WHO severe sepsis protocol at a community hospital in Haiti. Using a before-and-after study design, we retrospectively enrolled 99 adult Emergency Department patients with severe sepsis from January through March 2012. After protocol implementation in January 2014, we compared outcomes to 67 patients with severe sepsis retrospectively enrolled from February to April 2014. We defined sepsis according to the WHO's Integrated Management of Adult Illness guidelines and severe sepsis as sepsis plus organ dysfunction. After protocol implementation, quantity of fluid administered increased and the physician's differential diagnoses more often included sepsis. Patients were more likely to have follow-up vital signs taken sooner, a radiograph performed, and a lactic acid tested. There were no improvements in mortality, time to fluids or antimicrobials. Use of a simplified sepsis protocol based primarily on physiologic parameters allows for substantial improvements in process measures in the care of severely septic patients in a resource-constrained setting. Copyright © 2017 Elsevier Inc. All rights reserved.

The Verification-based Analysis of Reliable Multicast Protocol

NASA Technical Reports Server (NTRS)

Wu, Yunqing

1996-01-01

Reliable Multicast Protocol (RMP) is a communication protocol that provides an atomic, totally ordered, reliable multicast service on top of unreliable IP Multicasting. In this paper, we develop formal models for R.W using existing automatic verification systems, and perform verification-based analysis on the formal RMP specifications. We also use the formal models of RW specifications to generate a test suite for conformance testing of the RMP implementation. Throughout the process of RMP development, we follow an iterative, interactive approach that emphasizes concurrent and parallel progress between the implementation and verification processes. Through this approach, we incorporate formal techniques into our development process, promote a common understanding for the protocol, increase the reliability of our software, and maintain high fidelity between the specifications of RMP and its implementation.

Firewall Traversal for CORBA Applications Using an Implementation of Bidirectional IIOP in MICO

NASA Technical Reports Server (NTRS)

Griffin, Robert I.; Lopez, Isaac (Technical Monitor)

2002-01-01

The Object Management Group (OMG) has added specifications to the General Inter-ORB Protocol (GIOP 1.2), specifically the Internet Inter-ORB Protocol (IIOP 1.2), that allow servers and clients on opposing sides of a firewall to reverse roles and still communicate freely. This addition to the GIOP specifications is referred to as Bidirectional GIOP. The implementation of these specifications as applied to communication over TCP/IP connections is referred to as 'Bidirectional Internet Inter-ORB Protocol' or BiDirIIOP. This paper details the implementation and testing of the BiDirIIOP Specification in an open source ORB, MICO, that did not previously support Bidirectional GIOP. It also provides simple contextual information and a description of the OMG GIOP/IIOP messaging protocols.

Improving generalized inverted index lock wait times

NASA Astrophysics Data System (ADS)

Borodin, A.; Mirvoda, S.; Porshnev, S.; Ponomareva, O.

2018-01-01

Concurrent operations on tree like data structures is a cornerstone of any database system. Concurrent operations intended for improving read\\write performance and usually implemented via some way of locking. Deadlock-free methods of concurrency control are known as tree locking protocols. These protocols provide basic operations(verbs) and algorithm (ways of operation invocations) for applying it to any tree-like data structure. These algorithms operate on data, managed by storage engine which are very different among RDBMS implementations. In this paper, we discuss tree locking protocol implementation for General inverted index (Gin) applied to multiversion concurrency control (MVCC) storage engine inside PostgreSQL RDBMS. After that we introduce improvements to locking protocol and provide usage statistics about evaluation of our improvement in very high load environment in one of the world’s largest IT company.

Practical quantum coin flipping

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

Pappa, Anna; Diamanti, Eleni; Chailloux, Andre

2011-11-15

We show that in the unconditional security model, a single quantum strong coin flip with security guarantees that are strictly better than in any classical protocol is possible to implement with current technology. Our protocol takes into account all aspects of an experimental implementation, including losses, multiphoton pulses emitted by practical photon sources, channel noise, detector dark counts, and finite quantum efficiency. We calculate the abort probability when both players are honest, as well as the probability of one player forcing his desired outcome. For a channel length up to 21 km and commonly used parameter values, we can achievemore » honest abort and cheating probabilities that are better than in any classical protocol. Our protocol is, in principle, implementable using attenuated laser pulses, with no need for entangled photons or any other specific resources.« less

76 FR 69132 - Trademark Technical and Conforming Amendments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... Madrid Agreement Concerning the International Registration of Marks (``Madrid Rules'') to implement the... Cases and the Madrid Rules to implement the Trademark Technical and Conforming Amendment Act of 2010... Madrid Protocol (``Madrid Protocol registrants'') to file Affidavits or Declarations of Use or Excusable...

Examination of an interventionist-led HIV intervention among criminal justice-involved female prisoners

PubMed Central

Havens, Jennifer R.; Leukefeld, Carl G.; Oser, Carrie B.; Staton-Tindall, Michele; Knudsen, Hannah K.; Mooney, Jennifer; Duvall, Jamieson L.; Clarke, Jennifer G.; Frisman, Linda; Surratt, Hilary L.; Inciardi, James A.

2009-01-01

The purpose of this study was to examine the implementation, adherence and protocol fidelity for the Reducing Risky Relationships for HIV (RRR-HIV) study. The RRR-HIV study is a phase III trial of a randomized intervention to reduce human immunodeficiency virus (HIV) risk behaviors among incarcerated women in four US states: Connecticut, Delaware, Kentucky and Rhode Island. The intervention consists of five interventionist-led prison-based group sessions and a sixth individual community-based session. Data on adherence, implementation, acceptability and fidelity of the intervention were obtained from forms completed after the five prison-based sessions by both the interventionist and participant. Data from the sixth session were collected by the interventionist. Of the 363 women recruited to date, 173 (47.6%) have been randomly allocated to the experimental RRR intervention, of which implementation measures were available for 162 (93.6%). Almost three-quarters of women attended all five sessions, each of which lasted a median of 90 minutes, indicating successful implementation of the protocol across multiple study sites. Interventionists and participants alike reported that all of the topics for each session were discussed, suggesting adherence to the protocol. In addition, protocol interventionists indicated that more than 95% of the women were engaged/involved, interested, and understood the materials presented, indicating high levels of acceptability among the participants and fidelity to the intervention protocols. The majority of participants also answered all of the post-test questions correctly, which is another strong indicator of the fidelity to the intervention. Results suggest that the RRR-HIV study has been successfully implemented across multiple study sites. Adherence to the protocol, as well as protocol fidelity and acceptability, were also strong, which is essential to establish prior to examining outcome data. PMID:20090928

Protocols development for security and privacy of radio frequency identification systems

NASA Astrophysics Data System (ADS)

Sabbagha, Fatin

There are benefits to adopting radio frequency identification (RFID) technology, although there are methods of attack that can compromise the system. This research determined how that may happen and what possible solutions can keep that from happening. Protocols were developed to implement better security. In addition, new topologies were developed to handle the problems of the key management. Previously proposed protocols focused on providing mutual authentication and privacy between readers and tags. However, those protocols are still vulnerable to be attacked. These protocols were analyzed and the disadvantages shown for each one. Previous works assumed that the channels between readers and the servers were secure. In the proposed protocols, a compromised reader is considered along with how to prevent tags from being read by that reader. The new protocols provide mutual authentication between readers and tags and, at the same time, remove the compromised reader from the system. Three protocols are proposed. In the first protocol, a mutual authentication is achieved and a compromised reader is not allowed in the network. In the second protocol, the number of times a reader contacts the server is reduced. The third protocol provides authentication and privacy between tags and readers using a trusted third party. The developed topology is implemented using python language and simulates work to check the efficiency regarding the processing time. The three protocols are implemented by writing codes in C language and then compiling them in MSP430. IAR Embedded workbench is used, which is an integrated development environment with the C/C++ compiler to generate a faster code and to debug the microcontroller. In summary, the goal of this research is to find solutions for the problems on previously proposed protocols, handle a compromised reader, and solve key management problems.

The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability.

PubMed

Rodriguez, Violeta J; LaCabe, Richard P; Privette, C Kyle; Douglass, K Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo Willy; Horigian, Viviana; Weiss, Stephen M; Jones, Deborah L

2017-12-01

The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff-patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.

The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

PubMed Central

Rodriguez, Violeta J.; LaCabe, Richard P.; Privette, C. Kyle; Douglass, K. Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo “Willy”; Horigian, Viviana; Weiss, Stephen M.; Jones, Deborah L.

2017-01-01

Abstract The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention. PMID:28922974

Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital

PubMed Central

Ng, Karen; Dahri, Karen; Chow, Ivy; Legal, Michael

2011-01-01

Background: Alcohol withdrawal protocols involving symptom-triggered administration of benzodiazepine have been established to reduce the duration of treatment and the cumulative benzodiazepine dose (relative to usual care). However, the effects of a protocol combining fixed-schedule and symptom-triggered benzodiazepine dosing are less clear. Objective: To assess the efficacy and safety of a combination fixed-scheduled and symptom-triggered benzodiazepine dosing protocol for alcohol withdrawal, relative to usual care, for medical inpatients at a tertiary care hospital. Methods: A chart review of admissions to the internal medicine service for alcohol withdrawal was conducted to compare treatment outcomes before (October 2005 to April 2007) and after (October 2007 to April 2009) implementation of the combination protocol. The primary outcome was duration of benzodiazepine treatment for alcohol withdrawal. The secondary outcomes were cumulative benzodiazepine dose administered, safety implications, and use of adjunctive medications. Results: A total of 159 patients met the inclusion criteria. Assessable data were available for 71 charts from the pre-implementation period and 72 charts from the post-implementation period. The median duration of benzodiazepine treatment was 91 h before implementation and 57 h after implementation (p < 0.001). Use of the protocol was also associated with a significant reduction in severe complications of alcohol withdrawal (50% versus 33%, p = 0.019), median cumulative benzodiazepine dose (in lorazepam equivalents) (20.0 mg versus 15.5 mg, p = 0.026), and use of adjunctive medications (65% versus 38%, p = 0.001). The incidence of serious adverse outcomes of treatment with benzodiazepines was not significantly different between the 2 groups. Conclusions: Implementation of an alcohol withdrawal protocol with a combination of fixed-schedule and symptom-triggered benzodiazepine dosing in a medical ward was associated with a shorter duration of benzodiazepine use and a lower incidence of severe complications of alcohol withdrawal. PMID:22479099

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

Yu, Weikuan; Vetter, Jeffrey S

Parallel NFS (pNFS) is touted as an emergent standard protocol for parallel I/O access in various storage environments. Several pNFS prototypes have been implemented for initial validation and protocol examination. Previous efforts have focused on realizing the pNFS protocol to expose the best bandwidth potential from underlying file and storage systems. In this presentation, we provide an initial characterization of two pNFS prototype implementations, lpNFS (a Lustre-based parallel NFS implementation) and spNFS (another reference implementation from Network Appliance, Inc.). We show that both lpNFS and spNFS can faithfully achieve the primary goal of pNFS, i.e., aggregating I/O bandwidth from manymore » storage servers. However, they both face the challenge of scalable metadata management. Particularly, the throughput of sp-NFS metadata operations degrades significanlty with an increasing number of data servers. Even for the better-performing lpNFS, we discuss its architecture and propose a direct I/O request flow protocol to improve its performance.« less

How to customize a bona fide psychotherapy for generalized anxiety disorder? A two-arms, patient blinded, ABAB crossed-therapist randomized clinical implementation trial design [IMPLEMENT 2.0].

PubMed

Flückiger, Christoph; Wolfer, Christine; Held, Judith; Hilpert, Peter; Rubel, Julian; Allemand, Mathias; Zinbarg, Richard E; Vîslă, Andreea

2018-04-03

Bona fide psychotherapy approaches are effective treatments for generalized anxiety disorder (GAD) compared to no-treatment conditions. Treatment manuals and protocols allow a relatively high degree of freedom for the way therapists implement these overall treatment packages and there is a systematic lack of knowledge on how therapists should customize these treatments. The present study experimentally examines two implementation strategies of customizing a bona fide psychotherapy approach based on a 16 session time-limited cognitive-behavioral therapy (CBT) protocol and their relation to the post-session and ultimate treatment outcomes. This trial contrasts two different implementation strategies of how to customize the in-session structure of a manual-based CBT-protocol for GAD. The patients will be randomly assigned to two implementation conditions: (1) a systematic focus on subtle changes lasting from 7 to 20 min at the check-in phase of every psychotherapy session and (2) a state-of-the-art (SOTA) check-in phase lasting several minutes mainly focused on the session goals. Potential therapist effects will be examined based on an ABAB crossed-therapist design. Treatment outcomes will be assessed at the following times: post-session outcomes, treatment outcome at post assessment and 6- as well as 12-month follow-up. The proposed randomized clinical implementation trial addresses the clinically relevant question of how to customize a bona fide psychotherapy protocol experimentally contrasting two implementation strategies. Through the development and testing of the proposed implementation design, this trial has the potential to inform therapists about efficacious implementation strategies of how to customize a manual-based treatment protocol in respect to the timing of the in-session structure. This trial was registered at ClinicalTrials.gov ( NCT03079336 ) at March 14, 2017.

A KPI framework for process-based benchmarking of hospital information systems.

PubMed

Jahn, Franziska; Winter, Alfred

2011-01-01

Benchmarking is a major topic for monitoring, directing and elucidating the performance of hospital information systems (HIS). Current approaches neglect the outcome of the processes that are supported by the HIS and their contribution to the hospital's strategic goals. We suggest to benchmark HIS based on clinical documentation processes and their outcome. A framework consisting of a general process model and outcome criteria for clinical documentation processes is introduced.

Detecting child abuse based on parental characteristics: does the Hague Protocol cause parents to avoid the emergency department?

PubMed

Diderich, Hester M; Fekkes, Minne; Dechesne, Mark; Buitendijk, Simone E; Oudesluys-Murphy, Anne Marie

2015-04-01

The Hague Protocol is used by professionals at the adult Emergency Departments (ED) in The Netherlands to detect child abuse based on three parental characteristics: (1) domestic violence, (2) substance abuse or (3) suicide attempt or self-harm. After detection, a referral is made to the Reporting Center for Child Abuse and Neglect (RCCAN). This study investigates whether implementing this Protocol will lead parents to avoid medical care. We compared the number of patients (for whom the Protocol applied) who attended the ED prior to implementation with those attending after implementation. We conducted telephone interviews (n = 14) with parents whose children were referred to the RCCAN to investigate their experience with the procedure. We found no decline in the number of patients, included in the Protocol, visiting the ED during the 4 year implementation period (2008-2011). Most parents (n = 10 of the 14 interviewed) were positive and stated that they would, if necessary, re-attend the ED with the same complaints in the future. ED nurses and doctors referring children based on parental characteristics do not have to fear losing these families as patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Simulation of Read-time Scalable Coherent Interface

NASA Technical Reports Server (NTRS)

Li, Qiang; Grant, Terry; Grover, Radhika S.

1997-01-01

Scalable Coherent Interface (SCI, IEEE/ANSI Std 1596-1992) (SCI1, SCI2) is a high performance interconnect for shared memory multiprocessor systems. In this project we investigate an SCI Real Time Protocols (RTSCI1) using Directed Flow Control Symbols. We studied the issues of efficient generation of control symbols, and created a simulation model of the protocol on a ring-based SCI system. This report presents the results of the study. The project has been implemented using SES/Workbench. The details that follow encompass aspects of both SCI and Flow Control Protocols, as well as the effect of realistic client/server processing delay. The report is organized as follows. Section 2 provides a description of the simulation model. Section 3 describes the protocol implementation details. The next three sections of the report elaborate on the workload, results and conclusions. Appended to the report is a description of the tool, SES/Workbench, used in our simulation, and internal details of our implementation of the protocol.

Quantum gates by inverse engineering of a Hamiltonian

NASA Astrophysics Data System (ADS)

Santos, Alan C.

2018-01-01

Inverse engineering of a Hamiltonian (IEH) from an evolution operator is a useful technique for the protocol of quantum control with potential applications in quantum information processing. In this paper we introduce a particular protocol to perform IEH and we show how this scheme can be used to implement a set of quantum gates by using minimal quantum resources (such as entanglement, interactions between more than two qubits or auxiliary qubits). Remarkably, while previous protocols request three-qubit interactions and/or auxiliary qubits to implement such gates, our protocol requires just two-qubit interactions and no auxiliary qubits. By using this approach we can obtain a large class of Hamiltonians that allow us to implement single and two-qubit gates necessary for quantum computation. To conclude this article we analyze the performance of our scheme against systematic errors related to amplitude noise, where we show that the free parameters introduced in our scheme can be useful for enhancing the robustness of the protocol against such errors.

[Analysis of palliative sedation in hospitalised elderly patients: Effectiveness of a protocol].

PubMed

Mateos-Nozal, Jesús; García-Cabrera, Lorena; Montero Errasquín, Beatriz; Cruz-Jentoft, Alfonso José; Rexach Cano, Lourdes

2016-01-01

To measure changes in the practice of palliative sedation during agony in hospitalised elderly patients before and after the implementation of a palliative sedation protocol. A retrospective before-after study was performed in hospitalised patients over 65 years old who received midazolam during hospital admission and died in the hospital in two 3-month periods, before and after the implementation of the protocol. Non-sedative uses of midazolam and patients in intensive care were excluded. Patient and admission characteristics, the consent process, withdrawal of life-sustaining treatments, and the sedation process (refractory symptom treated, drug doses, assessment and use of other drugs) were recorded. Association was analysed using the Chi(2) and Student t tests. A total of 143 patients were included, with no significant differences between groups in demographic characteristics or symptoms. Do not resuscitate (DNR) orders were recorded in approximately 70% of the subjects of each group, and informed consent for sedation was recorded in 91% before vs. 84% after the protocol. Induction and maintenance doses of midazolam followed protocol recommendations in 1.3% before vs 10.4% after the protocol was implemented (P=.02) and adequate rescue doses were used in 1.3% vs 11.9% respectively (P=.01). Midazolam doses were significantly lower (9.86mg vs 18.67mg, P<.001) when the protocol was used than when it was not used. Ramsay sedation score was used in 8% vs. 12% and the Palliative Care Team was involved in 35.5% and 16.4% of the cases (P=.008) before and after the protocol, respectively. Use of midazolam slightly improved after the implementation of a hospital protocol on palliative sedation. The percentage of adequate sedations and the general process of sedation were mostly unchanged by the protocol. More education and further assessment is needed to gauge the effect of these measures in the future. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

The specification-based validation of reliable multicast protocol: Problem Report. M.S. Thesis

NASA Technical Reports Server (NTRS)

Wu, Yunqing

1995-01-01

Reliable Multicast Protocol (RMP) is a communication protocol that provides an atomic, totally ordered, reliable multicast service on top of unreliable IP multicasting. In this report, we develop formal models for RMP using existing automated verification systems, and perform validation on the formal RMP specifications. The validation analysis help identifies some minor specification and design problems. We also use the formal models of RMP to generate a test suite for conformance testing of the implementation. Throughout the process of RMP development, we follow an iterative, interactive approach that emphasizes concurrent and parallel progress of implementation and verification processes. Through this approach, we incorporate formal techniques into our development process, promote a common understanding for the protocol, increase the reliability of our software, and maintain high fidelity between the specifications of RMP and its implementation.

Research and implementation of SATA protocol link layer based on FPGA

NASA Astrophysics Data System (ADS)

Liu, Wen-long; Liu, Xue-bin; Qiang, Si-miao; Yan, Peng; Wen, Zhi-gang; Kong, Liang; Liu, Yong-zheng

2018-02-01

In order to solve the problem high-performance real-time, high-speed the image data storage generated by the detector. In this thesis, it choose an suitable portable image storage hard disk of SATA interface, it is relative to the existing storage media. It has a large capacity, high transfer rate, inexpensive, power-down data which is not lost, and many other advantages. This paper focuses on the link layer of the protocol, analysis the implementation process of SATA2.0 protocol, and build state machines. Then analyzes the characteristics resources of Kintex-7 FPGA family, builds state machines according to the agreement, write Verilog implement link layer modules, and run the simulation test. Finally, the test is on the Kintex-7 development board platform. It meets the requirements SATA2.0 protocol basically.

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

Applying Adult Ventilator-associated Pneumonia Bundle Evidence to the Ventilated Neonate.

PubMed

Weber, Carla D

2016-06-01

Ventilator-associated pneumonia (VAP) in neonates can be reduced by implementing preventive care practices. Implementation of a group, or bundle, of evidence-based practices that improve processes of care has been shown to be cost-effective and to have better outcomes than implementation of individual single practices. The purpose of this article is to describe a safe, effective, and efficient neonatal VAP prevention protocol developed for caregivers in the neonatal intensive care unit (NICU). Improved understanding of VAP causes, effects of care practices, and rationale for interventions can help reduce VAP risk to neonatal patients. In order to improve care practices to affect VAP rates, initial and annual education occurred on improved protocol components after surveying staff practices and auditing documentation compliance. In 2009, a tertiary care level III NICU in the Midwestern United States had 14 VAP cases. Lacking evidence-based VAP prevention practices for neonates, effective adult strategies were modified to meet the complex needs of the ventilated neonate. A protocol was developed over time and resulted in an annual decrease in VAP until rates were zero for 20 consecutive months from October 2012 to May 2014. This article describes a VAP prevention protocol developed to address care practices surrounding hand hygiene, intubation, feeding, suctioning, positioning, oral care, and respiratory equipment in the NICU. Implementation of this VAP prevention protocol in other facilities with appropriate monitoring and tracking would provide broader support for standardization of care. Individual components of this VAP protocol could be studied to strengthen the inclusion of each; however, bundled interventions are often considered stronger when implemented as a whole.

A decentralized software bus based on IP multicas ting

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd

1995-01-01

We describe decentralized reconfigurable implementation of a conference management system based on the low-level Internet Protocol (IP) multicasting protocol. IP multicasting allows low-cost, world-wide, two-way transmission of data between large numbers of conferencing participants through the Multicasting Backbone (MBone). Each conference is structured as a software bus -- a messaging system that provides a run-time interconnection model that acts as a separate agent (i.e., the bus) for routing, queuing, and delivering messages between distributed programs. Unlike the client-server interconnection model, the software bus model provides a level of indirection that enhances the flexibility and reconfigurability of a distributed system. Current software bus implementations like POLYLITH, however, rely on a centralized bus process and point-to-point protocols (i.e., TCP/IP) to route, queue, and deliver messages. We implement a software bus called the MULTIBUS that relies on a separate process only for routing and uses a reliable IP multicasting protocol for delivery of messages. The use of multicasting means that interconnections are independent of IP machine addresses. This approach allows reconfiguration of bus participants during system execution without notifying other participants of new IP addresses. The use of IP multicasting also permits an economy of scale in the number of participants. We describe the MULITIBUS protocol elements and show how our implementation performs better than centralized bus implementations.

Wireless Authentication Protocol Implementation: Descriptions of a Zero-Knowledge Proof (ZKP) Protocol Implementation for Testing on Ground and Airborne Mobile Networks

DTIC Science & Technology

2015-01-01

on AFRL’s small unmanned aerial vehicle (UAV) test bed . 15. SUBJECT TERMS Zero-Knowledge Proof Protocol Testing 16. SECURITY CLASSIFICATION OF...VERIFIER*** edition Version Information: Version 1.1.3 Version Details: Successful ZK authentication between two networked machines. Fixed a bug ...that causes intermittent bignum errors. Fixed a network hang bug and now allows continually authentication at the Verifier. Also now removing

Effectiveness of a myocardial infarction protocol in reducing door-to-ballon time.

PubMed

Correia, Luis Cláudio Lemos; Brito, Mariana; Kalil, Felipe; Sabino, Michael; Garcia, Guilherme; Ferreira, Felipe; Matos, Iracy; Jacobs, Peter; Ronzoni, Liliana; Noya-Rabelo, Márcia

2013-07-01

An adequate door-to-balloon time (<120 minutes) is the necessary condition for the efficacy of primary angioplasty in infarction to translate into effectiveness. To describe the effectiveness of a quality of care protocol in reducing the door-to-balloon time. Between May 2010 and August 2012, all individuals undergoing primary angioplasty in our hospital were analyzed. The door time was electronically recorded at the moment the patient took a number to be evaluated in the emergency room, which occurred prior to filling the check-in forms and to the triage. The balloon time was defined as the beginning of artery opening (introduction of the first device). The first 5 months of monitoring corresponded to the period of pre-implementation of the protocol. The protocol comprised the definition of a flowchart of actions from patient arrival at the hospital, the team's awareness raising in relation to the prioritization of time, and provision of a periodic feedback on the results and possible inadequacies. A total of 50 individuals were assessed. They were divided into five groups of 10 sequential patients (one group pre- and four groups post-protocol). The door-to-balloon time regarding the 10 cases recorded before protocol implementation was 200 ± 77 minutes. After protocol implementation, there was a progressive reduction of the door-to-balloon time to 142±78 minutes in the first 10 patients, then to 150±50 minutes, 131±37 minutes and, finally, 116±29 minutes in the three sequential groups of 10 patients, respectively. Linear regression between sequential patients and the door-to-balloon time (r = - 0.41) showed a regression coefficient of - 1.74 minutes. The protocol implementation proved effective in the reduction of the door-to-balloon time.

Continuous-variable measurement-device-independent quantum key distribution with photon subtraction

NASA Astrophysics Data System (ADS)

Ma, Hong-Xin; Huang, Peng; Bai, Dong-Yun; Wang, Shi-Yu; Bao, Wan-Su; Zeng, Gui-Hua

2018-04-01

It has been found that non-Gaussian operations can be applied to increase and distill entanglement between Gaussian entangled states. We show the successful use of the non-Gaussian operation, in particular, photon subtraction operation, on the continuous-variable measurement-device-independent quantum key distribution (CV-MDI-QKD) protocol. The proposed method can be implemented based on existing technologies. Security analysis shows that the photon subtraction operation can remarkably increase the maximal transmission distance of the CV-MDI-QKD protocol, which precisely make up for the shortcoming of the original CV-MDI-QKD protocol, and one-photon subtraction operation has the best performance. Moreover, the proposed protocol provides a feasible method for the experimental implementation of the CV-MDI-QKD protocol.

An eCK-Secure Authenticated Key Exchange Protocol without Random Oracles

NASA Astrophysics Data System (ADS)

Moriyama, Daisuke; Okamoto, Tatsuaki

This paper presents a (PKI-based) two-pass authenticated key exchange (AKE) protocol that is secure in the extended Canetti-Krawczyk (eCK) security model. The security of the proposed protocol is proven without random oracles (under three assumptions), and relies on no implementation techniques such as a trick by LaMacchia, Lauter and Mityagin (so-called the NAXOS trick). Since an AKE protocol that is eCK-secure under a NAXOS-like implementation trick will be no more eCK-secure if some realistic information leakage occurs through side-channel attacks, it has been an important open problem how to realize an eCK-secure AKE protocol without using the NAXOS tricks (and without random oracles).

78 FR 54612 - Closed Captioning of Internet Protocol-Delivered Video Programming: Implementation of the Twenty...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-05

... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 79 [MB Docket No. 11-154; DA 13-1785] Closed Captioning of Internet Protocol-Delivered Video Programming: Implementation of the Twenty-First Century Communications and Video Accessibility Act of 2010 AGENCY: Federal Communications Commission. ACTION: Proposed...

From Information Management to Information Visualization

PubMed Central

Karami, Mahtab

2016-01-01

Summary Objective The development and implementation of a dashboard of medical imaging department (MID) performance indicators. Method Several articles discussing performance measures of imaging departments were searched for this study. All the related measures were extracted. Then, a panel of imaging experts were asked to rate these measures with an open ended question to seek further potential indicators. A second round was performed to confirm the performance rating. The indicators and their ratings were then reviewed by an executive panel. Based on the final panel’s rating, a list of indicators to be used was developed. A team of information technology consultants were asked to determine a set of user interface requirements for the building of the dashboard. In the first round, based on the panel’s rating, a list of main features or requirements to be used was determined. Next, Qlikview was utilized to implement the dashboard to visualize a set of selected KPI metrics. Finally, an evaluation of the dashboard was performed. Results 92 MID indicators were identified. On top of this, 53 main user interface requirements to build of the prototype of dashboard were determined. Then, the project team successfully implemented a prototype of radiology management dashboards into study site. The visual display that was designed was rated highly by users. Conclusion To develop a dashboard, management of information is essential. It is recommended that a quality map be designed for the MID. It can be used to specify the sequence of activities, their related indicators and required data for calculating these indicators. To achieve both an effective dashboard and a comprehensive view of operations, it is necessary to design a data warehouse for gathering data from a variety of systems. Utilizing interoperability standards for exchanging data among different systems can be also effective in this regard. PMID:27437043

Use of Key Performance Indicators to Improve Milestone Assessment in Semi-Annual Clinical Competency Committee Meetings.

PubMed

Chen, Fei; Arora, Harendra; Martinelli, Susan M

2017-01-01

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1-3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure. The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53-.94, after=.74-.98). We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations.

Use of Key Performance Indicators to Improve Milestone Assessment in Semi-Annual Clinical Competency Committee Meetings

PubMed Central

Arora, Harendra; Martinelli, Susan M.

2017-01-01

Background: The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. Methods: A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1–3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure. Results: The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53–.94, after=.74–.98). Conclusion: We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations. PMID:29766033

Formation of production structural units within a construction company using the systemic integrated method when implementing high-rise development projects

NASA Astrophysics Data System (ADS)

Lapidus, Azary; Abramov, Ivan

2018-03-01

Development of efficient algorithms for designing future operations is a vital element in construction business. This paper studies various aspects of a methodology required to determine the integration index for construction crews performing various process-related jobs. The main objective of the study outlined in this paper is to define the notion of integration in respect to a construction crew that performs complete cycles of construction and assembly works in order to find the optimal organizational solutions, using the integrated crew algorithm built specifically for that purpose. As seen in the sequence of algorithm elements, it was designed to focus on the key factors affecting the level of integration of a construction crew depending on the value of each of those elements. The multifactor modelling approach is used to assess the KPI of integrated construction crews involved in large-sale high-rise construction projects. The purpose of this study is to develop a theoretical recommendation and a scientific methodological provision of organizational and technological nature to ensure qualitative formation of integrated construction crews to increase their productivity during integrated implementation of multi-task construction phases. The key difference of the proposed solution from the already existing ones is that it requires identification of the degree of impact of each factor, including the change in the qualification level, on the integration index of each separate element in the organizational and technological system in construction (integrated construction crew).

Mobile Virtual Private Networking

NASA Astrophysics Data System (ADS)

Pulkkis, Göran; Grahn, Kaj; Mårtens, Mathias; Mattsson, Jonny

Mobile Virtual Private Networking (VPN) solutions based on the Internet Security Protocol (IPSec), Transport Layer Security/Secure Socket Layer (SSL/TLS), Secure Shell (SSH), 3G/GPRS cellular networks, Mobile IP, and the presently experimental Host Identity Protocol (HIP) are described, compared and evaluated. Mobile VPN solutions based on HIP are recommended for future networking because of superior processing efficiency and network capacity demand features. Mobile VPN implementation issues associated with the IP protocol versions IPv4 and IPv6 are also evaluated. Mobile VPN implementation experiences are presented and discussed.

Experimental Quantum Coin Tossing

NASA Astrophysics Data System (ADS)

Molina-Terriza, G.; Vaziri, A.; Ursin, R.; Zeilinger, A.

2005-01-01

In this Letter we present the first implementation of a quantum coin-tossing protocol. This protocol belongs to a class of “two-party” cryptographic problems, where the communication partners distrust each other. As with a number of such two-party protocols, the best implementation of the quantum coin tossing requires qutrits, resulting in a higher security than using qubits. In this way, we have also performed the first complete quantum communication protocol with qutrits. In our experiment the two partners succeeded to remotely toss a row of coins using photons entangled in the orbital angular momentum. We also show the experimental bounds of a possible cheater and the ways of detecting him.

METHODS AND ANALYSES FOR IMPLEMENTING NATURAL ATTENUATION PROTOCOLS

EPA Science Inventory

Technical protocols for evaluating natural attenuation at petroleum hydrocarbon and chlorinated solvent contaminated sites specify the analysis of electron acceptors and metabolic by-products for identifying and quantifying natural attenuation processes. However, these protocols ...

Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.

PubMed

Campbell, Stephen M; Kontopantelis, Evangelos; Hannon, Kerin; Burke, Martyn; Barber, Annette; Lester, Helen E

2011-08-10

Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes.

Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

PubMed Central

2012-01-01

Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings. Discussion Given the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home. PMID:23164244

The test of the layout of polarimeter "UFP" on the telescope AZT-2

NASA Astrophysics Data System (ADS)

Levchenko, T. A.; Nevodovskyi, P. V.; Vidmachenko, A. P.; Morozhenko, O. V.; Saryboha, H. V.; Zbrutsky, O. V.; Ivakhiv, O. V.

2016-05-01

Main Astronomical Observatory of NAS of Ukraine in cooperation with the National Technical University of Ukraine "KPI" and National University "Lviv Polytechnic" for a long time working on the design of an optical polarimeter to study of the stratospheric layer of the Earth using of orbital satellite. During this time, was accumulated a large experience of such work, and was established a layout of compact ultraviolet polarimeter (UFP) on board of satellite

Extended resolvent and inverse scattering with an application to KPI

NASA Astrophysics Data System (ADS)

Boiti, M.; Pempinelli, F.; Pogrebkov, A. K.; Prinari, B.

2003-08-01

We present in detail an extended resolvent approach for investigating linear problems associated to 2+1 dimensional integrable equations. Our presentation is based as an example on the nonstationary Schrödinger equation with potential being a perturbation of the one-soliton potential by means of a decaying two-dimensional function. Modification of the inverse scattering theory as well as properties of the Jost solutions and spectral data as follows from the resolvent approach are given.

Aerial Port Location Study

DTIC Science & Technology

1997-09-01

the Uniform Material Movements and Issue Priority System (UMMIPS) is becoming an increasing difficult and expensive challenge . (3) According to...NEWZEALA 25,742 406 71 CUA CUBI POINT BATAAN PHILIPPIN 23,500 10 72 AJR ARVIDSJAUR SWEDEN 22,900 34 73 KPI KAPIT MALAYSIA 21,155 10 74 MGA MANAGUA...600 3 109 BDS BRINDISI ITALY 485 13 110 KUL KUALA LUMPUR INTL MALAYSIA 391 1 111 YES ISTANBUL TURKEY 352 3 112 DOH DOHA QATAR 208 3 113 ZAG

Extractive cultivation of recombinant Escherichia coli using aqueous two-phase systems for production and separation of intracellular heat shock proteins.

PubMed

Umakoshi, H; Yano, K; Kuboi, R; Komasawa, I

1996-01-01

The extractive cultivation of recombinant Escherichia coli cells to produce, release, and separate heat shock proteins (HSPs; GroEL and GroES) using poly(ethylene glycol) (PEG)/dextran (Dex) aqueous two-phase systems was developed. The growth rate of E. coli OW10/pND5 cells in the PEG/Dex two-phase media was almost the same value as that in the control media. The addition of 0.1 M potassium phosphate salts (KPi) increased the productivity of HSPs with keeping the growth rate of E. coli cells relatively high. The partition coefficients of HSPs were improved to greater values when phosphate salts were added at a concentration of more than 0.1 M. As a result, PEG/Dex systems supplemented with 0.1 M KPi were found to be the optimized two-phase systems for the extractive cultivation of E. coli cells. In the systems, the HSPs were selectively partitioned to the top phase while cells occupied the bottom phase and the interface between the two phases. This integrated process was extended to a semicontinuous operating mode, where the top phase containing the HSPs was recovered following intermittent heating and ultrasonic irradiation. The bottom phase containing cells and cell debris was recycled together with new top phase solution to repeat production and recovery of HSPs.

Islamic value to the modification of BSC model (a case study in evaluating company performance)

NASA Astrophysics Data System (ADS)

Harwati; Permana, Y.

2017-12-01

Halal is the key word for the Muslim community in consuming goods or services. Providing halal products is the main focus for companies with the largest consumers from the Muslim community. Halal is not only from the ingredients but also from the process in its production. The purpose of this study is to design a model of performance measurement for a company in order to provide halal products. Balance Score Card (BSC) is used as a framework. BSC as a performance measurement system has advantages not only focus on financial aspect but also non finance. Islamic values are incorporated into four perspective of BSC. They are: Selection of sharia financial institutions in financial perspective, payment method by consumer in consumer perspective, number of product with halal certificate and menu clarify in internal business process perspective, then accuracy of payroll time in learning and growth perspective. The modified BSC model obtains 17 Key Performance Indicators (KPI). The model is applied in a culinary industry (restaurant). Structured questionnaires and scheduled interviews are used to collect the important data. The result show that these industry fail to meet 8 from total 17 KPI so performance achievement is only 70.81%, and only reach 22.58% in Islamic value aspect. This is recorded by the company as an input to improve their performance in order to compete in halal food business.

Trends in Diagnosis and Clinical Features of Melanoma in situ in U.S. Men and Women: a prospective, observational study

PubMed Central

Wei, Erin X.; Qureshi, Abrar A.; Han, Jiali; Li, Tricia Y.; Cho, Eunyoung; Lin, Jennifer Y.; Li, Wen-Qing

2016-01-01

Background The incidence of melanoma in situ is rising, but little is known about its characteristics. Objective To determine trends in diagnosis and clinical features of melanoma in situ. Methods Incident cases of melanoma were collected prospectively from the Nurses’ Health Study from 1976–2010 and Health Professionals Follow-up Study from 1986–2010. Results MIS incidence increased from 2 to 42 per 100,000-person-year (100KPY) among women, and from 11 to 73 per 100KPY among men, exceeding the rate of increase of invasive melanomas. Melanoma mortality initially increased during the follow-up period then plateaued. Men were more likely than women to develop in situ melanomas on upper half of the body (p<0.001). Invasive melanomas were diagnosed at a younger age than melanoma in situ (p<0.001), and were more likely to be found on the lower extremities than in situ melanomas (p<0.001). Limitations This is a strictly descriptive study without examination into mechanisms. Conclusion We found epidemiologic and clinical differences in in situ and invasive melanomas, which support further examination into the variations in etiologic pathways. The lack of improvement in mortality despite increase in detection of in situ relative to invasive lesions further highlight the need to improve invasive melanoma-specific clinical screening features. PMID:27436155

DDN (Defense Data Network) Protocol Implementations and Vendors Guide,

DTIC Science & Technology

1988-02-01

TELNET) TCP/IP on an ethernet network. The program simulates a Hayes modem through the serial port. BWFTP is a thorough implementation of the FTP...25 IMP interface at VV from 19.2 Kbps to 56K bps. The IP, ICMP, TCP, Telnet. FFP and SMTP protocols are implemented along with R-Utxities...WANs. microcomputers, dataswitches. minicomputers. "black boxes" and modems . DOCUMENTATION: Software System Overview, Generic X.25 Porting Guide

PR-PR: Cross-Platform Laboratory Automation System

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

Linshiz, G; Stawski, N; Goyal, G

To enable protocol standardization, sharing, and efficient implementation across laboratory automation platforms, we have further developed the PR-PR open-source high-level biology-friendly robot programming language as a cross-platform laboratory automation system. Beyond liquid-handling robotics, PR-PR now supports microfluidic and microscopy platforms, as well as protocol translation into human languages, such as English. While the same set of basic PR-PR commands and features are available for each supported platform, the underlying optimization and translation modules vary from platform to platform. Here, we describe these further developments to PR-PR, and demonstrate the experimental implementation and validation of PR-PR protocols for combinatorial modified Goldenmore » Gate DNA assembly across liquid-handling robotic, microfluidic, and manual platforms. To further test PR-PR cross-platform performance, we then implement and assess PR-PR protocols for Kunkel DNA mutagenesis and hierarchical Gibson DNA assembly for microfluidic and manual platforms.« less

PR-PR: cross-platform laboratory automation system.

PubMed

Linshiz, Gregory; Stawski, Nina; Goyal, Garima; Bi, Changhao; Poust, Sean; Sharma, Monica; Mutalik, Vivek; Keasling, Jay D; Hillson, Nathan J

2014-08-15

To enable protocol standardization, sharing, and efficient implementation across laboratory automation platforms, we have further developed the PR-PR open-source high-level biology-friendly robot programming language as a cross-platform laboratory automation system. Beyond liquid-handling robotics, PR-PR now supports microfluidic and microscopy platforms, as well as protocol translation into human languages, such as English. While the same set of basic PR-PR commands and features are available for each supported platform, the underlying optimization and translation modules vary from platform to platform. Here, we describe these further developments to PR-PR, and demonstrate the experimental implementation and validation of PR-PR protocols for combinatorial modified Golden Gate DNA assembly across liquid-handling robotic, microfluidic, and manual platforms. To further test PR-PR cross-platform performance, we then implement and assess PR-PR protocols for Kunkel DNA mutagenesis and hierarchical Gibson DNA assembly for microfluidic and manual platforms.

Calibrated work function mapping by Kelvin probe force microscopy

NASA Astrophysics Data System (ADS)

Fernández Garrillo, Pablo A.; Grévin, Benjamin; Chevalier, Nicolas; Borowik, Łukasz

2018-04-01

We propose and demonstrate the implementation of an alternative work function tip calibration procedure for Kelvin probe force microscopy under ultrahigh vacuum, using monocrystalline metallic materials with known crystallographic orientation as reference samples, instead of the often used highly oriented pyrolytic graphite calibration sample. The implementation of this protocol allows the acquisition of absolute and reproducible work function values, with an improved uncertainty with respect to unprepared highly oriented pyrolytic graphite-based protocols. The developed protocol allows the local investigation of absolute work function values over nanostructured samples and can be implemented in electronic structures and devices characterization as demonstrated over a nanostructured semiconductor sample presenting Al0.7Ga0.3As and GaAs layers with variable thickness. Additionally, using our protocol we find that the work function of annealed highly oriented pyrolytic graphite is equal to 4.6 ± 0.03 eV.

The Impact of a Universal Decolonization Protocol on Hospital-Acquired Methicillin-Resistant Staphylococcus aureus in a Burn Population.

PubMed

Johnson, Arthur T; Nygaard, Rachel M; Cohen, Ellie M; Fey, Ryan M; Wagner, Anne Lambert

Hospital-acquired (HA) methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of HA infections and a significant concern for burn centers. The use of 2% chlorhexidine-impregnated wipes and nasal mupirocin significantly decreases the rate of HA-MRSA in adult intensive care units. The aim of this study was to examine the impact of universal decolonization on the rate of MRSA conversion in an American Burn Association verified adult and pediatric burn center. Universal decolonization protocol consisting of daily chlorhexidine baths and a 5-day course of nasal mupirocin was implemented in the burn unit. MRSA screening both on admission and weekly and contact isolation practices were in place in pre-decolonization and post-decolonization periods. Patient data were analyzed 2 years before and 1 year after implementation of the protocol. The incidence rate of MRSA was significantly decreased after the implementation of the decolonization protocol (11.8 vs 1.0 per 1000 patient days, P < .001). Secondary to the loss of the skin barrier and suppressed immune systems, burn patients are at greater risk for invasive infection leading to severe complications and death. The prevalence of HA-MRSA at our institution's burn center was significantly decreased after the implementation of a universal decolonization protocol.

SU-F-P-04: Implementation of Dose Monitoring Software: Successes and Pitfalls

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

Och, J

2016-06-15

Purpose: to successfully install a dose monitoring software (DMS) application to assist in CT protocol and dose management. Methods: Upon selecting the DMS, we began our implementation of the application. A working group composed of Medical Physics, Radiology Administration, Information Technology, and CT technologists was formed. On-site training in the application was supplied by the vendor. The decision was made to apply the process for all the CT protocols on all platforms at all facilities. Protocols were painstakingly mapped to the correct masters, and the system went ‘live’. Results: We are routinely using DMS as a tool in our Clinicalmore » Performance CT QA program. It is useful in determining the effectiveness of revisions to existing protocols, and establishing performance baselines for new units. However, the implementation was not without difficulty. We identified several pitfalls and obstacles which frustrated progress. Including: Training deficiencies, Nomenclature problems, Communication, DICOM variability. Conclusion: Dose monitoring software can be a potent tool for QA. However, implementation of the program can be problematic and requires planning, organization and commitment.« less

Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated-Transitional Care Program in a Non-Veterans Affairs Hospital.

PubMed

Kind, Amy J H; Brenny-Fitzpatrick, Maria; Leahy-Gross, Kris; Mirr, Jacquelyn; Chapman, Elizabeth; Frey, Brooke; Houlahan, Beth

2016-02-01

The Department of Veterans Affairs (VA) Coordinated-Transitional Care (C-TraC) program is a low-cost transitional care program that uses hospital-based nurse case managers, inpatient team integration, and in-depth posthospital telephone contacts to support high-risk patients and their caregivers as they transition from hospital to community. The low-cost, primarily telephone-based C-TraC program reduced 30-day rehospitalizations by one-third, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased-based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 individuals with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC participants experienced a 30-day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C-TraC was not available (n = 1,307) (P < .001). The new C-TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Implementation of bipartite or remote unitary gates with repeater nodes

NASA Astrophysics Data System (ADS)

Yu, Li; Nemoto, Kae

2016-08-01

We propose some protocols to implement various classes of bipartite unitary operations on two remote parties with the help of repeater nodes in-between. We also present a protocol to implement a single-qubit unitary with parameters determined by a remote party with the help of up to three repeater nodes. It is assumed that the neighboring nodes are connected by noisy photonic channels, and the local gates can be performed quite accurately, while the decoherence of memories is significant. A unitary is often a part of a larger computation or communication task in a quantum network, and to reduce the amount of decoherence in other systems of the network, we focus on the goal of saving the total time for implementing a unitary including the time for entanglement preparation. We review some previously studied protocols that implement bipartite unitaries using local operations and classical communication and prior shared entanglement, and apply them to the situation with repeater nodes without prior entanglement. We find that the protocols using piecewise entanglement between neighboring nodes often require less total time compared to preparing entanglement between the two end nodes first and then performing the previously known protocols. For a generic bipartite unitary, as the number of repeater nodes increases, the total time could approach the time cost for direct signal transfer from one end node to the other. We also prove some lower bounds of the total time when there are a small number of repeater nodes. The application to position-based cryptography is discussed.

Impact of a bladder scan protocol on discharge efficiency within a care pathway for ambulatory inguinal herniorraphy.

PubMed

Antonescu, I; Baldini, G; Watson, D; Kaneva, P; Fried, G M; Khwaja, K; Vassiliou, M C; Carli, F; Feldman, L S

2013-12-01

Postoperative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, with an incidence reaching 38%, and many surgeons require patients to void before discharge. This study aimed to assess whether the implementation of a bladder scan-based voiding protocol reduces the time until discharge after ambulatory inguinal herniorraphy without increasing the rate of POUR. As part of a perioperative care pathway, a protocol was implemented to standardize decision making after elective inguinal hernia repair (February 2012). Patients were assessed with a bladder scan, and those with <600 mL of urine were discharged home, whereas those with more than 600 mL of urine had an in-and-out catheterization before discharge. The patients received written information about urinary symptoms and instructions to present to the emergency department if they were unable to void at home. An audit of scheduled outpatient inguinal hernia repairs between October 2011 and July 2012 was performed. Comparisons were made using the t test, Fisher's exact test, and Wilcoxon rank sum test where appropriate. Statistical significance was defined a priori as a p value lower than 0.05. During the study period, 124 patients underwent hernia repair: 60 before and 64 after implementation of the protocol. The findings showed no significant differences in patient characteristics, laparoscopic approach (35 vs. 33%; p = 0.80), proportion receiving general anesthesia (70 vs. 73%; p = 0.67), or amount of intravenous fluids given (793 vs. 663 mL; p = 0.07). The proportion of patients voiding before discharge was higher after protocol implementation (73 vs. 89%; p = 0.02). The protocol had no impact on median time to discharge (190 vs. 205 min; p = 0.60). Only one patient in each group presented to the emergency department with POUR (2%). After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge. The incidence of POUR was lower than reported in the literature.

SU-E-I-68: Practical Considerations On Implementation of the Image Gently Pediatric CT Protocols

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

Zhang, J; Adams, C; Lumby, C

Purpose: One limitation associated with the Image Gently pediatric CT protocols is practical implementation of the recommended manual techniques. Inconsistency as a result of different practice is a possibility among technologist. An additional concern is the added risk of data error that would result in over or underexposure. The Automatic Exposure Control (AEC) features automatically reduce radiation for children. However, they do not work efficiently for the patients of very small size and relative large size. This study aims to implement the Image Gently pediatric CT protocols in the practical setting while maintaining the use of AEC features for pediatricmore » patients of varying size. Methods: Anthropomorphological abdomen phantoms were scanned in a CT scanner using the Image Gently pediatric protocols, the AEC technique with a fixed adult baseline, and automatic protocols with various baselines. The baselines were adjusted corresponding to patient age, weight and posterioranterior thickness to match the Image Gently pediatric CT manual techniques. CTDIvol was recorded for each examination. Image noise was measured and recorded for image quality comparison. Clinical images were evaluated by pediatric radiologists. Results: By adjusting vendor default baselines used in the automatic techniques, radiation dose and image quality can match those of the Image Gently manual techniques. In practice, this can be achieved by dividing pediatric patients into three major groups for technologist reference: infant, small child, and large child. Further division can be done but will increase the number of CT protocols. For each group, AEC can efficiently adjust acquisition techniques for children. This implementation significantly overcomes the limitation of the Image Gently manual techniques. Conclusion: Considering the effectiveness in clinical practice, Image Gently Pediatric CT protocols can be implemented in accordance with AEC techniques, with adjusted baselines, to achieve the goal of providing the most appropriate radiation dose for pediatric patients of varying sizes.« less

Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review.

PubMed

Gillman, Anna; Winkler, Renata; Taylor, Nicholas F

2017-06-01

The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain 'nil by mouth', as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients' perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.

Evaluation of a Low-risk Mild Traumatic Brain Injury and Intracranial Hemorrhage Emergency Department Observation Protocol.

PubMed

Yun, Brian J; Borczuk, Pierre; Wang, Lulu; Dorner, Stephen; White, Benjamin A; Raja, Ali S

2017-11-20

Among emergency physicians, there is wide variation in admitting practices for patients who suffered a mild traumatic brain injury (TBI) with an intracranial hemorrhage (ICH). The purpose of this study was to evaluate the effects of implementing a protocol in the emergency department (ED) observation unit for patients with mild TBI and ICH. This retrospective cohort study was approved by the institutional review board. Study subjects were patients ≥ 18 years of age with an International Classification of Diseases code corresponding to a traumatic ICH and admitted to an ED observation unit (EDOU) of an urban, academic Level I trauma center between February 1, 2015, and January 31, 2017. Patient data and discharge disposition were abstracted from the electronic health record, and imaging data, from the final neuroradiologist report. To measure kappa, two abstractors independently collected data for presence of neuro deficit from a 10% random sample of the medical charts. Using a multivariable logistic regression model with a propensity score of the probability of placement in the EDOU before and after protocol implementation as a covariate, we sought to determine the pre-post effects of implementing a protocol on the composite outcome of admission to the floor, intensive care unit, or operating room from the EDOU and the proportion of patients with worsening findings on repeat computed tomography (CT) head scan in the EDOU. A total of 379 patients were identified during the study period; 83 were excluded as they were found to have no ICH on chart review. Inter-rater reliability kappa statistic was 0.63 for 30 charts. Among the 296 patients who remained eligible and comprised the study population, 143 were in the preprotocol period and 153 after protocol implementation. The EDOU protocol was associated with an independently statistically significant decreased odds ratio (OR) for admission or worsening ICH on repeat CT scan (OR = 0.45, 95% confidence interval [CI] = 0.25-0.82, p = 0.009) in the observation unit. After a stay in the EDOU, 26% (37/143) of patients required an inpatient admission before implementation of the protocol and 13% (20/153) of patients required an inpatient admission after protocol implementation. There was no statistically significant difference in log transformed EDOU length of stay (LOS) between the groups after adjusting for propensity score (p = 0.34). While there was no difference in EDOU LOS, implementing a low-risk mild TBI and ICH protocol in the EDOU may decrease the rate of inpatient admissions from the EDOU. A protocol-driven observation unit may help physicians by standardizing eligibility criteria and by providing guidance on management. As the propensity score method limits our ability to create a straightforward predictive model, a future larger study should validate the results. © 2017 by the Society for Academic Emergency Medicine.

The Use of Efficient Broadcast Protocols in Asynchronous Distributed Systems. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Schmuck, Frank Bernhard

1988-01-01

Reliable broadcast protocols are important tools in distributed and fault-tolerant programming. They are useful for sharing information and for maintaining replicated data in a distributed system. However, a wide range of such protocols has been proposed. These protocols differ in their fault tolerance and delivery ordering characteristics. There is a tradeoff between the cost of a broadcast protocol and how much ordering it provides. It is, therefore, desirable to employ protocols that support only a low degree of ordering whenever possible. This dissertation presents techniques for deciding how strongly ordered a protocol is necessary to solve a given application problem. It is shown that there are two distinct classes of application problems: problems that can be solved with efficient, asynchronous protocols, and problems that require global ordering. The concept of a linearization function that maps partially ordered sets of events to totally ordered histories is introduced. How to construct an asynchronous implementation that solves a given problem if a linearization function for it can be found is shown. It is proved that in general the question of whether a problem has an asynchronous solution is undecidable. Hence there exists no general algorithm that would automatically construct a suitable linearization function for a given problem. Therefore, an important subclass of problems that have certain commutativity properties are considered. Techniques for constructing asynchronous implementations for this class are presented. These techniques are useful for constructing efficient asynchronous implementations for a broad range of practical problems.

Knowledge, attitudes and practices of dental hygienists regarding caries management by risk assessment.

PubMed

Urban, Ruth A; Rowe, Dorothy J

2015-02-01

The purpose of this study was to survey dental hygienists to determine their knowledge, attitudes and practices regarding the implementation of caries risk assessment, particularly caries management by risk assessment (CAMBRA), in private dental practices. A 17 item survey was developed to evaluate dental hygienists' knowledge, attitudes and practices related to CAMBRA and perceived barriers to CAMBRA implementation in private dental practice. Surveys were mailed to a randomized sample of 1,000 dental hygienists licensed to practice in California. Responses were tabulated for each respondent, and the response frequency for each survey item was calculated. Respondents' comments to the open-ended question were compiled, according to themes. The response rate was 18%. Only 66% of the respondents were familiar with the term CAMBRA, although 89% agreed with its underlying principles of risk assessment. CAMBRA protocol had been implemented in 40% of the respondents' employment sites. Respondents disagreed that time (45%) and cost of products (68%) were barriers to implementation. Many did not know their employers' knowledge or attitudes about CAMBRA and its implementation, as evidenced by a "don't know" response range of 29 to 48% for the 4 relevant statements. Respondents' comments included both successes and barriers implementing CAMBRA. CAMBRA protocol has not been widely implemented in private practice, although the current data do not indicate insurmountable barriers. Broader dissemination may be feasible if dental hygienists would obtain more comprehensive knowledge of evidence-based risk assessment protocols and would assume a leadership role in implementing CAMBRA protocols and procedures in private dental practices. Copyright © 2015 The American Dental Hygienists’ Association.

Minimizing irreversible losses in quantum systems by local counterdiabatic driving

PubMed Central

Sels, Dries; Polkovnikov, Anatoli

2017-01-01

Counterdiabatic driving protocols have been proposed [Demirplak M, Rice SA (2003) J Chem Phys A 107:9937–9945; Berry M (2009) J Phys A Math Theor 42:365303] as a means to make fast changes in the Hamiltonian without exciting transitions. Such driving in principle allows one to realize arbitrarily fast annealing protocols or implement fast dissipationless driving, circumventing standard adiabatic limitations requiring infinitesimally slow rates. These ideas were tested and used both experimentally and theoretically in small systems, but in larger chaotic systems, it is known that exact counterdiabatic protocols do not exist. In this work, we develop a simple variational approach allowing one to find the best possible counterdiabatic protocols given physical constraints, like locality. These protocols are easy to derive and implement both experimentally and numerically. We show that, using these approximate protocols, one can drastically suppress heating and increase fidelity of quantum annealing protocols in complex many-particle systems. In the fast limit, these protocols provide an effective dual description of adiabatic dynamics, where the coupling constant plays the role of time and the counterdiabatic term plays the role of the Hamiltonian. PMID:28461472

MR efficiency using automated MRI-desktop eProtocol

NASA Astrophysics Data System (ADS)

Gao, Fei; Xu, Yanzhe; Panda, Anshuman; Zhang, Min; Hanson, James; Su, Congzhe; Wu, Teresa; Pavlicek, William; James, Judy R.

2017-03-01

MRI protocols are instruction sheets that radiology technologists use in routine clinical practice for guidance (e.g., slice position, acquisition parameters etc.). In Mayo Clinic Arizona (MCA), there are over 900 MR protocols (ranging across neuro, body, cardiac, breast etc.) which makes maintaining and updating the protocol instructions a labor intensive effort. The task is even more challenging given different vendors (Siemens, GE etc.). This is a universal problem faced by all the hospitals and/or medical research institutions. To increase the efficiency of the MR practice, we designed and implemented a web-based platform (eProtocol) to automate the management of MRI protocols. It is built upon a database that automatically extracts protocol information from DICOM compliant images and provides a user-friendly interface to the technologists to create, edit and update the protocols. Advanced operations such as protocol migrations from scanner to scanner and capability to upload Multimedia content were also implemented. To the best of our knowledge, eProtocol is the first MR protocol automated management tool used clinically. It is expected that this platform will significantly improve the radiology operations efficiency including better image quality and exam consistency, fewer repeat examinations and less acquisition errors. These protocols instructions will be readily available to the technologists during scans. In addition, this web-based platform can be extended to other imaging modalities such as CT, Mammography, and Interventional Radiology and different vendors for imaging protocol management.

Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation.

PubMed

Hadjistavropoulos, Thomas; Williams, Jaime; Kaasalainen, Sharon; Hunter, Paulette V; Savoie, Maryse L; Wickson-Griffiths, Abigail

2016-01-01

Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.

An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy.

PubMed

Benton, Katie; Thomson, Iain; Isenring, Elisabeth; Mark Smithers, B; Agarwal, Ekta

2018-06-01

Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care. Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests. There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group. A standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.

Quantum cryptography protocols robust against photon number splitting attacks for weak laser pulse implementations.

PubMed

Scarani, Valerio; Acín, Antonio; Ribordy, Grégoire; Gisin, Nicolas

2004-02-06

We introduce a new class of quantum key distribution protocols, tailored to be robust against photon number splitting (PNS) attacks. We study one of these protocols, which differs from the original protocol by Bennett and Brassard (BB84) only in the classical sifting procedure. This protocol is provably better than BB84 against PNS attacks at zero error.

Novel Application of a Reverse Triage Protocol Providing Increased Access to Care in an Outpatient, Primary Care Clinic Setting.

PubMed

Sacino, Amanda N; Shuster, Jonathan J; Nowicki, Kamil; Carek, Peter J; Wegman, Martin P; Listhaus, Alyson; Gibney, Joseph M; Chang, Ku-Lang

2016-02-01

As the number of patients with access to care increases, outpatient clinics will need to implement innovative strategies to maintain or enhance clinic efficiency. One viable alternative involves reverse triage. A reverse triage protocol was implemented during a student-run free clinic. Each patient's chief complaint(s) were obtained at the beginning of the clinic session and ranked by increasing complexity. "Complexity" was defined as the subjective amount of time required to provide a full, thorough evaluation of a patient. Less complex cases were prioritized first since they could be expedited through clinic processing and allow for more time and resources to be dedicated to complex cases. Descriptive statistics were used to characterize and summarize the data obtained. Categorical variables were analyzed using chi-square. A time series analysis of the outcome versus centered time in weeks was also conducted. The average number of patients seen per clinic session increased by 35% (9.5 versus 12.8) from pre-implementation of the reverse triage protocol to 6 months after the implementation of the protocol. The implementation of a reverse triage in an outpatient setting significantly increased clinic efficiency as noted by a significant increase in the number of patients seen during a clinic session.

Continued Development of Internet Protocols under the IBM OS/MVS Operating System

DTIC Science & Technology

1985-01-25

developed a prototype TCP/IP implementation for an IBM MVS host under a previous DARPA contract’ as part of the Internet research effort on the design of...participated in the DARPA Internet research program which led to the present TCP and IP protocols. Development of a prototype implementation of TCP/IP

77 FR 62449 - Approval and Promulgation of Implementation Plans; Alabama; Disapproval of 110(a)(2)(E)(ii...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-15

... in their comment that EPA approve a conflict of interest protocol submitted for inclusion in the SIP... that with the inclusion of this protocol in the SIP, EPA would be able to approve Alabama's 1997 annual... the State Implementation Plan (SIP) submissions, submitted by the State of Alabama, through the...

Software Implements a Space-Mission File-Transfer Protocol

NASA Technical Reports Server (NTRS)

Rundstrom, Kathleen; Ho, Son Q.; Levesque, Michael; Sanders, Felicia; Burleigh, Scott; Veregge, John

2004-01-01

CFDP is a computer program that implements the CCSDS (Consultative Committee for Space Data Systems) File Delivery Protocol, which is an international standard for automatic, reliable transfers of files of data between locations on Earth and in outer space. CFDP administers concurrent file transfers in both directions, delivery of data out of transmission order, reliable and unreliable transmission modes, and automatic retransmission of lost or corrupted data by use of one or more of several lost-segment-detection modes. The program also implements several data-integrity measures, including file checksums and optional cyclic redundancy checks for each protocol data unit. The metadata accompanying each file can include messages to users application programs and commands for operating on remote file systems.

Design and implementation of a telemedicine system using Bluetooth protocol and GSM/GPRS network, for real time remote patient monitoring.

PubMed

Jasemian, Yousef; Nielsen, Lars Arendt

2005-01-01

This paper introduces the design and implementation of a generic wireless and Real-time Multi-purpose Health Care Telemedicine system applying Bluetooth protocol, Global System for Mobile Communications (GSM) and General Packet Radio Service (GPRS). The paper explores the factors that should be considered when evaluating different technologies for application in telemedicine system. The design and implementation of an embedded wireless communication platform utilising Bluetooth protocol is described, and the implementation problems and limitations are investigated. The system is tested and its telecommunication general aspects are verified. The results showed that the system has (97.9 +/- 1.3)% Up-time, 2.5 x 10(-5) Bit Error Rate, 1% Dropped Call Rate, 97.4% Call Success Rate, 5 second transmission delay in average, (3.42 +/- 0.11) kbps throughput, and the system may have application in electrocardiography.

An approach to verification and validation of a reliable multicasting protocol: Extended Abstract

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1995-01-01

This paper describes the process of implementing a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally using a combination of formal and informal techniques in an attempt to ensure the correctness of its implementation. Our development process involved three concurrent activities: (1) the initial construction and incremental enhancement of a formal state model of the protocol machine; (2) the initial coding and incremental enhancement of the implementation; and (3) model-based testing of iterative implementations of the protocol. These activities were carried out by two separate teams: a design team and a V&V team. The design team built the first version of RMP with limited functionality to handle only nominal requirements of data delivery. This initial version did not handle off-nominal cases such as network partitions or site failures. Meanwhile, the V&V team concurrently developed a formal model of the requirements using a variant of SCR-based state tables. Based on these requirements tables, the V&V team developed test cases to exercise the implementation. In a series of iterative steps, the design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation. This was done by generating test cases based on suspected errant or off-nominal behaviors predicted by the current model. If the execution of a test in the model and implementation agreed, then the test either found a potential problem or verified a required behavior. However, if the execution of a test was different in the model and implementation, then the differences helped identify inconsistencies between the model and implementation. In either case, the dialogue between both teams drove the co-evolution of the model and implementation. We have found that this interactive, iterative approach to development allows software designers to focus on delivery of nominal functionality while the V&V team can focus on analysis of off nominal cases. Testing serves as the vehicle for keeping the model and implementation in fidelity with each other. This paper describes (1) our experiences in developing our process model; and (2) three example problems found during the development of RMP. Although RMP has provided our research effort with a rich set of test cases, it also has practical applications within NASA. For example, RMP is being considered for use in the NASA EOSDIS project due to its significant performance benefits in applications that need to replicate large amounts of data to many network sites.

Data transmission protocol for Pi-of-the-Sky cameras

NASA Astrophysics Data System (ADS)

Uzycki, J.; Kasprowicz, G.; Mankiewicz, M.; Nawrocki, K.; Sitek, P.; Sokolowski, M.; Sulej, R.; Tlaczala, W.

2006-10-01

The large amount of data collected by the automatic astronomical cameras has to be transferred to the fast computers in a reliable way. The method chosen should ensure data streaming in both directions but in nonsymmetrical way. The Ethernet interface is very good choice because of its popularity and proven performance. However it requires TCP/IP stack implementation in devices like cameras for full compliance with existing network and operating systems. This paper describes NUDP protocol, which was made as supplement to standard UDP protocol and can be used as a simple-network protocol. The NUDP does not need TCP protocol implementation and makes it possible to run the Ethernet network with simple devices based on microcontroller and/or FPGA chips. The data transmission idea was created especially for the "Pi of the Sky" project.

Exploring the Implementation of Steganography Protocols on Quantum Audio Signals

NASA Astrophysics Data System (ADS)

Chen, Kehan; Yan, Fei; Iliyasu, Abdullah M.; Zhao, Jianping

2018-02-01

Two quantum audio steganography (QAS) protocols are proposed, each of which manipulates or modifies the least significant qubit (LSQb) of the host quantum audio signal that is encoded as an FRQA (flexible representation of quantum audio) audio content. The first protocol (i.e. the conventional LSQb QAS protocol or simply the cLSQ stego protocol) is built on the exchanges between qubits encoding the quantum audio message and the LSQb of the amplitude information in the host quantum audio samples. In the second protocol, the embedding procedure to realize it implants information from a quantum audio message deep into the constraint-imposed most significant qubit (MSQb) of the host quantum audio samples, we refer to it as the pseudo MSQb QAS protocol or simply the pMSQ stego protocol. The cLSQ stego protocol is designed to guarantee high imperceptibility between the host quantum audio and its stego version, whereas the pMSQ stego protocol ensures that the resulting stego quantum audio signal is better immune to illicit tampering and copyright violations (a.k.a. robustness). Built on the circuit model of quantum computation, the circuit networks to execute the embedding and extraction algorithms of both QAS protocols are determined and simulation-based experiments are conducted to demonstrate their implementation. Outcomes attest that both protocols offer promising trade-offs in terms of imperceptibility and robustness.

Application Transparent HTTP Over a Disruption Tolerant Smartnet

DTIC Science & Technology

2014-09-01

American Standard Code for Information Interchange BP Bundle Protocol BPA bundle protocol agent CLA convergence layer adapters CPU central processing...forwarding them through the plugin pipeline. The initial version of the DTNInput plugin uses the BBN Spindle bundle protocol agent ( BPA ) implementation

Space Wire Upper Layer Protocols

NASA Technical Reports Server (NTRS)

Rakow, Glenn; Schnurr, Richard; Gilley, Daniel; Parkes, Steve

2004-01-01

This viewgraph presentation addresses efforts to provide a streamlined approach for developing SpaceWire Upper layer protocols which allows industry to drive standardized communication solutions for real projects. The presentation proposes a simple packet header that will allow flexibility in implementing a diverse range of protocols.

National Sample Assessment Protocols

ERIC Educational Resources Information Center

Ministerial Council on Education, Employment, Training and Youth Affairs (NJ1), 2012

2012-01-01

These protocols represent a working guide for planning and implementing national sample assessments in connection with the national Key Performance Measures (KPMs). The protocols are intended for agencies involved in planning or conducting national sample assessments and personnel responsible for administering associated tenders or contracts,…

Compact Modbus TCP/IP protocol for data acquisition systems based on limited hardware resources

NASA Astrophysics Data System (ADS)

Bai, Q.; Jin, B.; Wang, D.; Wang, Y.; Liu, X.

2018-04-01

The Modbus TCP/IP has been a standard industry communication protocol and widely utilized for establishing sensor-cloud platforms on the Internet. However, numerous existing data acquisition systems built on traditional single-chip microcontrollers without sufficient resources cannot support it, because the complete Modbus TCP/IP protocol always works dependent on a full operating system which occupies abundant hardware resources. Hence, a compact Modbus TCP/IP protocol is proposed in this work to make it run efficiently and stably even on a resource-limited hardware platform. Firstly, the Modbus TCP/IP protocol stack is analyzed and the refined protocol suite is rebuilt by streamlining the typical TCP/IP suite. Then, specific implementation of every hierarchical layer is respectively presented in detail according to the protocol structure. Besides, the compact protocol is implemented in a traditional microprocessor to validate the feasibility of the scheme. Finally, the performance of the proposed scenario is assessed. The experimental results demonstrate that message packets match the frame format of Modbus TCP/IP protocol and the average bandwidth reaches to 1.15 Mbps. The compact protocol operates stably even based on a traditional microcontroller with only 4-kB RAM and 12-MHz system clock, and no communication congestion or frequent packet loss occurs.

Emergency Department Pain Management in Adult Patients With Traumatic Injuries Before and After Implementation of a Nurse-Initiated Pain Treatment Protocol Utilizing Fentanyl for Severe Pain.

PubMed

Ridderikhof, Milan L; Schyns, Frederick J; Schep, Niels W; Lirk, Philipp; Hollmann, Markus W; Goslings, J Carel

2017-04-01

Pain management in the emergency department (ED) remains suboptimal. Nursing staff protocols could improve this, but studies show divergent results. Our aim was to evaluate a nurse-initiated pain-management protocol in adult patients with traumatic injuries in the short and in the long term, utilizing fentanyl for severe pain. In this pre-post implementation study, ED patients were included during three periods. The protocol allowed nurses to administer acetaminophen, non-steroidal anti-inflammatory drugs, or fentanyl autonomously, based on Numeric Rating Scale pain scores. Primary outcome was frequency of analgesic administration at 6 and 18 months after implementation. Secondary outcomes were pain awareness, occurrence of adverse events, and pain treatment after discharge. Five hundred and twelve patients before implementation were compared with 507 and 468 patients at 6 and 18 months after implementation, respectively. Analgesic administration increased significantly at 18 months (from 29% to 36%; p = 0.016), not at 6 months (33%; p = 0.19) after implementation. Pain awareness increased from 30% to 51% (p = 0.00) at 6 months and to 56% (p = 0.00) at 18 months, due to a significant increase in pain assessment: 3% to 30% (p = 0.00) and 32% (p = 0.00), respectively. Post-discharge pain treatment increased significantly at 18 months compared to baseline (from 25% to 33%; p = 0.016) and to 6 months (from 24% to 33%; p = 0.004). No adverse events were recorded. Implementation of a nurse-initiated pain-management protocol only increases analgesic administration in adult patients with traumatic injuries in the long term. Auditing might have promoted adherence. Pain awareness increases significantly in the short and the long term. Copyright © 2016 Elsevier Inc. All rights reserved.

The Impact of National Standards Assessment in New Zealand, and National Testing Protocols in Norway on Indigenous Schooling

ERIC Educational Resources Information Center

Özerk, Kamil; Whitehead, David

2012-01-01

This paper first provides a critic of the implementation of compulsory national assessment protocols internationally, and then nationally through a review of the implementation process used for the introduction of National Standards in New Zealand, and National Testing in Norwegian mainstream schools. It then reviews the impact of these two…

Universal Network Access System

DTIC Science & Technology

2003-11-01

128 Figure 37 The detail of the SCM TX , (LO; local oscillator, LPF; Low-pass filter, AMP; Amplifier, BPF ...with UNAS, ( BPF : band-pass filter, BM Rx; Burst Mode receiver, AWGR; Arrayed waveguide grating router, FBG; Fiber Bragg Grating, TL; Tunable Laser...protocols. Standard specifications and RFCs will be used as guidelines for implementation. Table 1 UNAS Serial I/O Formats Protocol Implement1

Implementing clinical protocols in oncology: quality gaps and the learning curve phenomenon.

PubMed

Kedikoglou, Simos; Syrigos, Konstantinos; Skalkidis, Yannis; Ploiarchopoulou, Fani; Dessypris, Nick; Petridou, Eleni

2005-08-01

The quality improvement effort in clinical practice has focused mostly on 'performance quality', i.e. on the development of comprehensive, evidence-based guidelines. This study aimed to assess the 'conformance quality', i.e. the extent to which guidelines once developed are correctly and consistently applied. It also aimed to assess the existence of quality gaps in the treatment of certain patient segments as defined by age or gender and to investigate methods to improve overall conformance quality. A retrospective audit of clinical practice in a well-defined oncology setting was undertaken and the results compared to those obtained from prospectively applying an internally developed clinical protocol in the same setting and using specific tools to increase conformance quality. All indicators showed improvement after the implementation of the protocol that in many cases reached statistical significance, while in the entire cohort advanced age was associated (although not significantly) with sub-optimal delivery of care. A 'learning curve' phenomenon in the implementation of quality initiatives was detected, with all indicators improving substantially in the second part of the prospective study. Clinicians should pay separate attention to the implementation of chosen protocols and employ specific tools to increase conformance quality in patient care.

[The intervention mapping protocol: A structured process to develop, implement and evaluate health promotion programs].

PubMed

Fassier, J-B; Lamort-Bouché, M; Sarnin, P; Durif-Bruckert, C; Péron, J; Letrilliart, L; Durand, M-J

2016-02-01

Health promotion programs are expected to improve population health and reduce social inequalities in health. However, their theoretical foundations are frequently ill-defined, and their implementation faces many obstacles. The aim of this article is to describe the intervention mapping protocol in health promotion programs planning, used recently in several countries. The challenges of planning health promotion programs are presented, and the six steps of the intervention mapping protocol are described with an example. Based on a literature review, the use of this protocol, its requirements and potential limitations are discussed. The intervention mapping protocol has four essential characteristics: an ecological perspective (person-environment), a participative approach, the use of theoretical models in human and social sciences and the use of scientific evidence. It comprises six steps: conduct a health needs assessment, define change objectives, select theory-based change techniques and practical applications, organize techniques and applications into an intervention program (logic model), plan for program adoption, implementation, and sustainability, and generate an evaluation plan. This protocol was used in different countries and domains such as obesity, tobacco, physical activity, cancer and occupational health. Although its utilization requires resources and a critical stance, this protocol was used to develop interventions which efficacy was demonstrated. The intervention mapping protocol is an integrated process that fits the scientific and practical challenges of health promotion. It could be tested in France as it was used in other countries, in particular to reduce social inequalities in health. Copyright © 2016. Published by Elsevier Masson SAS.

Factors affecting adoption, implementation fidelity, and sustainability of the Redesigned Community Health Fund in Tanzania: a mixed methods protocol for process evaluation in the Dodoma region

PubMed Central

Kalolo, Albino; Radermacher, Ralf; Stoermer, Manfred; Meshack, Menoris; De Allegri, Manuela

2015-01-01

Background Despite the implementation of various initiatives to address low enrollment in voluntary micro health insurance (MHI) schemes in sub-Saharan Africa, the problem of low enrollment remains unresolved. The lack of process evaluations of such interventions makes it difficult to ascertain whether their poor results are because of design failures or implementation weaknesses. Objective In this paper, we describe a process evaluation protocol aimed at opening the ‘black box’ to evaluate the implementation processes of the Redesigned Community Health Fund (CHF) program in the Dodoma region of Tanzania. Design The study employs a cross-sectional mixed methods design and is being carried out 3 years after the launch of the Redesigned CHF program. The study is grounded in a conceptual framework which rests on the Diffusion of Innovation Theory and the Implementation Fidelity Framework. The study utilizes a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews, and document review), and aligns the evaluation to the Theory of Intervention developed by our team. Quantitative data will be used to measure program adoption, implementation fidelity, and their moderating factors. Qualitative data will be used to explore the responses of stakeholders to the intervention, contextual factors, and moderators of adoption, implementation fidelity, and sustainability. Discussion This protocol describes a systematic process evaluation in relation to the implementation of a reformed MHI. We trust that the theoretical approaches and methodologies described in our protocol may be useful to inform the design of future process evaluations focused on the assessment of complex interventions, such as MHI schemes. PMID:26679408

Software Modules for the Proximity-1 Space Link Interleaved Time Synchronization (PITS) Protocol

NASA Technical Reports Server (NTRS)

Woo, Simon S.; Veregge, John R.; Gao, Jay L.; Clare, Loren P.; Mills, David

2012-01-01

The Proximity-1 Space Link Interleaved Time Synchronization (PITS) protocol provides time distribution and synchronization services for space systems. A software prototype implementation of the PITS algorithm has been developed that also provides the test harness to evaluate the key functionalities of PITS with simulated data source and sink. PITS integrates time synchronization functionality into the link layer of the CCSDS Proximity-1 Space Link Protocol. The software prototype implements the network packet format, data structures, and transmit- and receive-timestamp function for a time server and a client. The software also simulates the transmit and receive-time stamp exchanges via UDP (User Datagram Protocol) socket between a time server and a time client, and produces relative time offsets and delay estimates.

Design, Implementation, and Verification of the Reliable Multicast Protocol. Thesis

NASA Technical Reports Server (NTRS)

Montgomery, Todd L.

1995-01-01

This document describes the Reliable Multicast Protocol (RMP) design, first implementation, and formal verification. RMP provides a totally ordered, reliable, atomic multicast service on top of an unreliable multicast datagram service. RMP is fully and symmetrically distributed so that no site bears an undue portion of the communications load. RMP provides a wide range of guarantees, from unreliable delivery to totally ordered delivery, to K-resilient, majority resilient, and totally resilient atomic delivery. These guarantees are selectable on a per message basis. RMP provides many communication options, including virtual synchrony, a publisher/subscriber model of message delivery, a client/server model of delivery, mutually exclusive handlers for messages, and mutually exclusive locks. It has been commonly believed that total ordering of messages can only be achieved at great performance expense. RMP discounts this. The first implementation of RMP has been shown to provide high throughput performance on Local Area Networks (LAN). For two or more destinations a single LAN, RMP provides higher throughput than any other protocol that does not use multicast or broadcast technology. The design, implementation, and verification activities of RMP have occurred concurrently. This has allowed the verification to maintain a high fidelity between design model, implementation model, and the verification model. The restrictions of implementation have influenced the design earlier than in normal sequential approaches. The protocol as a whole has matured smoother by the inclusion of several different perspectives into the product development.

Study on Cloud Security Based on Trust Spanning Tree Protocol

NASA Astrophysics Data System (ADS)

Lai, Yingxu; Liu, Zenghui; Pan, Qiuyue; Liu, Jing

2015-09-01

Attacks executed on Spanning Tree Protocol (STP) expose the weakness of link layer protocols and put the higher layers in jeopardy. Although the problems have been studied for many years and various solutions have been proposed, many security issues remain. To enhance the security and credibility of layer-2 network, we propose a trust-based spanning tree protocol aiming at achieving a higher credibility of LAN switch with a simple and lightweight authentication mechanism. If correctly implemented in each trusted switch, the authentication of trust-based STP can guarantee the credibility of topology information that is announced to other switch in the LAN. To verify the enforcement of the trusted protocol, we present a new trust evaluation method of the STP using a specification-based state model. We implement a prototype of trust-based STP to investigate its practicality. Experiment shows that the trusted protocol can achieve security goals and effectively avoid STP attacks with a lower computation overhead and good convergence performance.

Protocol standards and implementation within the digital engineering laboratory computer network (DELNET) using the universal network interface device (UNID). Part 2

NASA Astrophysics Data System (ADS)

Phister, P. W., Jr.

1983-12-01

Development of the Air Force Institute of Technology's Digital Engineering Laboratory Network (DELNET) was continued with the development of an initial draft of a protocol standard for all seven layers as specified by the International Standards Organization's (ISO) Reference Model for Open Systems Interconnections. This effort centered on the restructuring of the Network Layer to perform Datagram routing and to conform to the developed protocol standards and actual software module development of the upper four protocol layers residing within the DELNET Monitor (Zilog MCZ 1/25 Computer System). Within the guidelines of the ISO Reference Model the Transport Layer was developed utilizing the Internet Header Format (IHF) combined with the Transport Control Protocol (TCP) to create a 128-byte Datagram. Also a limited Application Layer was created to pass the Gettysburg Address through the DELNET. This study formulated a first draft for the DELNET Protocol Standard and designed, implemented, and tested the Network, Transport, and Application Layers to conform to these protocol standards.

[PROtocol-based MObilizaTION on intensive care units : Design of a cluster randomized pilot study].

PubMed

Nydahl, P; Diers, A; Günther, U; Haastert, B; Hesse, S; Kerschensteiner, C; Klarmann, S; Köpke, S

2017-10-12

Despite convincing evidence for early mobilization of patients on intensive care units (ICU), implementation in practice is limited. Protocols for early mobilization, including in- and exclusion criteria, assessments, safety criteria, and step schemes may increase the rate of implementation and mobilization. Patients (population) on ICUs with a protocol for early mobilization (intervention), compared to patients on ICUs without protocol (control), will be more frequently mobilized (outcome). A multicenter, stepped-wedge, cluster-randomized pilot study is presented. Five ICUs will receive an adapted, interprofessional protocol for early mobilization in randomized order. Before and after implementation, mobilization of ICU patients will be evaluated by randomized monthly one-day point prevalence surveys. Primary outcome is the percentage of patients mobilized out of bed, operationalized as a score of ≥3 on the ICU Mobility Scale. Secondary outcome parameters will be presence and/or length of mechanical ventilation, delirium, stay on ICU and in hospital, barriers to early mobilization, adverse events, and process parameters as identified barriers, used strategies, and adaptions to local conditions. Exploratory evaluation of study feasibility and estimation of effect sizes as the basis for a future explanatory study.

Object Management Group object transaction service based on an X/Open and International Organization for Standardization open systems interconnection transaction processing kernel

NASA Astrophysics Data System (ADS)

Liang, J.; Sédillot, S.; Traverson, B.

1997-09-01

This paper addresses federation of a transactional object standard - Object Management Group (OMG) object transaction service (OTS) - with the X/Open distributed transaction processing (DTP) model and International Organization for Standardization (ISO) open systems interconnection (OSI) transaction processing (TP) communication protocol. The two-phase commit propagation rules within a distributed transaction tree are similar in the X/Open, ISO and OMG models. Building an OTS on an OSI TP protocol machine is possible because the two specifications are somewhat complementary. OTS defines a set of external interfaces without specific internal protocol machine, while OSI TP specifies an internal protocol machine without any application programming interface. Given these observations, and having already implemented an X/Open two-phase commit transaction toolkit based on an OSI TP protocol machine, we analyse the feasibility of using this implementation as a transaction service provider for OMG interfaces. Based on the favourable result of this feasibility study, we are implementing an OTS compliant system, which, by initiating the extensibility and openness strengths of OSI TP, is able to provide interoperability between X/Open DTP and OMG OTS models.

Visual grading characteristics and ordinal regression analysis during optimisation of CT head examinations.

PubMed

Zarb, Francis; McEntee, Mark F; Rainford, Louise

2015-06-01

To evaluate visual grading characteristics (VGC) and ordinal regression analysis during head CT optimisation as a potential alternative to visual grading assessment (VGA), traditionally employed to score anatomical visualisation. Patient images (n = 66) were obtained using current and optimised imaging protocols from two CT suites: a 16-slice scanner at the national Maltese centre for trauma and a 64-slice scanner in a private centre. Local resident radiologists (n = 6) performed VGA followed by VGC and ordinal regression analysis. VGC alone indicated that optimised protocols had similar image quality as current protocols. Ordinal logistic regression analysis provided an in-depth evaluation, criterion by criterion allowing the selective implementation of the protocols. The local radiology review panel supported the implementation of optimised protocols for brain CT examinations (including trauma) in one centre, achieving radiation dose reductions ranging from 24 % to 36 %. In the second centre a 29 % reduction in radiation dose was achieved for follow-up cases. The combined use of VGC and ordinal logistic regression analysis led to clinical decisions being taken on the implementation of the optimised protocols. This improved method of image quality analysis provided the evidence to support imaging protocol optimisation, resulting in significant radiation dose savings. • There is need for scientifically based image quality evaluation during CT optimisation. • VGC and ordinal regression analysis in combination led to better informed clinical decisions. • VGC and ordinal regression analysis led to dose reductions without compromising diagnostic efficacy.

Application Level Protocol Development for Library and Information Science Applications. Volume 1: Service Definition. Volume 2: Protocol Specification. Report No. TG.1.5; TG.50.

ERIC Educational Resources Information Center

Aagaard, James S.; And Others

This two-volume document specifies a protocol that was developed using the Reference Model for Open Systems Interconnection (OSI), which provides a framework for communications within a heterogeneous network environment. The protocol implements the features necessary for bibliographic searching, record maintenance, and mail transfer between…

[Protocol of the animal assisted activity program at a university hospital].

PubMed

Silveira, Isa Rodrigues; Santos, Nanci Cristiano; Linhares, Daniela Ribeiro

2011-03-01

Animal-Assisted Activity (AAA) consists in visitation and recreation through contact with animals, aiming at entertainment and improving the interpersonal relationship between patients and staff. Permission for the animals to visit an Institution requires a protocol with rules and safety routines to avoid accidents and zoonoses. The objective of this study is to describe the important points of the protocol to implement the AAA program. The protocol includes: introduction, objectives, inclusion and exclusion criteria for animals, drivers and patients; recommendations to the handlers and the health team, responsibilities of the Nosocomial Infection Control Committee, zoonoses posters, vaccination schedule for dogs and cats, free-informed consent to take part in the program and records with behavioral analysis of the animals. We believe that disclosing the protocol, based on scientific studies, favors the implementation of new programs in institutions considering the lack of national publications.

System and methods for predicting transmembrane domains in membrane proteins and mining the genome for recognizing G-protein coupled receptors

DOEpatents

Trabanino, Rene J; Vaidehi, Nagarajan; Hall, Spencer E; Goddard, William A; Floriano, Wely

2013-02-05

The invention provides computer-implemented methods and apparatus implementing a hierarchical protocol using multiscale molecular dynamics and molecular modeling methods to predict the presence of transmembrane regions in proteins, such as G-Protein Coupled Receptors (GPCR), and protein structural models generated according to the protocol. The protocol features a coarse grain sampling method, such as hydrophobicity analysis, to provide a fast and accurate procedure for predicting transmembrane regions. Methods and apparatus of the invention are useful to screen protein or polynucleotide databases for encoded proteins with transmembrane regions, such as GPCRs.

Configurable unitary transformations and linear logic gates using quantum memories.

PubMed

Campbell, G T; Pinel, O; Hosseini, M; Ralph, T C; Buchler, B C; Lam, P K

2014-08-08

We show that a set of optical memories can act as a configurable linear optical network operating on frequency-multiplexed optical states. Our protocol is applicable to any quantum memories that employ off-resonant Raman transitions to store optical information in atomic spins. In addition to the configurability, the protocol also offers favorable scaling with an increasing number of modes where N memories can be configured to implement arbitrary N-mode unitary operations during storage and readout. We demonstrate the versatility of this protocol by showing an example where cascaded memories are used to implement a conditional cz gate.

Aligning business strategy of incubator center and tenants

NASA Astrophysics Data System (ADS)

Prasetyawan, Yudha; Agustiani, Elly; Jumayla, Sari

2017-06-01

Incubator center is developed to help a particular group of small business players to achieve the expected business growth. In this center, business players often called as tenants will get assistances in pertaining with space, professional network, marketing, investment or funding, and training to improve their business capability. There are three types of incubator center, namely universities that help their alumni or business people in their surrounded area, company that supports small business as the corporate social responsibility, and independent organizations that have specialties in the business development. Some might success in increasing the capacity of the tenants, while other can have difficulties to increase the simplest business capability, e.g., to define the production cost to measure the profit. This study was intended to propose a model to align the business strategy between incubator center and its tenants. The sales and profit growth are the main priorities for the tenants together with their business capability and sustainability. The proposed alignment model provides measurement tools that link the motivation of tenants for joining the incubation process with the mission of incubator center. The linkage covered the key performance indicators (KPI), steps to achieve the target and evaluation tools to improve the current handicaps. An experiment on 4 (four) diverse business fields of the tenants of an incubator center was performed to test the model. As a result, the increase of KPI of incubator center will simultaneously yield a higher value of the tenants' sales.

Matrix elements of the electromagnetic operator between kaon and pion states

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

Baum, I.; Lubicz, V.; INFN, Sezione di Roma Tre, Via della Vasca Navale 84, I-00146 Roma

2011-10-01

We compute the matrix elements of the electromagnetic operator sF{sub {mu}{nu}}{sigma}{sup {mu}{nu}}d between kaon and pion states, using lattice QCD with maximally twisted-mass fermions and two flavors of dynamical quarks (N{sub f}=2). The operator is renormalized nonperturbatively in the RI'/MOM scheme and our simulations cover pion masses as light as 270 MeV and three values of the lattice spacing from {approx_equal}0.07 up to {approx_equal}0.1 fm. At the physical point our result for the corresponding tensor form factor at zero-momentum transfer is f{sub T}{sup K{pi}}(0)=0.417(14{sub stat})(5{sub syst}), where the systematic error does not include the effect of quenching the strange andmore » charm quarks. Our result differs significantly from the old quenched result f{sub T}{sup K{pi}}(0)=0.78(6) obtained by the SPQ{sub cd}R Collaboration with pion masses above 500 MeV. We investigate the source of this difference and conclude that it is mainly related to the chiral extrapolation. We also study the tensor charge of the pion and obtain the value f{sub T}{sup {pi}{pi}}(0)=0.195(8{sub stat})(6{sub syst}) in good agreement with, but more accurate than the result f{sub T}{sup {pi}{pi}}(0)=0.216(34) obtained by the QCDSF Collaboration using higher pion masses.« less

Multi-Agency Radiological Laboratory Analytical Protocols Manual (MARLAP)

EPA Pesticide Factsheets

The Multi-Agency Radiological Laboratory Analytical Protocols Manual (MARLAP) provides guidance for the planning, implementation and assessment phases of projects that require laboratory analysis of radionuclides.

A process evaluation of implementing a vocational enablement protocol for employees with hearing difficulties in clinical practice.

PubMed

Gussenhoven, Arjenne H M; Singh, Amika S; Goverts, S Theo; van Til, Marten; Anema, Johannes R; Kramer, Sophia E

2015-08-01

A multidisciplinary vocational rehabilitation programme, the Vocational Enablement Protocol (VEP) was developed to address the specific needs of employees with hearing difficulties. In the current study we evaluated the process of implementing the VEP in audiologic care among employees with hearing impairment. In conjunction with a randomized controlled trial, we collected and analysed data on seven process parameters: recruitment, reach, fidelity, dose delivered, dose received and implemented, satisfaction, and perceived benefit. Sixty-six employees with hearing impairment participated in the VEP. The multidisciplinary team providing the VEP comprised six professionals. The professionals performed the VEP according to the protocol. Of the recommendations delivered by the professionals, 31% were perceived as implemented by the employees. Compliance rate was highest for hearing-aid uptake (51%). Both employees and professionals were highly satisfied with the VEP. Participants rated good perceived benefit from it. Our results indicate that the VEP could be a useful treatment for employees with hearing difficulties from a process evaluation perspective. Implementation research in the audiological setting should be encouraged in order to further provide insight into parameters facilitating or hindering successful implementation of an intervention and to improve its quality and efficacy.

The impacts of electricity dispatch protocols on the emission reductions due to wind power and carbon tax.

PubMed

Yu, Yang; Rajagopal, Ram

2015-02-17

Two dispatch protocols have been adopted by electricity markets to deal with the uncertainty of wind power but the effects of the selection between the dispatch protocols have not been comprehensively analyzed. We establish a framework to compare the impacts of adopting different dispatch protocols on the efficacy of using wind power and implementing a carbon tax to reduce emissions. We suggest that a market has high potential to achieve greater emission reduction by adopting the stochastic dispatch protocol instead of the static protocol when the wind energy in the market is highly uncertain or the market has enough adjustable generators, such as gas-fired combustion generators. Furthermore, the carbon-tax policy is more cost-efficient for reducing CO2 emission when the market operates according to the stochastic protocol rather than the static protocol. An empirical study, which is calibrated according to the data from the Electric Reliability Council of Texas market, confirms that using wind energy in the Texas market results in a 12% CO2 emission reduction when the market uses the stochastic dispatch protocol instead of the 8% emission reduction associated with the static protocol. In addition, if a 6$/ton carbon tax is implemented in the Texas market operated according to the stochastic protocol, the CO2 emission is similar to the emission level from the same market with a 16$/ton carbon tax operated according to the static protocol. Correspondingly, the 16$/ton carbon tax associated with the static protocol costs 42.6% more than the 6$/ton carbon tax associated with the stochastic protocol.

Implementation of a Rapid, Protocol-based TIA Management Pathway.

PubMed

Jarhult, Susann J; Howell, Melissa L; Barnaure-Nachbar, Isabelle; Chang, Yuchiao; White, Benjamin A; Amatangelo, Mary; Brown, David F; Singhal, Aneesh B; Schwamm, Lee H; Silverman, Scott B; Goldstein, Joshua N

2018-03-01

Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA). We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup. Recommended workup included brain imaging, vascular imaging, cardiac monitoring, and observation. Patients were included if clinical providers determined the need for workup for TIA. We included consecutive patients presenting during a six-month period prior to protocol implementation, and those presenting between 6-12 months after implementation. Outcomes included ED length of stay (LOS), hospital LOS, use of neuroimaging, and 90-day risk of stroke or TIA. From 01/2012 to 06/2012, 130 patients were evaluated for TIA symptoms in the ED, and from 01/2013 to 06/2013, 150 patients. The final diagnosis was TIA or stroke in 45% before vs. 41% after (p=0.18). Following the intervention, the inpatient admission rate decreased from 62% to 24% (p<0.001), median ED LOS decreased by 1.2 hours (5.7 to 4.9 hours, p=0.027), and median total hospital LOS from 29.4 hours to 23.1 hours (p=0.019). The proportion of patients receiving head computed tomography (CT) went from 68% to 58% (p=0.087); brain magnetic resonance (MR) imaging from 83% to 88%, (p=0.44) neck CT angiography from 32% to 22% (p=0.039); and neck MR angiography from 61% to 72% (p=0.046). Ninety-day stroke or recurrent TIA among those with final diagnosis of TIA was 3% for both periods. Implementation of a TIA protocol significantly reduced ED LOS and total hospital LOS.

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

PubMed

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores.

Discharge planning in a cardiology out-patient clinic: a clinical audit.

PubMed

Ingram, Shirley; Khan, Barkat

2014-01-01

The purpose of this paper is to audit the active discharge (DC) planning process in a general cardiology clinic, by pre-assessing patients' medical notes and highlighting those suitable for potential DC to the clinic physician. The cardiology clinical nurse specialist (CNS) identified patients' for nine- to 12-month return visits one week prior to attendance. The previous consultation letter was accessed and information was documented by the CNS in the medical record. The key performance indicator (KPI) used was patient DCs for each clinic visit. The process was audited at three separate times to reflect recommended action carried out. The CNS pre-assessment and presence at the clinics significantly increased total DCs during the first period compared to usual care, 11 vs 34 per cent (p < 0.0001). During the third audit period, DCs fell (9 per cent) with a reduction in CNS pre-assessed DCs (10 per cent). Recommendations were implemented. The process was continued by clinic administration staff, colour coding all nine- to 12-month returns, resulted in a 19 per cent DC rate in 2012. CNS pre-assessment and highlighting DC suitability increased the number of patient DCs. As the CNS presence at the clinic reduced so did the rate of DC. Specific personnel need to be responsible for monitoring and reminding staff of the process; this does not always have to be medical or nursing. Implementing positive discharging procedures is aimed at improving quality, increasing efficiency and accessibility of services for patients. This audit describes a process to promote DC planning from cardiology outpatients.

Fuzz Testing of Industrial Network Protocols in Programmable Logic Controllers

DTIC Science & Technology

2017-12-01

PLCs) are vital components in these cyber-physical systems. The industrial network protocols used to communicate between nodes in a control network...AB/RA) MicroLogix 1100 PLC through its implementation of EtherNet/IP, Common Industrial Protocol (CIP), and Programmable Controller Communication ...Commands (PCCC) communication protocols. This research also examines whether cross-generational vulnerabilities exist in the more advanced AB/RA

Implementation of a protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic use in very low birth weight infants.

PubMed

Pinto, Maria Cristina F Guedes; Bueno, Arnaldo C; Vieira, Alan A

2013-01-01

To analyze the implementation of a protocol proposed by the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA) to improve sepsis diagnosis in very low birth weight newborns. This was a prospective study that evaluated the implementation of a protocol involving clinical and laboratory criteria (hematologic scoring system of Rodwell and C-reactive protein serial measurements), recommended by ANVISA, to improve the diagnosis of neonatal sepsis in very low birth weight newborns. The study included all patients who were born and remained in the neonatal intensive care unit until discharge or death, and excluded those with congenital diseases. The main outcomes measured in newborns before (2006-2007) and after implementation of the protocol (2008) were the rates of early and late-onset sepsis, use of antibiotics, and mortality. Means were compared by Student's t-test and categorical variables were compared by the chi-squared test; the significance level for all tests was set at 95%. The study included 136 newborns with very low birth weight. There was no difference between groups regarding general clinical characteristics in the studied periods. There was, however, a decrease in the number of diagnoses of probable early-onset sepsis (p<0.001), use of antimicrobial regimens (p<0.001), and overall mortality and infection-related mortality (p=0.009 and p=0.049, respectively). The implementation of the protocol allowed improvement of sepsis diagnosis by reducing the diagnosis of probable early-onset sepsis, thus promoting efficient antimicrobial use in this population. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Prospective Intervention of a Novel Levothyroxine Dosing Protocol Based on Body Mass Index after Thyroidectomy.

PubMed

Elfenbein, Dawn M; Schaefer, Sarah; Shumway, Cynthia; Chen, Herbert; Sippel, Rebecca S; Schneider, David F

2016-01-01

Weight-based postoperative levothyroxine (LT4) dosing often fails to appropriately dose overweight and underweight patients. Previously, we created an LT4-dosing algorithm based on BMI. We hypothesize that more patients will achieve euthyroidism at their postoperative visit with the use of the protocol. A prospective evaluation was performed of our previously published BMI-based LT4 dosing. All adults who underwent thyroidectomy for benign disease between January 1, 2011 and December 31, 2013 were included; the new protocol was implemented in October 2012. Serum TSH was measured for all patients 6 to 8 weeks postoperatively, and adjustments were based on TSH. Three hundred and thirty patients were included, with 54% undergoing thyroidectomy after institution of the protocol. The groups were well matched. Before protocol implementation, LT4 was dosed solely by weight and 25% of patients were euthyroid at initial follow-up. After the protocol, 39% of patients were euthyroid (p = 0.01). The percentage of patients who were given too high a dose of LT4 remained the same (46% vs 42%), and there was a significant reduction in the number of patients who were given too little (29% vs 19%; p = 0.05). The effect was most profound in patients with low and normal BMI, and there were slight differences between sexes. Although correct initial dosing of LT4 remains challenging, this dosing protocol that we developed and implemented has improved patient care by increasing the number of patients who achieve euthyroidism at the first postoperative visit. We have made a change to our original protocol to incorporate sex differences into the calculation. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system.

PubMed

Neinstein, Aaron; MacMaster, Heidemarie Windham; Sullivan, Mary M; Rushakoff, Robert

2014-07-01

In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process. Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation. © 2014 Diabetes Technology Society.

Implementation of a protocol for assembling DNA in a Teflon tube

NASA Astrophysics Data System (ADS)

Walsh, Edmond J.; Feuerborn, Alexander; Cook, Peter R.

2017-02-01

Droplet based microfluidics continues to grow as a platform for chemical and biological reactions using small quantities of fluids, however complex protocols are rarely possible in existing devices. This paper implements a new approach to merging of drops, combined with magnetic bead manipulation, for the creation of ligated double-stranded DNA molecule using "Gibson assembly" chemistry. DNA assembly is initially accomplished through the merging, and mixing, of five drops followed by a thermal cycle. Then, integrating this drop merging method with magnetic beads enable the implementation of amore complete protocol consisting of nine wash steps,merging of four drop, transport of selective reagents between twelve drops using magnetic particles, followed by a thermal cycle and finally the deposition of a purified drop into an Eppendorf for downstream analysis. Gel electrophoresis is used to confirm successful DNA assembly.

Coherent-pulse implementations of quantum cryptography protocols resistant to photon-number-splitting attacks

NASA Astrophysics Data System (ADS)

Acín, Antonio; Gisin, Nicolas; Scarani, Valerio

2004-01-01

We propose a class of quantum cryptography protocols that are robust against photon-number-splitting attacks (PNS) in a weak coherent-pulse implementation. We give a quite exhaustive analysis of several eavesdropping attacks on these schemes. The honest parties (Alice and Bob) use present-day technology, in particular an attenuated laser as an approximation of a single-photon source. The idea of the protocols is to exploit the nonorthogonality of quantum states to decrease the information accessible to Eve due to the multiphoton pulses produced by the imperfect source. The distance at which the key distribution becomes insecure due to the PNS attack is significantly increased compared to the existing schemes. We also show that strong-pulse implementations, where a strong pulse is included as a reference, allow for key distribution robust against photon-number-splitting attacks.

A Novel Quantum Solution to Privacy-Preserving Nearest Neighbor Query in Location-Based Services

NASA Astrophysics Data System (ADS)

Luo, Zhen-yu; Shi, Run-hua; Xu, Min; Zhang, Shun

2018-04-01

We present a cheating-sensitive quantum protocol for Privacy-Preserving Nearest Neighbor Query based on Oblivious Quantum Key Distribution and Quantum Encryption. Compared with the classical related protocols, our proposed protocol has higher security, because the security of our protocol is based on basic physical principles of quantum mechanics, instead of difficulty assumptions. Especially, our protocol takes single photons as quantum resources and only needs to perform single-photon projective measurement. Therefore, it is feasible to implement this protocol with the present technologies.

Nonblocking and orphan free message logging protocols

NASA Technical Reports Server (NTRS)

Alvisi, Lorenzo; Hoppe, Bruce; Marzullo, Keith

1992-01-01

Currently existing message logging protocols demonstrate a classic pessimistic vs. optimistic tradeoff. We show that the optimistic-pessimistic tradeoff is not inherent to the problem of message logging. We construct a message-logging protocol that has the positive features of both optimistic and pessimistic protocol: our protocol prevents orphans and allows simple failure recovery; however, it requires no blocking in failure-free runs. Furthermore, this protocol does not introduce any additional message overhead as compared to one implemented for a system in which messages may be lost but processes do not crash.

Nonblocking and orphan free message logging protocols

NASA Astrophysics Data System (ADS)

Alvisi, Lorenzo; Hoppe, Bruce; Marzullo, Keith

1992-12-01

Currently existing message logging protocols demonstrate a classic pessimistic vs. optimistic tradeoff. We show that the optimistic-pessimistic tradeoff is not inherent to the problem of message logging. We construct a message-logging protocol that has the positive features of both optimistic and pessimistic protocol: our protocol prevents orphans and allows simple failure recovery; however, it requires no blocking in failure-free runs. Furthermore, this protocol does not introduce any additional message overhead as compared to one implemented for a system in which messages may be lost but processes do not crash.

Continuous-variable quantum-key-distribution protocols with a non-Gaussian modulation

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

Leverrier, Anthony; Grangier, Philippe; Laboratoire Charles Fabry, Institut d'Optique, CNRS, Univ. Paris-Sud, Campus Polytechnique, RD 128, F-91127 Palaiseau Cedex

2011-04-15

In this paper, we consider continuous-variable quantum-key-distribution (QKD) protocols which use non-Gaussian modulations. These specific modulation schemes are compatible with very efficient error-correction procedures, hence allowing the protocols to outperform previous protocols in terms of achievable range. In their simplest implementation, these protocols are secure for any linear quantum channels (hence against Gaussian attacks). We also show how the use of decoy states makes the protocols secure against arbitrary collective attacks, which implies their unconditional security in the asymptotic limit.

Mars Sample Handling Protocol Workshop Series: Workshop 4

NASA Technical Reports Server (NTRS)

Race Margaret S. (Editor); DeVincenzi, Donald L. (Editor); Rummel, John D. (Editor); Acevedo, Sara E. (Editor)

2001-01-01

In preparation for missions to Mars that will involve the return of samples to Earth, it will be necessary to prepare for the receiving, handling, testing, distributing, and archiving of martian materials here on Earth. Previous groups and committees have studied selected aspects of sample return activities, but specific detailed protocols for the handling and testing of returned samples must still be developed. To further refine the requirements for sample hazard testing and to develop the criteria for subsequent release of sample materials from quarantine, the NASA Planetary Protection Officer convened a series of workshops in 2000-2001. The overall objective of the Workshop Series was to produce a Draft Protocol by which returned martian sample materials can be assessed for biological hazards and examined for evidence of life (extant or extinct) while safeguarding the purity of the samples from possible terrestrial contamination. This report also provides a record of the proceedings of Workshop 4, the final Workshop of the Series, which was held in Arlington, Virginia, June 5-7, 2001. During Workshop 4, the sub-groups were provided with a draft of the protocol compiled in May 2001 from the work done at prior Workshops in the Series. Then eight sub-groups were formed to discuss the following assigned topics: Review and Assess the Draft Protocol for Physical/Chemical Testing Review and Assess the Draft Protocol for Life Detection Testing Review and Assess the Draft Protocol for Biohazard Testing Environmental and Health/Monitoring and Safety Issues Requirements of the Draft Protocol for Facilities and Equipment Contingency Planning for Different Outcomes of the Draft Protocol Personnel Management Considerations in Implementation of the Draft Protocol Draft Protocol Implementation Process and Update Concepts This report provides the first complete presentation of the Draft Protocol for Mars Sample Handling to meet planetary protection needs. This Draft Protocol, which was compiled from deliberations and recommendations from earlier Workshops in the Series, represents a consensus that emerged from the discussions of all the sub-groups assembled over the course of the five Workshops of the Series. These discussions converged on a conceptual approach to sample handling, as well as on specific analytical requirements. Discussions also identified important issues requiring attention, as well as research and development needed for protocol implementation.

Quantum gambling using mesoscopic ring qubits

NASA Astrophysics Data System (ADS)

Pakuła, Ireneusz

2007-07-01

Quantum Game Theory provides us with new tools for practising games and some other risk related enterprices like, for example, gambling. The two party gambling protocol presented by Goldenberg {\\it et al} is one of the simplest yet still hard to implement applications of Quantum Game Theory. We propose potential physical realisation of the quantum gambling protocol with use of three mesoscopic ring qubits. We point out problems in implementation of such game.

Attacks exploiting deviation of mean photon number in quantum key distribution and coin tossing

NASA Astrophysics Data System (ADS)

Sajeed, Shihan; Radchenko, Igor; Kaiser, Sarah; Bourgoin, Jean-Philippe; Pappa, Anna; Monat, Laurent; Legré, Matthieu; Makarov, Vadim

2015-03-01

The security of quantum communication using a weak coherent source requires an accurate knowledge of the source's mean photon number. Finite calibration precision or an active manipulation by an attacker may cause the actual emitted photon number to deviate from the known value. We model effects of this deviation on the security of three quantum communication protocols: the Bennett-Brassard 1984 (BB84) quantum key distribution (QKD) protocol without decoy states, Scarani-Acín-Ribordy-Gisin 2004 (SARG04) QKD protocol, and a coin-tossing protocol. For QKD we model both a strong attack using technology possible in principle and a realistic attack bounded by today's technology. To maintain the mean photon number in two-way systems, such as plug-and-play and relativistic quantum cryptography schemes, bright pulse energy incoming from the communication channel must be monitored. Implementation of a monitoring detector has largely been ignored so far, except for ID Quantique's commercial QKD system Clavis2. We scrutinize this implementation for security problems and show that designing a hack-proof pulse-energy-measuring detector is far from trivial. Indeed, the first implementation has three serious flaws confirmed experimentally, each of which may be exploited in a cleverly constructed Trojan-horse attack. We discuss requirements for a loophole-free implementation of the monitoring detector.

Implementation of an antenatal magnesium sulfate protocol for fetal neuroprotection in preterm infants.

PubMed

Bouet, Pierre-Emmanuel; Brun, Stéphanie; Madar, Hugo; Baisson, Anne-Laure; Courtay, Véronique; Gascoin-Lachambre, Géraldine; Lasocki, Sigismond; Sentilhes, Loïc

2015-09-29

The aim of our study was to assess the feasibility of implementing a protocol for the use of magnesium sulfate to prevent cerebral palsy. This retrospective single-center study included all women with fetuses of gestational age <33 weeks of gestation whose birth was planned or expected within 24 hours from September 2011 to December 2012. They were to receive magnesium sulfate, administered intravenously as a 4-g bolus followed by a constant infusion of 1 g per hour. If delivery had not occurred after 12 hours and was no longer considered imminent, the infusion was to be discontinued. The study included 119 women, 81 (68.1%) of whom received magnesium sulfate. Among the latter, 71 (87.5%) gave birth within 24 hours. The reasons treatment was not given were: omission by medical team (19/38, 50%), urgent delivery (18/38, 47.4%), and contraindication to treatment (1/38, 2.6%). The mean gestational age at protocol implementation was 29.6 +/- 2.1 weeks. Maternal monitoring, especially at the onset of infusion, appeared suboptimal. No major maternal side effects were observed. Our study shows that implementing a protocol for prevention of cerebral palsy by magnesium sulfate is feasible in a tertiary obstetric center.

Comparing policies for children of parents attending hospital emergency departments after intimate partner violence, substance abuse or suicide attempt.

PubMed

Hoytema van Konijnenburg, Eva M M; Diderich, Hester M; Teeuw, Arianne H; Klein Velderman, Mariska; Oudesluys-Murphy, Anne Marie; van der Lee, Johanna H

2016-03-01

To improve identification of child maltreatment, a new policy ('Hague protocol') was implemented in hospitals in The Netherlands, stating that adults attending the hospital emergency department after intimate partner violence, substance abuse or a suicide attempt should be asked whether they care for children. If so, these children are referred to the Reporting Center for Child Abuse and Neglect (RCCAN), for assessment and referrals to support services. An adapted, hospital-based version of this protocol ('Amsterdam protocol') was implemented in another region. Children are identified in the same manner, but, instead of a RCCAN referral, they are referred to the pediatric outpatient department for an assessment, including a physical examination, and referrals to services. We compared results of both protocols to assess how differences between the protocols affect the outcomes on implementation, detection of child maltreatment and referrals to services. Furthermore, we assessed social validity and results of a screening physical examination. We included 212 families from the Amsterdam protocol (cohort study with reports by pediatric staff and parents) and 565 families from the Hague protocol (study of RCCAN records and telephone interviews with parents). We found that the RCCAN identified more maltreatment than pediatric staff (98% versus at least 51%), but referrals to services were similar (82% versus 80% of the total sample) and parents were positive about both interventions. Physical examination revealed signs of maltreatment in 5%. We conclude that, despite the differences, both procedures can serve as suitable methods to identify and refer children at risk for maltreatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws.

PubMed

Patel, Neha A; Bly, Randall A; Adams, Seth; Carlin, Kristen; Parikh, Sanjay R; Dahl, John P; Manning, Scott

2018-02-01

Postoperative calcium management is challenging following pediatric thyroidectomy given potential limitations in self-reporting symptoms and compliance with phlebotomy. A protocol was created at our tertiary children's institution utilizing intraoperative parathyroid hormone (PTH) levels to guide electrolyte management during hospitalization. The objective of this study was to determine the effect of a new thyroidectomy postoperative management protocol on two primary outcomes: (1) the number of postoperative calcium blood draws and (2) the length of hospital stay. Institutional review board approved retrospective study (2010-2016). Consecutive pediatric total thyroidectomy and completion thyroidectomy ± neck dissection cases from 1/1/2010 through 8/5/2016 at a single tertiary children's institution were retrospectively reviewed before and after initiation of a new management protocol. All cases after 2/1/2014 comprised the experimental group (post-protocol implementation). The pre-protocol control group consisted of cases prior to 2/1/2014. Multivariable linear and Poisson regression models were used to compare the control and experimental groups for outcome measure of number of calcium lab draws and hospital length of stay. 53 patients were included (n = 23, control group; n = 30 experimental group). The median age was 15 years. 41 patients (77.4%) were female. Postoperative calcium draws decreased from a mean of 5.2 to 3.6 per day post-protocol implementation (Rate Ratio = 0.70, p < .001), adjusting for covariates. The mean number of total inpatient calcium draws before protocol initiation was 13.3 (±13.20) compared to 7.2 (±4.25) in the post-protocol implementation group. Length of stay was 2.1 days in the control group and 1.8 days post-protocol implementation (p = .29). Patients who underwent concurrent neck dissection had a longer mean length of stay of 2.32 days compared to 1.66 days in those patients who did not undergo a neck dissection (p = .02). Hypocalcemia was also associated with a longer mean length of stay of 2.41 days compared to 1.60 days in patients who did not develop hypocalcemia (p < .01). The number of calcium blood draws was significantly reduced after introduction of a standardized protocol based on intraoperative PTH levels. The hospital length of stay did not change. Adoption of a standardized postoperative protocol based on intraoperative PTH levels may reduce the number of blood draws in children undergoing thyroidectomy. Copyright © 2017 Elsevier B.V. All rights reserved.

Concerning the use of multifunctional photometer - polarimeter for studying the invasion of cosmic bodies into the Earth's atmosphere

NASA Astrophysics Data System (ADS)

Geraimchuk, M. D.; Vidmachenko, A. P.; Nevodovskyi, P. V.; Steklov, O. F.

2018-05-01

Main astronomical observatory of the National Academy of Sciences of Ukraine together with the National Technical University of Ukraine "KPI" for many years working on the development of photometers-polarimeters for the study of cosmic bodies and Earth's atmosphere. We proposed an option of the development of a multipurpose panoramic photometer-polarimeter, which takes into account the shortcomings of the previous versions of the instrument and also allows for the registration of tracks of bolides, and study of their tails, and weak meteor phenomena.

Verknüpfung von DQ-Indikatoren mit KPIs und Auswirkungen auf das Return on Investment

NASA Astrophysics Data System (ADS)

Block, Frank

Häufig ist nicht klar, welche Beziehungen zwischen Datenqualitätsindikatoren (DQI, Definition folgt weiter unten) und Key Performance Indicators (KPI, s. Abschnitt 1.3 für weitere Details) eines Unternehmens oder einer Organisation bestehen. Dies ist insbesondere deshalb von Bedeutung, da die Kenntnis dieser Beziehungen maßgeblich die Ausprägung eines Datenqualitätsprojekts beeinflusst. Sie ist als Entscheidungsgrundlage unabdingbar und gibt Antworten auf folgende Fragen: Was kostet unserem Unternehmen/unserer Organisation1 schlechte Datenqualität? Können wir uns das leisten?

Serial Interface through Stream Protocol on EPICS Platform for Distributed Control and Monitoring

NASA Astrophysics Data System (ADS)

Das Gupta, Arnab; Srivastava, Amit K.; Sunil, S.; Khan, Ziauddin

2017-04-01

Remote operation of any equipment or device is implemented in distributed systems in order to control and proper monitoring of process values. For such remote operations, Experimental Physics and Industrial Control System (EPICS) is used as one of the important software tool for control and monitoring of a wide range of scientific parameters. A hardware interface is developed for implementation of EPICS software so that different equipment such as data converters, power supplies, pump controllers etc. could be remotely operated through stream protocol. EPICS base was setup on windows as well as Linux operating system for control and monitoring while EPICS modules such as asyn and stream device were used to interface the equipment with standard RS-232/RS-485 protocol. Stream Device protocol communicates with the serial line with an interface to asyn drivers. Graphical user interface and alarm handling were implemented with Motif Editor and Display Manager (MEDM) and Alarm Handler (ALH) command line channel access utility tools. This paper will describe the developed application which was tested with different equipment and devices serially interfaced to the PCs on a distributed network.

WE-E-304-01: SBRT Credentialing: Understanding the Process From Inquiry to Approval

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

Followill, D.

SBRT is having a dramatic impact on radiation therapy of early-stage, locally advanced cancers. A number of national protocols have been and are being developed to assess the clinical efficacy of SBRT for various anatomical sites, such as lung and spine. Physics credentialing for participating and implementation of trial protocols involve a broad spectrum of requirements from image guidance, motion management, to planning technology and dosimetric constrains. For radiation facilities that do not have extensive experiences in SBRT treatment and protocol credentialing, these complex processes of credentialing and implementation could be very challenging and, sometimes, may lead to ineffective evenmore » unsuccessful execution of these processes. In this proposal, we will provide comprehensive review of some current SBRT protocols, explain the requirements and their underline rationales, illustrate representative failed and successful experiences, related to SBRT credentialing, and discuss strategies for effective SBRT credentialing and implementation. Learning Objectives: Understand requirements and challenges of SBRT credentailing and implentation Discuss processes and strategies of effective SBRT credentailing Discuss practical considerations, potential pitfalls and solutions of SBRT implentation.« less

Experimental high-speed network

NASA Astrophysics Data System (ADS)

McNeill, Kevin M.; Klein, William P.; Vercillo, Richard; Alsafadi, Yasser H.; Parra, Miguel V.; Dallas, William J.

1993-09-01

Many existing local area networking protocols currently applied in medical imaging were originally designed for relatively low-speed, low-volume networking. These protocols utilize small packet sizes appropriate for text based communication. Local area networks of this type typically provide raw bandwidth under 125 MHz. These older network technologies are not optimized for the low delay, high data traffic environment of a totally digital radiology department. Some current implementations use point-to-point links when greater bandwidth is required. However, the use of point-to-point communications for a total digital radiology department network presents many disadvantages. This paper describes work on an experimental multi-access local area network called XFT. The work includes the protocol specification, and the design and implementation of network interface hardware and software. The protocol specifies the Physical and Data Link layers (OSI layers 1 & 2) for a fiber-optic based token ring providing a raw bandwidth of 500 MHz. The protocol design and implementation of the XFT interface hardware includes many features to optimize image transfer and provide flexibility for additional future enhancements which include: a modular hardware design supporting easy portability to a variety of host system buses, a versatile message buffer design providing 16 MB of memory, and the capability to extend the raw bandwidth of the network to 3.0 GHz.

Adaptive Probabilistic Protocols for Advanced Networks/Assuring the Integrity of Highly Decentralized Communications Systems

DTIC Science & Technology

2005-03-01

to obtain a protocol customized to the needs of a specific setting, under control of an automated theorem proving system that can guarantee...new “compositional” method for protocol design and implementation, in which small microprotocols are combined to obtain a protocol customized to the...and Network Centric Enterprise (NCES) visions. This final report documents a wide range of contributions and technology transitions, including: A

Communication-Gateway Software For NETEX, DECnet, And TCP/IP

NASA Technical Reports Server (NTRS)

Keith, B.; Ferry, D.; Fendler, E.

1990-01-01

Communications gateway software, GATEWAY, provides process-to-process communication between remote applications programs in different protocol domains. Communicating peer processes may be resident on any paired combination of NETEX, DECnet, or TCP/IP hosts. Provides necessary mapping from one protocol to another and facilitates practical intermachine communications in cost-effective manner by eliminating need to standardize on single protocol or to implement multiple protocols in host computers. Written in Ada.

Secure authentication protocol for Internet applications over CATV network

NASA Astrophysics Data System (ADS)

Chin, Le-Pond

1998-02-01

An authentication protocol is proposed in this paper to implement secure functions which include two way authentication and key management between end users and head-end. The protocol can protect transmission from frauds, attacks such as reply and wiretap. Location privacy is also achieved. A rest protocol is designed to restore the system once when systems fail. The security is verified by taking several security and privacy requirements into consideration.

TRIGA: Telecommunications Protocol Processing Subsystem Using Reconfigurable Interoperable Gate Arrays

NASA Technical Reports Server (NTRS)

Pang, Jackson; Pingree, Paula J.; Torgerson, J. Leigh

2006-01-01

We present the Telecommunications protocol processing subsystem using Reconfigurable Interoperable Gate Arrays (TRIGA), a novel approach that unifies fault tolerance, error correction coding and interplanetary communication protocol off-loading to implement CCSDS File Delivery Protocol and Datalink layers. The new reconfigurable architecture offers more than one order of magnitude throughput increase while reducing footprint requirements in memory, command and data handling processor utilization, communication system interconnects and power consumption.

Toward Synthesis, Analysis, and Certification of Security Protocols

NASA Technical Reports Server (NTRS)

Schumann, Johann

2004-01-01

Implemented security protocols are basically pieces of software which are used to (a) authenticate the other communication partners, (b) establish a secure communication channel between them (using insecure communication media), and (c) transfer data between the communication partners in such a way that these data only available to the desired receiver, but not to anyone else. Such an implementation usually consists of the following components: the protocol-engine, which controls in which sequence the messages of the protocol are sent over the network, and which controls the assembly/disassembly and processing (e.g., decryption) of the data. the cryptographic routines to actually encrypt or decrypt the data (using given keys), and t,he interface to the operating system and to the application. For a correct working of such a security protocol, all of these components must work flawlessly. Many formal-methods based techniques for the analysis of a security protocols have been developed. They range from using specific logics (e.g.: BAN-logic [4], or higher order logics [12] to model checking [2] approaches. In each approach, the analysis tries to prove that no (or at least not a modeled intruder) can get access to secret data. Otherwise, a scenario illustrating the &tack may be produced. Despite the seeming simplicity of security protocols ("only" a few messages are sent between the protocol partners in order to ensure a secure communication), many flaws have been detected. Unfortunately, even a perfect protocol engine does not guarantee flawless working of a security protocol, as incidents show. Many break-ins and security vulnerabilities are caused by exploiting errors in the implementation of the protocol engine or the underlying operating system. Attacks using buffer-overflows are a very common class of such attacks. Errors in the implementation of exception or error handling can open up additional vulnerabilities. For example, on a website with a log-in screen: multiple tries with invalid passwords caused the expected error message (too many retries). but let the user nevertheless pass. Finally, security can be compromised by silly implementation bugs or design decisions. In a commercial VPN software, all calls to the encryption routines were incidentally replaced by stubs, probably during factory testing. The product worked nicely. and the error (an open VPN) would have gone undetected, if a team member had not inspected the low-level traffic out of curiosity. Also, the use secret proprietary encryption routines can backfire, because such algorithms often exhibit weaknesses which can be exploited easily (see e.g., DVD encoding). Summarizing, there is large number of possibilities to make errors which can compromise the security of a protocol. In today s world with short time-to-market and the use of security protocols in open and hostile networks for safety-critical applications (e.g., power or air-traffic control), such slips could lead to catastrophic situations. Thus, formal methods and automatic reasoning techniques should not be used just for the formal proof of absence of an attack, but they ought to be used to provide an end-to-end tool-supported framework for security software. With such an approach all required artifacts (code, documentation, test cases) , formal analyses, and reliable certification will be generated automatically, given a single, high level specification. By a combination of program synthesis, formal protocol analysis, certification; and proof-carrying code, this goal is within practical reach, since all the important technologies for such an approach actually exist and only need to be assembled in the right way.

The Evaluation of Vocational Programming in Secondary School Settings: A Suggested Protocol

ERIC Educational Resources Information Center

George, Jennifer C.; Seruya, Francine M.

2018-01-01

The primary purpose of this project was to determine if a therapist-created protocol to develop a prevocational program provided sufficient information for a practitioner to implement a vocational program within another high school setting. The developed protocol was evaluated on feasibility and efficacy for replication within another setting by…

Quantum error correction of continuous-variable states against Gaussian noise

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

Ralph, T. C.

2011-08-15

We describe a continuous-variable error correction protocol that can correct the Gaussian noise induced by linear loss on Gaussian states. The protocol can be implemented using linear optics and photon counting. We explore the theoretical bounds of the protocol as well as the expected performance given current knowledge and technology.

Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes.

PubMed

Angel, Luis F; Levine, Deborah J; Restrepo, Marcos I; Johnson, Scott; Sako, Edward; Carpenter, Andrea; Calhoon, John; Cornell, John E; Adams, Sandra G; Chisholm, Gary B; Nespral, Joe; Roberson, Ann; Levine, Stephanie M

2006-09-15

One of the limitations associated with lung transplantation is the lack of available organs. To determine whether a lung donor-management protocol could increase the number of lungs for transplantation without affecting the survival rates of the recipients. We implemented the San Antonio Lung Transplant protocol for managing potential lung donors according to modifications of standard criteria for donor selection and strategies for donor management. We then compared information gathered during a 4-yr period, during which the protocol was used with information gathered during a 4-yr period before protocol implementation. Primary outcome measures were the procurement rate of lungs and the 30-d and 1-yr survival rates of recipients. We reviewed data from 711 potential lung donors. The mean rate of lung procurement was significantly higher (p < 0.0001) during the protocol period (25.5%) than during the pre-protocol period (11.5%), with an estimated risk ratio of 2.2 in favor of the protocol period. More patients received transplants during the protocol period (n = 121) than during the pre-protocol period (n = 53; p < 0.0001). Of 98 actual lung donors during the protocol period, 53 (54%) had initially been considered poor donors; these donors provided 64 (53%) of the 121 lung transplants. The type of donor was not associated with significant differences in recipients' 30-d and 1-yr survival rates or any clinical measures of adequate graft function. The protocol was associated with a significant increase in the number of lung donors and transplant procedures without compromising pulmonary function, length of stay, or survival of the recipients.

[Multidisciplinary protocol for computed tomography imaging and angiographic embolization of splenic injury due to trauma: assessment of pre-protocol and post-protocol outcomes].

PubMed

Koo, M; Sabaté, A; Magalló, P; García, M A; Domínguez, J; de Lama, M E; López, S

2011-11-01

To assess conservative treatment of splenic injury due to trauma, following a protocol for computed tomography (CT) and angiographic embolization. To quantify the predictive value of CT for detecting bleeding and need for embolization. The care protocol developed by the multidisciplinary team consisted of angiography with embolization of lesions revealed by contrast extravasation under CT as well as embolization of grade III-V injuries observed, or grade I-II injuries causing hemodynamic instability and/or need for blood transfusion. We collected data on demographic variables, injury severity score (ISS), angiographic findings, and injuries revealed by CT. Pre-protocol and post-protocol outcomes were compared. The sensitivity and specificity of CT findings were calculated for all patients who required angiographic embolization. Forty-four and 30 angiographies were performed in the pre- and post-protocol periods, respectively. The mean (SD) ISSs in the two periods were 25 (11) and 26 (12), respectively. A total of 24 (54%) embolizations were performed in the pre-protocol period and 28 (98%) after implementation of the protocol. Two and 7 embolizations involved the spleen in the 2 periods, respectively; abdominal laparotomies numbered 32 and 25, respectively, and 10 (31%) vs 4 (16%) splenectomies were performed. The specificity and sensitivity values for contrast extravasation found on CT and followed by embolization were 77.7% and 79.5%. The implementation of this multidisciplinary protocol using CT imaging and angiographic embolization led to a decrease in the number of splenectomies. The protocol allows us to take a more conservative treatment approach.

In-Space Networking on NASA's SCAN Testbed

NASA Technical Reports Server (NTRS)

Brooks, David E.; Eddy, Wesley M.; Clark, Gilbert J.; Johnson, Sandra K.

2016-01-01

The NASA Space Communications and Navigation (SCaN) Testbed, an external payload onboard the International Space Station, is equipped with three software defined radios and a flight computer for supporting in-space communication research. New technologies being studied using the SCaN Testbed include advanced networking, coding, and modulation protocols designed to support the transition of NASAs mission systems from primarily point to point data links and preplanned routes towards adaptive, autonomous internetworked operations needed to meet future mission objectives. Networking protocols implemented on the SCaN Testbed include the Advanced Orbiting Systems (AOS) link-layer protocol, Consultative Committee for Space Data Systems (CCSDS) Encapsulation Packets, Internet Protocol (IP), Space Link Extension (SLE), CCSDS File Delivery Protocol (CFDP), and Delay-Tolerant Networking (DTN) protocols including the Bundle Protocol (BP) and Licklider Transmission Protocol (LTP). The SCaN Testbed end-to-end system provides three S-band data links and one Ka-band data link to exchange space and ground data through NASAs Tracking Data Relay Satellite System or a direct-to-ground link to ground stations. The multiple data links and nodes provide several upgradable elements on both the space and ground systems. This paper will provide a general description of the testbeds system design and capabilities, discuss in detail the design and lessons learned in the implementation of the network protocols, and describe future plans for continuing research to meet the communication needs for evolving global space systems.

SU-E-P-03: Implementing a Low Dose Lung Screening CT Program Meeting Regulatory Requirements

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

LaFrance, M; Marsh, S; O'Donnell, G

Purpose: To provide information pertaining to IROC Houston QA Center's (RPC) credentialing process for institutions participating in NCI-sponsored clinical trials. Purpose: Provide guidance to the Radiology Departments with the intent of implementing a Low Dose CT Screening Program using different CT Scanners with multiple techniques within the framework of the required state regulations. Method: State Requirements for the purpose of implementing a Low Dose CT Lung Protocol required working with the Radiology and Pulmonary Department in setting up a Low Dose Screening Protocol designed to reduce the radiation burden to the patients enrolled. Radiation dose measurements (CTDIvol) for various CTmore » manufacturers (Siemens16, Siemens 64, Philips 64, and Neusoft128) for three different weight based protocols. All scans were reviewed by the Radiologist. Prior to starting a low dose lung screening protocol, information had to be submitted to the state for approval. Performing a Healing Arts protocol requires extensive information. This not only includes name and address of the applicant but a detailed description of the disease, the x-ray examination and the population to be examined. The unit had to be tested by a qualified expert using the technique charts. The credentials of all the operators, the supervisors and the Radiologists had to be submitted to the state. Results: All the appropriate documentation was sent to the state for review. The measured results between the Low Dose Protocol versus the default Adult Chest Protocol showed that there was a dose reduction of 65% for small (100-150 lb.) patient, 75% for the Medium patient (151-250 lbs.), and a 55% reduction for the Large patient ( over 250 lbs.). Conclusion: Measured results indicated that the Low Dose Protocol indeed lowered the screening patient's radiation dose and the institution was able to submit the protocol to the State's regulators.« less

Two-Stage Residual Inclusion Estimation in Health Services Research and Health Economics.

PubMed

Terza, Joseph V

2018-06-01

Empirical analyses in health services research and health economics often require implementation of nonlinear models whose regressors include one or more endogenous variables-regressors that are correlated with the unobserved random component of the model. In such cases, implementation of conventional regression methods that ignore endogeneity will likely produce results that are biased and not causally interpretable. Terza et al. (2008) discuss a relatively simple estimation method that avoids endogeneity bias and is applicable in a wide variety of nonlinear regression contexts. They call this method two-stage residual inclusion (2SRI). In the present paper, I offer a 2SRI how-to guide for practitioners and a step-by-step protocol that can be implemented with any of the popular statistical or econometric software packages. We introduce the protocol and its Stata implementation in the context of a real data example. Implementation of 2SRI for a very broad class of nonlinear models is then discussed. Additional examples are given. We analyze cigarette smoking as a determinant of infant birthweight using data from Mullahy (1997). It is hoped that the discussion will serve as a practical guide to implementation of the 2SRI protocol for applied researchers. © Health Research and Educational Trust.

FISH-in-CHIPS: A Microfluidic Platform for Molecular Typing of Cancer Cells.

PubMed

Perez-Toralla, Karla; Mottet, Guillaume; Tulukcuoglu-Guneri, Ezgi; Champ, Jérôme; Bidard, François-Clément; Pierga, Jean-Yves; Klijanienko, Jerzy; Draskovic, Irena; Malaquin, Laurent; Viovy, Jean-Louis; Descroix, Stéphanie

2017-01-01

Microfluidics offer powerful tools for the control, manipulation, and analysis of cells, in particular for the assessment of cell malignancy or the study of cell subpopulations. However, implementing complex biological protocols on chip remains a challenge. Sample preparation is often performed off chip using multiple manually performed steps, and protocols usually include different dehydration and drying steps that are not always compatible with a microfluidic format.Here, we report the implementation of a Fluorescence in situ Hybridization (FISH) protocol for the molecular typing of cancer cells in a simple and low-cost device. The geometry of the chip allows integrating the sample preparation steps to efficiently assess the genomic content of individual cells using a minute amount of sample. The FISH protocol can be fully automated, thus enabling its use in routine clinical practice.

Site visits to initiate recruitment in a clinical trial: does it matter who conducts the visit? Protocol for implementation in trials.

PubMed

Nollett, Claire; Kelson, Mark; Hood, Kerenza

2016-11-01

The Study Within a Trial (SWAT) program exists to 'embed research within research, so as to resolve uncertainties about the different ways of designing, conducting, analyzing, and interpreting evaluations of health and social care' (1). Published in this journal in 2013, a template for the first SWAT protocol outlined an investigation into the effects of site visits by the principal investigator on recruitment in multicentre randomized controlled trials (1). We have now designed a SWAT protocol to extend this question and ask 'does it matter who conducts the site visit?' Our aim is to provide a protocol that trials can implement to address this research question. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

HIV patient retention: the implementation of a North Carolina clinic-based protocol.

PubMed

Keller, Jennifer; Heine, Amy; LeViere, Anna Finestone; Donovan, Jenna; Wilkin, Aimee; Sullivan, Kristen; Quinlivan, Evelyn Byrd

2017-05-01

Decreased visit attendance leads to poor health outcomes, decreased viral suppression, and higher mortality rates for persons living with HIV. Retention in care is an important factor in improving health status for people living with HIV but continues to be a challenge in clinical settings. This paper details the development and implementation of the NC-LINK Retention Protocol, a clinic-based protocol to locate and reengage out-of-care patients, as part of overall clinic retention efforts. The protocol was implemented as one of four interventions of the NC-LINK Systems and Linkages Project, a multi-site initiative funded by the HIV/AIDS Bureau and the Special Projects of National Significance. Lists of out-of-care patients who had not received HIV medical care in over nine months and did not have a future appointment were created each month. Patient navigators, case managers, and other staff then followed a standardized protocol to locate and reengage these patients in care. A total of 452 patients were identified for reengagement services. Of those, 194 (43%) returned to care, 108 (24%) had another definitive outcome (incarcerated, deceased, or relocated) and 150 (33%) were referred for additional follow-up to locate and reengage in care. In summary, 67% of patients were located through the efforts of the clinic staff. The results of this intervention indicate that it is possible to successfully integrate a protocol into the existing infrastructure of a clinic and reengage a majority of out-of-care patients into medical care.

Improving preterm infant outcomes: implementing an evidence-based oral feeding advancement protocol in the neonatal intensive care unit.

PubMed

Kish, Mary Z

2014-10-01

The ability of a preterm infant to exclusively oral feed is a necessary standard for discharge readiness from the neonatal intensive care unit (NICU). Many of the interventions related to oral feeding advancement currently employed for preterm infants in the NICU are based on individual nursing observations and judgment. Studies involving standardized feeding protocols for oral feeding advancement have been shown to decrease variability in feeding practices, facilitate shortened transition times from gavage to oral feedings, improve bottle feeding performance, and significantly decrease the length of stay (LOS) in the NICU. This project critically evaluated the implementation of an oral feeding advancement protocol in a 74-bed level III NICU in an attempt to standardize the process of advancing oral feedings in medically stable preterm infants. A comprehensive review of the literature identified key features for successful oral feeding in preterm infants. Strong levels of evidence suggested an association between both nonnutritive sucking (NNS) opportunities and standardized feeding advancement protocols with successful oral feeding in preterm infants. These findings prompted a pilot practice change using a feeding advancement protocol and consisted of NNS and standardized oral feeding advancement opportunities. Time to exclusive oral feedings and LOS were compared pre- and postprotocol implementation during more than a 2-month evaluation period. Infants using NNS and the standardized oral feeding advancement protocol had an observed reduction in time to exclusive oral feedings and LOS, although statistical significance was not achieved.

A tailored implementation strategy to reduce the duration of intravenous antibiotic treatment in community-acquired pneumonia: a controlled before-and-after study.

PubMed

Engel, M F; Bruns, A H W; Hulscher, M E J L; Gaillard, C A J M; Sankatsing, S U C; Teding van Berkhout, F; Emmelot-Vonk, M H; Kuck, E M; Steeghs, M H M; den Breeijen, J H; Stellato, R K; Hoepelman, A I M; Oosterheert, J J

2014-11-01

We previously showed that 40 % of clinically stable patients hospitalised for community-acquired pneumonia (CAP) are not switched to oral therapy in a timely fashion because of physicians' barriers. We aimed to decrease this proportion by implementing a novel protocol. In a multi-centre controlled before-and-after study, we evaluated the effect of an implementation strategy tailored to previously identified barriers to an early switch. In three Dutch hospitals, a protocol dictating a timely switch strategy was implemented using educational sessions, pocket reminders and active involvement of nursing staff. Primary outcomes were the proportion of patients switched timely and the duration of intravenous antibiotic therapy. Length of hospital stay (LOS), patient outcome, education effects 6 months after implementation and implementation costs were secondary outcomes. Statistical analysis was performed using mixed-effects models. Prior to implementation, 146 patients were included and, after implementation, 213 patients were included. The case mix was comparable. The implementation did not change the proportion of patients switched on time (66 %). The median duration of intravenous antibiotic administration decreased from 4 days [interquartile range (IQR) 2-5] to 3 days (IQR 2-4), a decrease of 21 % [95 % confidence interval (CI) 11 %; 30 %) in the multi-variable analysis. LOS and patient outcome were comparable before and after implementation. Forty-three percent (56/129) of physicians attended the educational sessions. After 6 months, 24 % (10/42) of the interviewed attendees remembered the protocol's main message. Cumulative implementation costs were 5,798 (20/reduced intravenous treatment day). An implementation strategy tailored to previously identified barriers reduced the duration of intravenous antibiotic administration in hospitalised CAP patients by 1 day, at minimal cost.

76 FR 59963 - Closed Captioning of Internet Protocol-Delivered Video Programming: Implementation of the Twenty...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-28

...In this document, the Commission proposes rules to implement provisions of the Twenty-First Century Communications and Video Accessibility Act of 2010 (``CVAA'') that mandate rules for closed captioning of certain video programming delivered using Internet protocol (``IP''). The Commission seeks comment on rules that would apply to the distributors, providers, and owners of IP-delivered video programming, as well as the devices that display such programming.

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

Bauer, Gerry; et al.

The DAQ system of the CMS experiment at CERN collects data from more than 600 custom detector Front-End Drivers (FEDs). During 2013 and 2014 the CMS DAQ system will undergo a major upgrade to address the obsolescence of current hardware and the requirements posed by the upgrade of the LHC accelerator and various detector components. For a loss-less data collection from the FEDs a new FPGA based card implementing the TCP/IP protocol suite over 10Gbps Ethernet has been developed. To limit the TCP hardware implementation complexity the DAQ group developed a simplified and unidirectional but RFC 793 compliant version ofmore » the TCP protocol. This allows to use a PC with the standard Linux TCP/IP stack as a receiver. We present the challenges and protocol modifications made to TCP in order to simplify its FPGA implementation. We also describe the interaction between the simplified TCP and Linux TCP/IP stack including the performance measurements.« less

Optimal continuous variable quantum teleportation protocol for realistic settings

NASA Astrophysics Data System (ADS)

Luiz, F. S.; Rigolin, Gustavo

2015-03-01

We show the optimal setup that allows Alice to teleport coherent states | α > to Bob giving the greatest fidelity (efficiency) when one takes into account two realistic assumptions. The first one is the fact that in any actual implementation of the continuous variable teleportation protocol (CVTP) Alice and Bob necessarily share non-maximally entangled states (two-mode finitely squeezed states). The second one assumes that Alice's pool of possible coherent states to be teleported to Bob does not cover the whole complex plane (| α | < ∞). The optimal strategy is achieved by tuning three parameters in the original CVTP, namely, Alice's beam splitter transmittance and Bob's displacements in position and momentum implemented on the teleported state. These slight changes in the protocol are currently easy to be implemented and, as we show, give considerable gain in performance for a variety of possible pool of input states with Alice.

Report on July 2015 Additional Protocol Coordinators Best Practices Workshop

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

Gitau, Ernest T.N.; Burbank, Roberta L.; Finch, Valerie A.

After 10 years of implementation experience, the Office of Nonproliferation and Arms Control (NPAC) within the Department of Energy/National Nuclear Security Administration (DOE/NNSA) conducted the Additional Protocol (AP) Coordinators Best Practices Workshop at Oak Ridge National Laboratory from July 29-30, 2015. The goal of this workshop was to identify implementation best practices, lessons learned, and compliance challenges from the various Additional Protocol Coordinators (APCs) at each laboratory in the DOE/NNSA complex and associated sites. The workshop provided the opportunity for participants to share their insights and establish networks that APCs can utilize to continue to discuss challenges (new and old),more » identify best practices, and enhance communication and coordination for reporting multi-lab research projects during review activities. Workshop participants included DOE/NNSA HQ, laboratory and site APCs, seasoned experts, members of the original implementation outreach team, and Field Element and site security representatives.« less

Coherent-pulse implementations of quantum cryptography protocols resistant to photon-number-splitting attacks

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

Acin, Antonio; Gisin, Nicolas; Scarani, Valerio

2004-01-01

We propose a class of quantum cryptography protocols that are robust against photon-number-splitting attacks (PNS) in a weak coherent-pulse implementation. We give a quite exhaustive analysis of several eavesdropping attacks on these schemes. The honest parties (Alice and Bob) use present-day technology, in particular an attenuated laser as an approximation of a single-photon source. The idea of the protocols is to exploit the nonorthogonality of quantum states to decrease the information accessible to Eve due to the multiphoton pulses produced by the imperfect source. The distance at which the key distribution becomes insecure due to the PNS attack is significantlymore » increased compared to the existing schemes. We also show that strong-pulse implementations, where a strong pulse is included as a reference, allow for key distribution robust against photon-number-splitting attacks.« less

The EURECA telecommanding chain: Experience with packet telecommand and telemetry systems

NASA Technical Reports Server (NTRS)

Mueller, C.; Bater, R.; Sorensen, E. M.

1993-01-01

The European Retrieval Carrier (EURECA) was launched on its first flight on the 31st July 1992 by the Space Shuttle Atlantis. EURECA is characterized by several new on-board features, most notable Packet Telemetry and a partial implementation of Packet Telecommanding using an early version of the Command Operation Procedure (COP-1) protocol. EURECA has also very low contact time with its Ground Station, with a consequent high number of out-of-visibility onboard operations. This paper concentrates on the implementation and operational experience with the COP-1 Protocol and the effect the short ground contact time has on the design of the Commanding System. Another interesting feature is that the COP-1 is implemented at the control center rather than at the ground station. The COP-1 protocol also successfully supported the mission during the launch where commands were sent via NASCOM and the Shuttle.

Derivation and Implementation of a Protocol in Israel for Organ Donation after Cardio-Circulatory Death.

PubMed

Cohen, Jonathan; Rahamimov, Ruth; Hoffman, Aaron; Katvan, Eyal; Grozovski, Kyril; Ashkenazi, Tamar

2017-09-01

Strategies aimed at expanding the organ donor pool have been sought, which has resulted in renewed interest in donation after cardio-circulatory death (DCCD), also known as non-heart beating donors (NHBDs). To describe the derivation and implementation of a protocol for DCCD in Israel and report on the results with the first six cases. After receiving approval from an extraordinary ethics committee, Ministry of Health, the steering committee of the National Transplant Center defined and reached consensus on the unique challenges presented by a DCCD program. These protocol included medical aspects (construction of a clinical pathway), social and ethical aspects (presentation of the protocol at a public gathering(, legal/ethical aspects (consent for organ preservation procedures being either implied if the donor had signed an organ donor card or received directly from a surrogate decision maker), and logistical aspects (pilot study confined to kidney retrieval and to four medical centers). Data regarding organ donors and recipients were recorded. The protocol was implemented at four medical centers. Consent for organ donation was received from four of the six potential donors meeting criteria for inclusion, in all cases, from a surrogate decision maker. Of the eight kidneys retrieved, only four were suitable for transplantation, which was carried out successfully for four recipients. Graft function remained normal in all cases in 6-12 months follow-up. The DCCD program was successfully implemented and initial results are encouraging, suggesting that expansion of the program might further aid in decreasing the gap between needs and availability of organs.

The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial.

PubMed

Hershberg, Julie A; Rose, Dorian K; Tilson, Julie K; Brutsch, Bettina; Correa, Anita; Gallichio, Joann; McLeod, Molly; Moore, Craig; Wu, Sam; Duncan, Pamela W; Behrman, Andrea L

2017-01-01

Despite efforts to translate knowledge into clinical practice, barriers often arise in adapting the strict protocols of a randomized, controlled trial (RCT) to the individual patient. The Locomotor Experience Applied Post-Stroke (LEAPS) RCT demonstrated equal effectiveness of 2 intervention protocols for walking recovery poststroke; both protocols were more effective than usual care physical therapy. The purpose of this article was to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols into clinical practice. Participants from 2 of the trial's intervention arms: (1) early Locomotor Training Program (LTP) and (2) Home Exercise Program (HEP) were chosen for case presentation. The two cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise. Decision algorithms and guidelines for progression represent the interface between implementation of an RCT standardized intervention protocol and clinical decision-making. In each case, the participant presents with a distinct clinical challenge that the therapist addresses by integrating the participant's unique presentation with the therapist's expertise while maintaining fidelity to the LEAPS protocol. Both participants progressed through an increasingly challenging intervention despite their own unique presentation. Decision algorithms and exercise progression for the LTP and HEP protocols facilitate translation of the RCT protocol to the real world of clinical practice. The two case examples to facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A147).

From policy to practice: implementing frontline community health services for substance dependence--study protocol.

PubMed

Gill, Kathryn J; Campbell, Emily; Gauthier, Gail; Xenocostas, Spyridoula; Charney, Dara; Macaulay, Ann C

2014-08-20

Substance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada, issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2). Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence. Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health. Findings from this research program will contribute to the understanding of factors associated with implementation of frontline services for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.

Experimental eavesdropping attack against Ekert's protocol based on Wigner's inequality

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

Bovino, F. A.; Colla, A. M.; Castagnoli, G.

2003-09-01

We experimentally implemented an eavesdropping attack against the Ekert protocol for quantum key distribution based on the Wigner inequality. We demonstrate a serious lack of security of this protocol when the eavesdropper gains total control of the source. In addition we tested a modified Wigner inequality which should guarantee a secure quantum key distribution.

Suicide Risk Protocols: Addressing the Needs of High Risk Youths Identified through Suicide Prevention Efforts and in Clinical Settings

ERIC Educational Resources Information Center

Heilbron, Nicole; Goldston, David; Walrath, Christine; Rodi, Michael; McKeon, Richard

2013-01-01

Several agencies have emphasized the importance of establishing clear protocols or procedures to address the needs of youths who are identified as suicidal through suicide prevention programs or in emergency department settings. What constitutes optimal guidelines for developing and implementing such protocols, however, is unclear. At the request…

In vitro selection and amplification protocols for isolation of aptameric sensors for small molecules

PubMed Central

Yang, Kyung-Ae; Pei, Renjun; Stojanovic, Milan N.

2016-01-01

We recently optimized a procedure that directly yields aptameric sensors for small molecules in so-called structure-switching format. The protocol has a high success rate, short time, and is sufficiently simple to be readily implemented in a non-specialist laboratory. We provide a stepwise guide to this selection protocol. PMID:27155227

Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa.

PubMed

Melcer, Yaakov; Jauniaux, Eric; Maymon, Shlomit; Tsviban, Anna; Pekar-Zlotin, Marina; Betser, Moshe; Maymon, Ron

2018-04-01

Placenta accreta spectrum and vasa previa (VP) are congenital disorders of placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes. The objective of the study was to compare perinatal outcome in women with placenta accreta spectrum or vasa previa before and after implementation of targeted scanning protocols. This retrospective study included 2 nonconcurrent cohorts for each condition before and after implementation of the corresponding protocols (2004-1012 vs 2013-2016 for placenta accreta spectrum and 1988-2007 vs 2008-2016 for vasa previa). Clinical reports of women diagnosed with placenta accreta spectrum and vasa previa during the study periods were reviewed and outcomes were compared. In total, there were 97 cases of placenta accreta spectrum and 51 cases with vasa previa, all confirmed at delivery. In both cohorts, the prenatal detection rate increased after implementation of the scanning protocols (28 of 65 cases [43.1%] vs 31 of 32 cases [96.9%], P < .001, for placenta accreta spectrum and 9 of 18 cases [50%] vs 29 of 33 cases [87.9%], 87.9%, P < .01 for vasa previa). The perinatal outcome improved also significantly in both cohorts after implementation of the protocols. In the placenta accreta spectrum cohort, the estimated blood loss and the postoperative hospitalization stay decreased between periods (1520 ± 845 vs 1168 ± 707 mL, P < .01, and 10.9 ± 14.1 vs 5.7 ± 2.2 days, P < .05, respectively). In the vasa previa cohort, the number of 5 minute Apgar score ≤5 and umbilical cord pH <7 decreased between periods (5 of 18 cases [27.8%] vs 1 of 33 cases [3%]; P < .05, and 4 of 18 cases [22.2%] vs 1 of 33 cases [3%], P < .05, respectively). The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for placenta accreta spectrum and vasa previa was associated with improved maternal and neonatal outcomes. The continuous increases in the rates of caesarean deliveries and use of assisted reproductive technology highlights the need to develop training programs and introduce targeted scanning protocols at the national and international levels. Copyright © 2018 Elsevier Inc. All rights reserved.

Evaluation of a protocol-based intervention to promote timely switching from intravenous to oral paracetamol for post-operative pain management: an interrupted time series analysis.

PubMed

Sabry, Nirmeen; Dawoud, Dalia; Alansary, Adel; Hounsome, Natalia; Baines, Darrin

2015-12-01

Timely switching from intravenous to oral therapy ensures optimized treatment and efficient use of health care resources. Intravenous (IV) paracetamol is widely used for post-operative pain management but not always switched to the oral form in a timely manner, leading to unnecessary increase in expenditure. This study aims to evaluate the impact of a multifaceted intervention to promote timely switching from the IV to oral form in the post-operative setting. An evidence-based prescribing protocol was designed and implemented by the clinical pharmacy team in a single district general hospital in Egypt. The protocol specified the criteria for appropriate prescribing of IV paracetamol. Doctors were provided with information and educational sessions prior to implementation. A prospective, quasi-experimental study was undertaken to evaluate its impact on IV paracetamol utilization and costs. Data on monthly utilization and costs were recorded for 12 months before and after implementation (January 2012 to December 2013). Data were analysed using interrupted time series analysis. Prior to implementation, in 2012, total spending on IV paracetamol was 674 154.00 Egyptian Pounds (L.E.) ($23,668.00). There was a non-significant (P > 0.05) downward trend in utilization (-32 ampoules per month) and costs [reduction of 632 L.E. ($222) per month]. Following implementation, immediate decrease in utilization and costs (P < 0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95% CI: 24% to 28%, P < 0.001). A multifaceted, protocol-based intervention to ensure timely switching from IV-to-oral paracetamol achieved significant reduction in utilization and cost of IV paracetamol in the first 5 months of its implementation. © 2015 John Wiley & Sons, Ltd.

Impact of a Newly Implemented Burn Protocol on Surgically Managed Partial Thickness Burns at a Specialized Burns Center in Singapore.

PubMed

Tay, Khwee-Soon Vincent; Chong, Si-Jack; Tan, Bien-Keem

2016-03-01

This study evaluated the impact of a newly implemented protocol for superficial to mid-dermal partial thickness burns which involves early surgery and rapid coverage with biosynthetic dressing in a specialized national burns center in Singapore. Consecutive patients with 5% or greater total body surface area (TBSA) superficial to mid-dermal partial thickness burns injury admitted to the Burns Centre at the Singapore General Hospital between August and December 2014 for surgery within 48 hours of injury were prospectively recruited into the study to form the protocol group. Comparable historical cases from the year 2013 retrieved from the burns center audit database were used to form the historical control group. Demographics (age, sex), type and depth of burns, %TBSA burnt, number of operative sessions, and length of stay were recorded for each patient of both cohorts. Thirty-nine burns patients managed under the new protocol were compared with historical control (n = 39) comparable in age and extensiveness of burns. A significantly shorter length of stay (P < 0.05) per TBSA burns was observed in the new protocol group (0.74 day/%TBSA) versus historical control (1.55 day/%TBSA). Fewer operative sessions were needed under the new protocol for burns 10% or greater TBSA burns (P < 0.05). The authors report their promising experience with a newly implemented protocol for surgically managed burns patients which involves early surgery and appropriate use of biosynthetic dressing on superficial to mid-dermal partial thickness burns. Clinically, shorter lengths of stay, fewer operative sessions, and decreased need for skin grafting of burns patient were observed.

3D geostatistical modelling for identifying sinkhole disaster potential zones around the Verkhnekamskoye potash deposit (Russia)

NASA Astrophysics Data System (ADS)

Royer, J. J.; Litaudon, J.; Filippov, L. O.; Lyubimova, T.; Maximovich, N.

2017-07-01

This work results from a cooperative scientific program between the Perm State University (Russia) and the University of Lorraine (France). Its objectives are to integrate modern 3D geomodeling in order to improve sustainable mining extraction, especially for predicting and avoiding the formation of sinkholes disaster potential zones. Systematic exploration drill holes performed in the Verkhnekamskoye potash deposit (Perm region, Russia) have been used to build a comprehensive 3D model for better understanding the spatial repartition of the ore quality (geometallurgy). A precise modelling of the mineralized layers allows an estimation of the in-situ ore reserves after interpolating by kriging the potassium (K) and magnesium (Mg) contents at the node of a regular centred grid (over a million cells). Total resources in potassium vary according to the cut-off between 4.7Gt @ 16.1 % K2O; 0.32 % MgCl2 for a cut-off grade at 13.1% K2O and 2.06 Gt @ 18.2 % K2O; 0.32 % MgCl2 at a cut-off of 16.5% K2O. Most of reserves are located in the KPI, KPII and KPIII layers, the KPI being the richest, and KPIII the largest in terms of tonnage. A systematic study of the curvature calculated along the roof of the mineralized layers points out the location of potential main faults which play a major role in the formation of sinkhole during exploitation. A risk map is then derived from this attribute.

Red blood cell distribution width as a predictor of survival in nasal-type, extranodal natural killer/T-cell lymphoma

PubMed Central

He, Qiao; Cai, Shaolei; Li, Shi; Zeng, Jian; Zhang, Qing; Gao, Yu; Yu, Sisi

2017-01-01

We retrospectively enrolled 191 nasal-type, extranodal natural killer/T-cell lymphoma (ENKTL) patients newly diagnosed from 2008 to 2016 at the Sichuan Cancer Hospital, in order to evaluate the relationship between disease outcomes, demographic and clinical factors, and red blood cell distribution width (RDW). C-index, fisher's exact test, univariate analysis, and cox regression analysis were applied. The median age of patients was 44 years and 134 (70%) were men. The cutoff of RDW was 46.2 fL determined by Cutoff Finder. Patients with RDW≤46.2 fL had significantly better progression-free survival (PFS) (3-year PFS, 80.4% vs. 63.1%; P=0.01) and overall survival (OS) (3-year OS, 83.2% vs. 65.5%; P=0.004) than those with RDW>46.2 fL. Multivariate analysis demonstrated that elevated RDW is an independent adverse predictor of OS (P=0.021, HR=2.04). RDW is an independent predictor of survival outcomes in ENKTL, which we found to be superior to both the prognostic index of natural killer lymphoma (PINK) and the Korean Prognostic Index (KPI) in discriminating patients with different outcomes in low-risk and high-risk groups (all P < 0.05). The new models combining RDW with the International Prognostic Index (IPI), KPI, and PINK showed more powerful prognostic value than corresponding original models. RDW represents an easily available and inexpensive marker for risk stratification in patients with ENKTL treated with radiotherapy-based treatment. Further prospective studies are warranted to confirm the prognostic value of RDW in ENKTL. PMID:29190934

Red blood cell distribution width as a predictor of survival in nasal-type, extranodal natural killer/T-cell lymphoma.

PubMed

Luo, Huaichao; Quan, Xiaoying; Song, Xiao-Yu; Zhang, Li; Yin, Yilin; He, Qiao; Cai, Shaolei; Li, Shi; Zeng, Jian; Zhang, Qing; Gao, Yu; Yu, Sisi

2017-11-03

We retrospectively enrolled 191 nasal-type, extranodal natural killer/T-cell lymphoma (ENKTL) patients newly diagnosed from 2008 to 2016 at the Sichuan Cancer Hospital, in order to evaluate the relationship between disease outcomes, demographic and clinical factors, and red blood cell distribution width (RDW). C-index, fisher's exact test, univariate analysis, and cox regression analysis were applied. The median age of patients was 44 years and 134 (70%) were men. The cutoff of RDW was 46.2 fL determined by Cutoff Finder. Patients with RDW≤46.2 fL had significantly better progression-free survival (PFS) (3-year PFS, 80.4% vs. 63.1%; P =0.01) and overall survival (OS) (3-year OS, 83.2% vs. 65.5%; P =0.004) than those with RDW>46.2 fL. Multivariate analysis demonstrated that elevated RDW is an independent adverse predictor of OS ( P =0.021, HR=2.04). RDW is an independent predictor of survival outcomes in ENKTL, which we found to be superior to both the prognostic index of natural killer lymphoma (PINK) and the Korean Prognostic Index (KPI) in discriminating patients with different outcomes in low-risk and high-risk groups (all P < 0.05). The new models combining RDW with the International Prognostic Index (IPI), KPI, and PINK showed more powerful prognostic value than corresponding original models. RDW represents an easily available and inexpensive marker for risk stratification in patients with ENKTL treated with radiotherapy-based treatment. Further prospective studies are warranted to confirm the prognostic value of RDW in ENKTL.

Estimating the right allocation of resources on weekends and public holidays in Green Zone using hybrid methods

NASA Astrophysics Data System (ADS)

Yusoff, Nazhatul Sahima Mohd; Liong, Choong-Yeun; Ismail, Wan Rosmanira; Noh, Abu Yazid Md; Noor, Nur Amalina Mohd

2018-04-01

Long patient waiting time and congestion is a major problem faced by Green Zone in Emergency Department at Hospital Universiti Sains Malaysia (EDHUSM) especially during weekends and public holidays. Even though the Green Zone is servicing only the non-critical patients, patient waiting time, causing the department fails to achieve its Key Performance Indicator (KPI). The long waiting time is due to the insufficient resources provided during the weekends and public holidays versus the large number of patients. Currently, only two doctors supported by two nurses are scheduled for every shift during weekends and public holidays. The numbers of patients are higher during weekends and public holidays as compared to weekdays, but the scheduled number of doctors and nurses are the same as weekdays. Therefore, this study presents a hybrid method to estimate the right number of doctors and nurses for improving the services of the Green Zone during weekends and public holidays. Fifty scenarios based on current and proposed schedules of doctors and nurses are simulated and analysed using the hybrid method of Discrete Event Simulation (DES) and Data Envelopment Analysis (DEA). Banker, Charnes and Cooper (BCC) input-oriented model and Super-Efficiency models of DEA were used to analyse the efficiency of the scenarios. The results show that the best schedule is a combination of four doctors supported by four nurses in every shift during weekends and public holidays for the Green Zone. The findings show that such schedule will not only help the department to achieve its KPI but also enable a more optimal utilization of the resources.

Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health

PubMed Central

Holt, Kathryn E.; Wertheim, Heiman; Zadoks, Ruth N.; Baker, Stephen; Whitehouse, Chris A.; Dance, David; Jenney, Adam; Connor, Thomas R.; Hsu, Li Yang; Severin, Juliëtte; Brisse, Sylvain; Cao, Hanwei; Wilksch, Jonathan; Gorrie, Claire; Schultz, Mark B.; Edwards, David J.; Nguyen, Kinh Van; Nguyen, Trung Vu; Dao, Trinh Tuyet; Mensink, Martijn; Minh, Vien Le; Nhu, Nguyen Thi Khanh; Schultsz, Constance; Kuntaman, Kuntaman; Newton, Paul N.; Moore, Catrin E.; Strugnell, Richard A.; Thomson, Nicholas R.

2015-01-01

Klebsiella pneumoniae is now recognized as an urgent threat to human health because of the emergence of multidrug-resistant strains associated with hospital outbreaks and hypervirulent strains associated with severe community-acquired infections. K. pneumoniae is ubiquitous in the environment and can colonize and infect both plants and animals. However, little is known about the population structure of K. pneumoniae, so it is difficult to recognize or understand the emergence of clinically important clones within this highly genetically diverse species. Here we present a detailed genomic framework for K. pneumoniae based on whole-genome sequencing of more than 300 human and animal isolates spanning four continents. Our data provide genome-wide support for the splitting of K. pneumoniae into three distinct species, KpI (K. pneumoniae), KpII (K. quasipneumoniae), and KpIII (K. variicola). Further, for K. pneumoniae (KpI), the entity most frequently associated with human infection, we show the existence of >150 deeply branching lineages including numerous multidrug-resistant or hypervirulent clones. We show K. pneumoniae has a large accessory genome approaching 30,000 protein-coding genes, including a number of virulence functions that are significantly associated with invasive community-acquired disease in humans. In our dataset, antimicrobial resistance genes were common among human carriage isolates and hospital-acquired infections, which generally lacked the genes associated with invasive disease. The convergence of virulence and resistance genes potentially could lead to the emergence of untreatable invasive K. pneumoniae infections; our data provide the whole-genome framework against which to track the emergence of such threats. PMID:26100894

Applications of the balanced scorecard for strategic management and performance measurement in the health sector.

PubMed

Behrouzi, Farshad; Shaharoun, Awaluddin Mohamed; Ma'aram, Azanizawati

2014-05-01

In order to attain a useful balanced scorecard (BSC), appropriate performance perspectives and indicators are crucial to reflect all strategies of the organisation. The objectives of this survey were to give an insight regarding the situation of the BSC in the health sector over the past decade, and to afford a generic approach of the BSC development for health settings with specific focus on performance perspectives, performance indicators and BSC generation. After an extensive search based on publication date and research content, 29 articles published since 2002 were identified, categorised and analysed. Four critical attributes of each article were analysed, including BSC generation, performance perspectives, performance indicators and auxiliary tools. The results showed that 'internal business process' was the most notable BSC perspective as it was included in all reviewed articles. After investigating the literature, it was concluded that its comprehensiveness is the reason for the importance and high usage of this perspective. The findings showed that 12 cases out of 29 reviewed articles (41%) exceeded the maximum number of key performance indicators (KPI) suggested in a previous study. It was found that all 12 cases were large organisations with numerous departments (e.g. national health organisations). Such organisations require numerous KPI to cover all of their strategic objectives. It was recommended to utilise the cascaded BSC within such organisations to avoid complexity and difficulty in gathering, analysing and interpreting performance data. Meanwhile it requires more medical staff to contribute in BSC development, which will result in greater reliability of the BSC.

An economic cost analysis of emergency department key performance indicators in Ireland.

PubMed

Gannon, Brenda; Jones, Cheryl; McCabe, Aileen; O'Sullivan, Ronan; Wakai, Abel

2017-06-01

High quality data is fundamental to using key performance indicators (KPIs) for performance monitoring. However, the resources required to collect high quality data are often significant and should usually be targeted at high priority areas. As part of a study of 11 emergency department (ED) KPIs in Ireland, the primary objective of this study was to estimate the relative cost of collecting the additional minimum data set (MDS) elements for those 11 KPIs. An economic cost analysis focused on 12 EDs in the Republic of Ireland. The resource use data were obtained using two separate focus group interviews. The number of available MDS elements was obtained from a sample of 100 patient records per KPI per participating ED. Unit costs for all resource use were taken at the midpoint of the relevant staff salary scales. An ED would need to spend an estimated additional &OV0556;3561 per month on average to capture all the MDS elements relevant to the 11 KPIs investigated. The additional cost ranges from 14.8 to 39.2%; this range is 13.9-32.3% for small EDs, whereas the range for medium EDs is 11.7-40%. Regional EDs have a higher additional estimated cost to capture all the relevant MDS elements (&OV0556;3907), compared with urban EDs (&OV0556;3353). The additional cost of data collection, contingent on that already collected, required to capture all the relevant MDS elements for the KPIs examined, ranges from 14.8 to 39.2% per KPI, with variation identified between regional and urban hospitals.

Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach.

PubMed

Krzyżaniak, Natalia; Pawłowska, Iga; Bajorek, Beata

2018-03-31

Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI's) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI's structured along Donabedian's domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.

Implementation of a written protocol for management of central venous access devices: a theoretical and practical education, including bedside examinations.

PubMed

Ahlin, Catharina; Klang-Söderkvist, Birgitta; Brundin, Seija; Hellström, Birgitta; Pettersson, Karin; Johansson, Eva

2006-01-01

The objectives of this study were to evaluate registered nurses' (RN) compliance with a local clinical central venous access device (CVAD) protocol after completing an educational program and to determine RNs' perception of the program. Seventy-five RNs working in hematology participated in the educational part of the program. Sixty-eight RNs were examined while changing CVAD dressings or placing a Huber needle into a port on actual patients. Sixty percent of the RNs passed the examination and reported that the program increased their knowledge. The results indicated that the educational program could be recommended for use when implementing a new clinical protocol.

Two-party secret key distribution via a modified quantum secret sharing protocol.

PubMed

Grice, W P; Evans, P G; Lawrie, B; Legré, M; Lougovski, P; Ray, W; Williams, B P; Qi, B; Smith, A M

2015-03-23

We present and demonstrate a novel protocol for distributing secret keys between two and only two parties based on N-party single-qubit Quantum Secret Sharing (QSS). We demonstrate our new protocol with N = 3 parties using phase-encoded photons. We show that any two out of N parties can build a secret key based on partial information from each other and with collaboration from the remaining N - 2 parties. Our implementation allows for an accessible transition between N-party QSS and arbitrary two party QKD without modification of hardware. In addition, our approach significantly reduces the number of resources such as single photon detectors, lasers and dark fiber connections needed to implement QKD.

A Practical Approach to Implementing Real-Time Semantics

NASA Technical Reports Server (NTRS)

Luettgen, Gerald; Bhat, Girish; Cleaveland, Rance

1999-01-01

This paper investigates implementations of process algebras which are suitable for modeling concurrent real-time systems. It suggests an approach for efficiently implementing real-time semantics using dynamic priorities. For this purpose a proces algebra with dynamic priority is defined, whose semantics corresponds one-to-one to traditional real-time semantics. The advantage of the dynamic-priority approach is that it drastically reduces the state-space sizes of the systems in question while preserving all properties of their functional and real-time behavior. The utility of the technique is demonstrated by a case study which deals with the formal modeling and verification of the SCSI-2 bus-protocol. The case study is carried out in the Concurrency Workbench of North Carolina, an automated verification tool in which the process algebra with dynamic priority is implemented. It turns out that the state space of the bus-protocol model is about an order of magnitude smaller than the one resulting from real-time semantics. The accuracy of the model is proved by applying model checking for verifying several mandatory properties of the bus protocol.

General Approach to Quantum Channel Impossibility by Local Operations and Classical Communication.

PubMed

Cohen, Scott M

2017-01-13

We describe a general approach to proving the impossibility of implementing a quantum channel by local operations and classical communication (LOCC), even with an infinite number of rounds, and find that this can often be demonstrated by solving a set of linear equations. The method also allows one to design a LOCC protocol to implement the channel whenever such a protocol exists in any finite number of rounds. Perhaps surprisingly, the computational expense for analyzing LOCC channels is not much greater than that for LOCC measurements. We apply the method to several examples, two of which provide numerical evidence that the set of quantum channels that are not LOCC is not closed and that there exist channels that can be implemented by LOCC either in one round or in three rounds that are on the boundary of the set of all LOCC channels. Although every LOCC protocol must implement a separable quantum channel, it is a very difficult task to determine whether or not a given channel is separable. Fortunately, prior knowledge that the channel is separable is not required for application of our method.

Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

PubMed Central

Segelman, Josefin; Nygren, Jonas

2014-01-01

Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies. PMID:25469030

Practical quantum appointment scheduling

NASA Astrophysics Data System (ADS)

Touchette, Dave; Lovitz, Benjamin; Lütkenhaus, Norbert

2018-04-01

We propose a protocol based on coherent states and linear optics operations for solving the appointment-scheduling problem. Our main protocol leaks strictly less information about each party's input than the optimal classical protocol, even when considering experimental errors. Along with the ability to generate constant-amplitude coherent states over two modes, this protocol requires the ability to transfer these modes back-and-forth between the two parties multiple times with very low losses. The implementation requirements are thus still challenging. Along the way, we develop tools to study quantum information cost of interactive protocols in the finite regime.

Economical impact associated with a biological therapy prioritization protocol in patients with rheumatoid arthritis in the Hospital of Sagunto.

PubMed

Borrás-Blasco, Joaquín; Casterá, M Dolores-Elvira; Cortes, Xavier; Rosique-Robles, J Dolores; Abad, F Javier

2014-11-01

Until 2010 the cost of biological treatments in Rheumatoid Arthritis (RA) was increasing annually by 15% in our hospital. In 1st January 2011, a Hospital Commission of Biological Therapies involving rheumatology and pharmacy services was created to improve the management of biological drugs and a biological therapy prioritization protocol in RA patients was also established to improve the efficient usage of biological drugs in RA. To evaluate the economic impact associated with a biological therapy prioritization protocol for RA patients in the Hospital of Sagunto. Observational, ambispective study comparing the associated cost of RA patients treated with biological drugs in the pre-protocol (2009 - 2010) versus post-protocol periods (2011 - 2012). RA patients treated with Abatacept (ABA), Adalimumab (ADA), Etanercept (ETN) or Infliximab (IFX) for at least 6 months during the study period (2009 - 2012) were included. In 2012, Tocilizumab (TCZ) was also included in the prioritization protocol. Prioritization protocol was established based on both clinical and economical aspects and supervised case by case by our Commission. Cost savings and economic impact were calculated using Spanish official prices. In the pre-protocol period (2009 - 2010), total expenses were increasing by €110,000, up to €1,761,000 in 2010 (€11,362 pat/year). After protocol implementation, total expenses decreased by 53,676€ on the 2010 - 2011 period, and 149,200€ on the 2011 - 2012 period. On the 2010 - 2011 period the cost of biological therapy per patient-year decreased 355€ (11,007€ pat/year) and additional 653€ (up to 10,354€ pat/year) by 2012, with a cumulative effect of the protocol implementation of 1,008€ per patient-year. In the pre-protocol period (2009), the annual cost/patient was 10.812€ with ETN, 10.942€ with IFX, 12.961€ with ADA and 12.739€ with ABA. By 1st January 2013, the annual cost per patient was 9,469€ with ETN, 10,579€ with IFX, 11,117€ with ADA, 13,540€ with ABA and 14,932€ with TCZ. The creation of our Commission of Biological Therapies is key to rational management of RA patients and optimization of resources, allowing us to save 200,000€ after 2-year efficiency protocol implementation.

Modified classification and single-stage microsurgical repair of posttraumatic infected massive bone defects in lower extremities.

PubMed

Yang, Yun-fa; Xu, Zhong-he; Zhang, Guang-ming; Wang, Jian-wei; Hu, Si-wang; Hou, Zhi-qi; Xu, Da-chuan

2013-11-01

Posttraumatic infected massive bone defects in lower extremities are difficult to repair because they frequently exhibit massive bone and/or soft tissue defects, serious bone infection, and excessive scar proliferation. This study aimed to determine whether these defects could be classified and repaired at a single stage. A total of 51 cases of posttraumatic infected massive bone defect in lower extremity were included in this study. They were classified into four types on the basis of the conditions of the bone defects, soft tissue defects, and injured limb length, including Type A (without soft tissue defects), Type B (with soft tissue defects of 10 × 20 cm or less), Type C (with soft tissue defects of 10 × 20 cm or more), and Type D (with the limb shortening of 3 cm or more). Four types of single-stage microsurgical repair protocols were planned accordingly and implemented respectively. These protocols included the following: Protocol A, where vascularized fibular graft was implemented for Type A; Protocol B, where vascularized fibular osteoseptocutaneous graft was implemented for Type B; Protocol C, where vascularized fibular graft and anterior lateral thigh flap were used for Type C; and Protocol D, where limb lengthening and Protocols A, B, or C were used for Type D. There were 12, 33, 4, and 2 cases of Types A, B, C, and D, respectively, according to this classification. During the surgery, three cases of planned Protocol B had to be shifted into Protocol C; however, all microsurgical repairs were completed. With reference to Johner-Wruhs evaluation method, the total percentage of excellent and good results was 82.35% after 6 to 41 months of follow-up. It was concluded that posttraumatic massive bone defects could be accurately classified into four types on the basis of the conditions of bone defects, soft tissue coverage, and injured limb length, and successfully repaired with the single-stage repair protocols after thorough debridement. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Improving metabolic monitoring in patients maintained on antipsychotics in Penang, Malaysia.

PubMed

Hor, Esther Sl; Subramaniam, Sivasangari; Koay, Jun Min; Bharathy, Arokiamary; Vasudevan, Umadevi; Panickulam, Joseph J; Ng, InnTiong; Arif, Nor Hayati; Russell, Vincent

2016-02-01

To evaluate the monitoring of metabolic parameters among outpatients maintained on antipsychotic medications in a general hospital setting in Malaysia and to assess the impact of a local monitoring protocol. By performing a baseline audit of files from a random sample of 300 patients prescribed antipsychotic medications for at least 1 year; we determined the frequency of metabolic monitoring. The findings informed the design of a new local protocol, on which clinical staff was briefed. We re-evaluated metabolic monitoring immediately after implementation, in a small sample of new referrals and current patients. We explored staff perceptions of the initiative with a follow-up focus group, 6 months post-implementation. The baseline audit revealed a sub-optimal frequency of metabolic parameter recording. Re-audit, following implementation of the new protocol, revealed improved monitoring but persisting deficits. Dialogue with the clinical staff led to further protocol modification, clearer definition of staff roles and use of a standard recording template. Focus group findings revealed positive perceptions of the initiative, but persisting implementation barriers, including cultural issues surrounding waist circumference measurement. Responding to challenges in achieving improved routine metabolic monitoring of patients maintained on antipsychotics required on-going dialogue with the clinical staff, in order to address both service pressures and cultural concerns. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Advanced orbiting systems test-bedding and protocol verification

NASA Technical Reports Server (NTRS)

Noles, James; De Gree, Melvin

1989-01-01

The Consultative Committee for Space Data Systems (CCSDS) has begun the development of a set of protocol recommendations for Advanced Orbiting Systems (SOS). The AOS validation program and formal definition of AOS protocols are reviewed, and the configuration control of the AOS formal specifications is summarized. Independent implementations of the AOS protocols by NASA and ESA are discussed, and cross-support/interoperability tests which will allow the space agencies of various countries to share AOS communication facilities are addressed.

Generic Verification Protocol for Verification of Online Turbidimeters

EPA Science Inventory

This protocol provides generic procedures for implementing a verification test for the performance of online turbidimeters. The verification tests described in this document will be conducted under the Environmental Technology Verification (ETV) Program. Verification tests will...

A Passive Testing Approach for Protocols in Wireless Sensor Networks

PubMed Central

Che, Xiaoping; Maag, Stephane; Tan, Hwee-Xian; Tan, Hwee-Pink; Zhou, Zhangbing

2015-01-01

Smart systems are today increasingly developed with the number of wireless sensor devices drastically increasing. They are implemented within several contexts throughout our environment. Thus, sensed data transported in ubiquitous systems are important, and the way to carry them must be efficient and reliable. For that purpose, several routing protocols have been proposed for wireless sensor networks (WSN). However, one stage that is often neglected before their deployment is the conformance testing process, a crucial and challenging step. Compared to active testing techniques commonly used in wired networks, passive approaches are more suitable to the WSN environment. While some works propose to specify the protocol with state models or to analyze them with simulators and emulators, we here propose a logic-based approach for formally specifying some functional requirements of a novel WSN routing protocol. We provide an algorithm to evaluate these properties on collected protocol execution traces. Further, we demonstrate the efficiency and suitability of our approach by its application into common WSN functional properties, as well as specific ones designed from our own routing protocol. We provide relevant testing verdicts through a real indoor testbed and the implementation of our protocol. Furthermore, the flexibility, genericity and practicability of our approach have been proven by the experimental results. PMID:26610495

A Passive Testing Approach for Protocols in Wireless Sensor Networks.

PubMed

Che, Xiaoping; Maag, Stephane; Tan, Hwee-Xian; Tan, Hwee-Pink; Zhou, Zhangbing

2015-11-19

Smart systems are today increasingly developed with the number of wireless sensor devices drastically increasing. They are implemented within several contexts throughout our environment. Thus, sensed data transported in ubiquitous systems are important, and the way to carry them must be efficient and reliable. For that purpose, several routing protocols have been proposed for wireless sensor networks (WSN). However, one stage that is often neglected before their deployment is the conformance testing process, a crucial and challenging step. Compared to active testing techniques commonly used in wired networks, passive approaches are more suitable to the WSN environment. While some works propose to specify the protocol with state models or to analyze them with simulators and emulators, we here propose a logic-based approach for formally specifying some functional requirements of a novel WSN routing protocol. We provide an algorithm to evaluate these properties on collected protocol execution traces. Further, we demonstrate the efficiency and suitability of our approach by its application into common WSN functional properties, as well as specific ones designed from our own routing protocol. We provide relevant testing verdicts through a real indoor testbed and the implementation of our protocol. Furthermore, the flexibility, genericity and practicability of our approach have been proven by the experimental results.

Reducing recurrence in child protective services: impact of a targeted safety protocol.

PubMed

Fluke, J; Edwards, M; Bussey, M; Wells, S; Johnson, W

2001-08-01

Statewide implementation of a child safety assessment protocol by the Illinois Department of Children and Family Services (DCFS) in 1995 is assessed to determine its impact on near-term recurrence of child maltreatment. Literature on the use of risk and safety assessment as a decision-making tool supports the DCFS's approach. The literature on the use of recurrence as a summative measure for evaluation is described. Survival analysis is used with an administrative data set of 400,000 children reported to DCFS between October 1994 and November 1997. An ex-post facto design tests the hypothesis that the use of the protocol cannot be ruled out as an explanation for the observed decline in recurrence following implementation. Several alternative hypotheses are tested: change in use of protective custody, other concurrent changes in state policy, and the concurrent experience of other states. The impact of the protocol to reduce recurrence was not ruled out.

Implementing an intravenous insulin protocol in your practice: practical advice to overcome clinical, administrative, and financial barriers.

PubMed

Kelly, Janet L; Hirsch, Irl B; Furnary, Anthony P

2006-01-01

Diabetes mellitus is the fourth most common comorbid condition among hospitalized patients, and 30% of patients undergoing open-heart surgery have diabetes. The link between hyperglycemia and poor outcome has been well described, and large clinical trials have shown that aggressive control of blood glucose with an insulin infusion can improve these outcomes. The barriers to implementing an insulin infusion protocol are numerous, despite the fact that doing so is paramount to clinical success. Barriers include safety concerns, such as fear of hypoglycemia, insufficient nursing staff to patient ratios, lack of administrative and physician support, various system and procedural issues, and resistance to change. Key steps to overcome the barriers include building support with multidisciplinary champions, involving key staff, educating staff, and administrators of the clinical and economic benefits of improving glycemic control, setting realistic goals, selecting a validated insulin infusion protocol, and internally marketing the success of the protocol.

Proposal for the Development of a Standardized Protocol for Assessing the Economic Costs of HIV Prevention Interventions

PubMed Central

Pinkerton, Steven D.; Pearson, Cynthia R.; Eachus, Susan R.; Berg, Karina M.; Grimes, Richard M.

2008-01-01

Summary Maximizing our economic investment in HIV prevention requires balancing the costs of candidate interventions against their effects and selecting the most cost-effective interventions for implementation. However, many HIV prevention intervention trials do not collect cost information, and those that do use a variety of cost data collection methods and analysis techniques. Standardized cost data collection procedures, instrumentation, and analysis techniques are needed to facilitate the task of assessing intervention costs and to ensure comparability across intervention trials. This article describes the basic elements of a standardized cost data collection and analysis protocol and outlines a computer-based approach to implementing this protocol. Ultimately, the development of such a protocol would require contributions and “buy-in” from a diverse range of stakeholders, including HIV prevention researchers, cost-effectiveness analysts, community collaborators, public health decision makers, and funding agencies. PMID:18301128

Megahertz-Rate Semi-Device-Independent Quantum Random Number Generators Based on Unambiguous State Discrimination

NASA Astrophysics Data System (ADS)

Brask, Jonatan Bohr; Martin, Anthony; Esposito, William; Houlmann, Raphael; Bowles, Joseph; Zbinden, Hugo; Brunner, Nicolas

2017-05-01

An approach to quantum random number generation based on unambiguous quantum state discrimination is developed. We consider a prepare-and-measure protocol, where two nonorthogonal quantum states can be prepared, and a measurement device aims at unambiguously discriminating between them. Because the states are nonorthogonal, this necessarily leads to a minimal rate of inconclusive events whose occurrence must be genuinely random and which provide the randomness source that we exploit. Our protocol is semi-device-independent in the sense that the output entropy can be lower bounded based on experimental data and a few general assumptions about the setup alone. It is also practically relevant, which we demonstrate by realizing a simple optical implementation, achieving rates of 16.5 Mbits /s . Combining ease of implementation, a high rate, and a real-time entropy estimation, our protocol represents a promising approach intermediate between fully device-independent protocols and commercial quantum random number generators.

The Intersystem - Internetworking for space systems

NASA Astrophysics Data System (ADS)

Landauer, C.

This paper is a description of the Intersystem, which is a mechanism for internetworking among existing and planned military satellite communication systems. The communication systems interconnected with this mechanism are called member systems, and the interconnected set of communication systems is called the Intersystem. The Intersystem is implemented with higher layer protocols that impose a common organization on the different signaling conventions, so that end users of different systems can communicate with each other. The Intersystem provides its coordination of member system access and resource requests with Intersystem Resource Controllers (IRCs), which are processors that implement the Intersystem protocols and have interfaces to the member systems' own access and resource control mechanisms. The IRCs are connected to each other to form the IRC Subnetwork. Terminals request services from the IRC Subnetwork using the Intersystem Access Control Protocols, and the IRC Subnetwork responses to the requests are coordinated using the RCRC (Resource Controller to Resource Controller) Protocols.

Network Security via Biometric Recognition of Patterns of Gene Expression

NASA Technical Reports Server (NTRS)

Shaw, Harry C.

2016-01-01

Molecular biology provides the ability to implement forms of information and network security completely outside the bounds of legacy security protocols and algorithms. This paper addresses an approach which instantiates the power of gene expression for security. Molecular biology provides a rich source of gene expression and regulation mechanisms, which can be adopted to use in the information and electronic communication domains. Conventional security protocols are becoming increasingly vulnerable due to more intensive, highly capable attacks on the underlying mathematics of cryptography. Security protocols are being undermined by social engineering and substandard implementations by IT (Information Technology) organizations. Molecular biology can provide countermeasures to these weak points with the current security approaches. Future advances in instruments for analyzing assays will also enable this protocol to advance from one of cryptographic algorithms to an integrated system of cryptographic algorithms and real-time assays of gene expression products.

Network Security via Biometric Recognition of Patterns of Gene Expression

NASA Technical Reports Server (NTRS)

Shaw, Harry C.

2016-01-01

Molecular biology provides the ability to implement forms of information and network security completely outside the bounds of legacy security protocols and algorithms. This paper addresses an approach which instantiates the power of gene expression for security. Molecular biology provides a rich source of gene expression and regulation mechanisms, which can be adopted to use in the information and electronic communication domains. Conventional security protocols are becoming increasingly vulnerable due to more intensive, highly capable attacks on the underlying mathematics of cryptography. Security protocols are being undermined by social engineering and substandard implementations by IT organizations. Molecular biology can provide countermeasures to these weak points with the current security approaches. Future advances in instruments for analyzing assays will also enable this protocol to advance from one of cryptographic algorithms to an integrated system of cryptographic algorithms and real-time expression and assay of gene expression products.

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

Duan, Sisi; Nicely, Lucas D; Zhang, Haibin

Modern large-scale networks require the ability to withstand arbitrary failures (i.e., Byzantine failures). Byzantine reliable broadcast algorithms can be used to reliably disseminate information in the presence of Byzantine failures. We design a novel Byzantine reliable broadcast protocol for loosely connected and synchronous networks. While previous such protocols all assume correct senders, our protocol is the first to handle Byzantine senders. To achieve this goal, we have developed new techniques for fault detection and fault tolerance. Our protocol is efficient, and under normal circumstances, no expensive public-key cryptographic operations are used. We implement and evaluate our protocol, demonstrating that ourmore » protocol has high throughput and is superior to the existing protocols in uncivil executions.« less

Provably-Secure (Chinese Government) SM2 and Simplified SM2 Key Exchange Protocols

PubMed Central

Nam, Junghyun; Kim, Moonseong

2014-01-01

We revisit the SM2 protocol, which is widely used in Chinese commercial applications and by Chinese government agencies. Although it is by now standard practice for protocol designers to provide security proofs in widely accepted security models in order to assure protocol implementers of their security properties, the SM2 protocol does not have a proof of security. In this paper, we prove the security of the SM2 protocol in the widely accepted indistinguishability-based Bellare-Rogaway model under the elliptic curve discrete logarithm problem (ECDLP) assumption. We also present a simplified and more efficient version of the SM2 protocol with an accompanying security proof. PMID:25276863

Issues in providing a reliable multicast facility

NASA Technical Reports Server (NTRS)

Dempsey, Bert J.; Strayer, W. Timothy; Weaver, Alfred C.

1990-01-01

Issues involved in point-to-multipoint communication are presented and the literature for proposed solutions and approaches surveyed. Particular attention is focused on the ideas and implementations that align with the requirements of the environment of interest. The attributes of multicast receiver groups that might lead to useful classifications, what the functionality of a management scheme should be, and how the group management module can be implemented are examined. The services that multicasting facilities can offer are presented, followed by mechanisms within the communications protocol that implements these services. The metrics of interest when evaluating a reliable multicast facility are identified and applied to four transport layer protocols that incorporate reliable multicast.

Early warning systems and rapid response to the deteriorating patient in hospital: A realist evaluation.

PubMed

McGaughey, Jennifer; O'Halloran, Peter; Porter, Sam; Trinder, John; Blackwood, Bronagh

2017-12-01

To test the Rapid Response Systems programme theory against actual practice components of the Rapid Response Systems implemented to identify those contexts and mechanisms which have an impact on the successful achievement of desired outcomes in practice. Rapid Response Systems allow deteriorating patients to be recognized using Early Warning Systems, referred early via escalation protocols and managed at the bedside by competent staff. Realist evaluation. The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland which followed the principles of Realist Evaluation. We used various mixed methods including individual and focus group interviews, observation of nursing practice between June-November 2010 and document analysis of Early Warning Systems audit data between May-October 2010 and hospital acute care training records over 4.5 years from 2003-2008. Data were analysed using NiVivo8 and SPPS. A cross-case analysis highlighted similar patterns of factors which enabled or constrained successful recognition, referral and response to deteriorating patients in practice. Key enabling factors were the use of clinical judgement by experienced nurses and the empowerment of nurses as a result of organizational change associated with implementation of Early Warning System protocols. Key constraining factors were low staffing and inappropriate skill mix levels, rigid implementation of protocols and culturally embedded suboptimal communication processes. Successful implementation of Rapid Response Systems was dependent on adopting organizational and cultural changes that facilitated staff empowerment, flexible implementation of protocols and ongoing experiential learning. © 2017 John Wiley & Sons Ltd.

Cochrane Qualitative and Implementation Methods Group guidance series-paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis.

PubMed

Harris, Janet L; Booth, Andrew; Cargo, Margaret; Hannes, Karin; Harden, Angela; Flemming, Kate; Garside, Ruth; Pantoja, Tomas; Thomas, James; Noyes, Jane

2018-05-01

This paper updates previous Cochrane guidance on question formulation, searching, and protocol development, reflecting recent developments in methods for conducting qualitative evidence syntheses to inform Cochrane intervention reviews. Examples are used to illustrate how decisions about boundaries for a review are formed via an iterative process of constructing lines of inquiry and mapping the available information to ascertain whether evidence exists to answer questions related to effectiveness, implementation, feasibility, appropriateness, economic evidence, and equity. The process of question formulation allows reviewers to situate the topic in relation to how it informs and explains effectiveness, using the criterion of meaningfulness, appropriateness, feasibility, and implementation. Questions related to complex questions and interventions can be structured by drawing on an increasingly wide range of question frameworks. Logic models and theoretical frameworks are useful tools for conceptually mapping the literature to illustrate the complexity of the phenomenon of interest. Furthermore, protocol development may require iterative question formulation and searching. Consequently, the final protocol may function as a guide rather than a prescriptive route map, particularly in qualitative reviews that ask more exploratory and open-ended questions. Copyright © 2017 Elsevier Inc. All rights reserved.

Early risk assessment for viral haemorrhagic fever: experience at the Hospital for Tropical Diseases, London, UK.

PubMed

Woodrow, Charles J; Eziefula, Alice C; Agranoff, Dan; Scott, Geoffrey M; Watson, Julie; Chiodini, Peter L; Lockwood, Diana N J; Grant, Alison D

2007-01-01

To implement a policy of systematic screening for viral haemorrhagic fever (VHF) among travellers returning from African countries with fever, commencing at initial clinical contact. A protocol based on UK Advisory Committee on Dangerous Pathogens guidance was developed collaboratively by medical, nursing and laboratory staff. Audit was carried out to quantify resource demands and effects on time to diagnose malaria, the main differential diagnosis. A protocol is now implemented for all patients presenting to HTD with fever, with clear guidelines for interaction with clinical and laboratory staff at each stage. The protocol required moderate amounts of clinical and laboratory staff time and resulted in some additional hospital admissions. The time to a diagnosis of malaria increased from a median of 90 (range 50-125) min in patients without VHF risk to a median of 140 (range 101-225) min (p=0.0025) in those assessed as at risk. Although all acute medical services need to have robust procedures for early detection of patients with serious transmissible conditions, few implement such a policy. Our protocol requires increased human and other resources but has no important impact on the rapidity of diagnosis of malaria, and is now embedded in local practice.

How to Improve the Peer Review Method: Free-Selection vs Assigned-Pair Protocol Evaluated in a Computer Networking Course

ERIC Educational Resources Information Center

Papadopoulos, Pantelis M.; Lagkas, Thomas D.; Demetriadis, Stavros N.

2012-01-01

This study provides field research evidence on the efficiency of a "free-selection" peer review assignment protocol as compared to the typically implemented "assigned-pair" protocol. The study employed 54 sophomore students who were randomly assigned into three groups: Assigned-Pair (AP) (the teacher assigns student works for review to student…

The Interplanetary Overlay Networking Protocol Accelerator

NASA Technical Reports Server (NTRS)

Pang, Jackson; Torgerson, Jordan L.; Clare, Loren P.

2008-01-01

A document describes the Interplanetary Overlay Networking Protocol Accelerator (IONAC) an electronic apparatus, now under development, for relaying data at high rates in spacecraft and interplanetary radio-communication systems utilizing a delay-tolerant networking protocol. The protocol includes provisions for transmission and reception of data in bundles (essentially, messages), transfer of custody of a bundle to a recipient relay station at each step of a relay, and return receipts. Because of limitations on energy resources available for such relays, data rates attainable in a conventional software implementation of the protocol are lower than those needed, at any given reasonable energy-consumption rate. Therefore, a main goal in developing the IONAC is to reduce the energy consumption by an order of magnitude and the data-throughput capability by two orders of magnitude. The IONAC prototype is a field-programmable gate array that serves as a reconfigurable hybrid (hardware/ firmware) system for implementation of the protocol. The prototype can decode 108,000 bundles per second and encode 100,000 bundles per second. It includes a bundle-cache static randomaccess memory that enables maintenance of a throughput of 2.7Gb/s, and an Ethernet convergence layer that supports a duplex throughput of 1Gb/s.

Study of consensus-based time synchronization in wireless sensor networks.

PubMed

He, Jianping; Li, Hao; Chen, Jiming; Cheng, Peng

2014-03-01

Recently, various consensus-based protocols have been developed for time synchronization in wireless sensor networks. However, due to the uncertainties lying in both the hardware fabrication and network communication processes, it is not clear how most of the protocols will perform in real implementations. In order to reduce such gap, this paper investigates whether and how the typical consensus-based time synchronization protocols can tolerate the uncertainties in practical sensor networks through extensive testbed experiments. For two typical protocols, i.e., Average Time Synchronization (ATS) and Maximum Time Synchronization (MTS), we first analyze how the time synchronization accuracy will be affected by various uncertainties in the system. Then, we implement both protocols on our sensor network testbed consisted of Micaz nodes, and investigate the time synchronization performance and robustness under various network settings. Noticing that the synchronized clocks under MTS may be slightly faster than the desirable clock, by adopting both maximum consensus and minimum consensus, we propose a modified protocol, MMTS, which is able to drive the synchronized clocks closer to the desirable clock while maintaining the convergence rate and synchronization accuracy of MTS. © 2013 ISA. Published by ISA. All rights reserved.

Quantum fingerprinting with coherent states and a constant mean number of photons

NASA Astrophysics Data System (ADS)

Arrazola, Juan Miguel; Lütkenhaus, Norbert

2014-06-01

We present a protocol for quantum fingerprinting that is ready to be implemented with current technology and is robust to experimental errors. The basis of our scheme is an implementation of the signal states in terms of a coherent state in a superposition of time-bin modes. Experimentally, this requires only the ability to prepare coherent states of low amplitude and to interfere them in a balanced beam splitter. The states used in the protocol are arbitrarily close in trace distance to states of O (log2n) qubits, thus exhibiting an exponential separation in abstract communication complexity compared to the classical case. The protocol uses a number of optical modes that is proportional to the size n of the input bit strings but a total mean photon number that is constant and independent of n. Given the expended resources, our protocol achieves a task that is provably impossible using classical communication only. In fact, even in the presence of realistic experimental errors and loss, we show that there exist a large range of input sizes for which our quantum protocol transmits an amount of information that can be more than two orders of magnitude smaller than a classical fingerprinting protocol.

Effectiveness of the implementation of a simple radiation reduction protocol in the catheterization laboratory.

PubMed

Jurado-Román, Alfonso; Sánchez-Pérez, Ignacio; Lozano Ruíz-Poveda, Fernando; López-Lluva, María T; Pinilla-Echeverri, Natalia; Moreno Arciniegas, Andrea; Agudo-Quilez, Pilar; Gil Agudo, Antonio

2016-01-01

A reduction in radiation doses at the catheterization laboratory, maintaining the quality of procedures is essential. Our objective was to analyze the results of a simple radiation reduction protocol at a high-volume interventional cardiology unit. We analyzed 1160 consecutive procedures: 580 performed before the implementation of the protocol and 580 after it. The protocol consisted in: the reduction of the number of ventriculographies and aortographies, the optimization of the collimation and the geometry of the X ray tube-patient-receptor, the use of low dose-rate fluoroscopy and the reduction of the number of cine sequences using the software "last fluoroscopy hold". There were no significant differences in clinical baseline features or in the procedural characteristics with the exception of a higher percentage of radial approach (30.7% vs 69.6%; p<0.001) and of percutaneous coronary interventions of chronic total occlusions after the implementation of the protocol (2.1% vs 6.7%; p=0,001). Angiographic success was similar during both periods (98.3% vs 99.2%; p=0.2). There were no significant differences between both periods regarding the overall duration of the procedures (26.9 vs 29.6min; p=0.14), or the fluoroscopy time (13.3 vs 13.2min; p=0.8). We observed a reduction in the percentage of procedures with ventriculography (80.9% vs 7.1%; p<0.0001) or aortography (15.4% vs 4.4%; p<0.0001), the cine runs (21.8 vs 6.9; p<0.0001) and the dose-area product (165 vs 71 Gyxcm(2); p<0.0001). With the implementation of a simple radiation reduction protocol, a 57% reduction of dose-area product was observed without a reduction in the quality or the complexity of procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a PAIN OUT project.

PubMed

Cui, Cui; Wang, Ling-Xiao; Li, Qi; Zaslansky, Ruth; Li, Li

2018-04-01

To investigate the effect of introducing a standardised pain management nursing protocol in orthopaedic patients undergoing surgery. Postoperative pain is a common phenomenon but is still undertreated in hospitalised patients. Nurses' lack of sufficient knowledge and skills about pain management may be a contributing factor to poor outcomes. An interventional, separate sample pre- and post-test. A pain management nursing protocol was introduced and a handbook and training sessions regarding management of postsurgical pain were provided to the nurses on a Joint Orthopaedic ward at a university-affiliated general hospital in Guangzhou, China. Before and after the intervention, nurses' knowledge about pain management and attitudes were assessed, and perioperative management practices and pain-related patient-reported outcomes were evaluated. Sixteen and 15 registered nurses, and 77 and 71 patients participated in the study before and after the intervention, respectively. Nurses' scores related to knowledge and skills increased significantly after the protocol was introduced but were still insufficient with regard to pharmacological-related items. The proportion of patients receiving a combined opioid and nonopioid increased after the intervention. Clinically significant changes were observed in some patient-reported outcomes, such as worst pain since surgery, percentage of time experiencing severe pain, and pain interference with activities out of bed. There were significant changes in nonpharmacological methods administered by nurses to patients or used by patients to relieve pain. Implementation of a pain management nursing protocol combined with education in one surgical ward was associated with nurses' increased knowledge and attitudes regarding pain, a change in some management practices, and improvement in a number of pain-related patient-reported outcomes. It was feasible to develop and implement a standardised pain management nursing protocol and use it in the clinical routine. The intervention had an effect on changing some features of care, with an improvement in patient-reported outcomes. Support by leaders and medical team facilitated the process of the implementation. © 2017 John Wiley & Sons Ltd.

Cost-effectiveness analysis of an enteral nutrition protocol for children with common gastrointestinal diseases in China: good start but still a long way to go.

PubMed

Yang, Min; Chen, Pei-Yu; Gong, Si-Tang; Lyman, Beth; Geng, Lan-Lan; Liu, Li-Ying; Liang, Cui-Ping; Xu, Zhao-Hui; Li, Hui-Wen; Fang, Tie-Fu; Li, Ding-You

2014-11-01

A standard nutrition screening and enteral nutrition (EN) protocol was implemented in January 2012 in a tertiary children's center in China. The aims of the present study were to evaluate the cost-effectiveness of a standard EN protocol in hospitalized patients. A retrospective chart review was performed in the gastroenterology inpatient unit. We included all inpatient children requiring EN from January 1, 2010, to December 31, 2013, with common gastrointestinal (GI) diseases. Children from January 1, 2012, to December 31, 2013, served as the standard EN treatment group, and those from January 1, 2010, to December 31, 2011, were the control EN group. Pertinent patient information was collected. We also analyzed the length of hospital stay, cost of care, and in-hospital infection rates. The standard EN treatment group received more nasojejunal tube feedings. There was a tendency for the standard EN treatment group to receive more elemental and hydrolyzed protein formulas. Implementation of a standard EN protocol significantly reduced the time to initiate EN (32.38 ± 24.50 hours vs 18.76 ± 13.53 hours; P = .011) and the time to reach a targeted calorie goal (7.42 ± 3.98 days vs 5.06 ± 3.55 days; P = .023); length of hospital stay was shortened by 3.2 days after implementation of the standard EN protocol but did not reach statistical significance. However, the shortened length of hospital stay contributed to a significant reduction in the total cost of hospital care (13,164.12 ± 6722.95 Chinese yuan [CNY] vs 9814.96 ± 4592.91 CNY; P < .032). Implementation of a standard EN protocol resulted in early initiation of EN, shortened length of stay, and significantly reduced total cost of care in hospitalized children with common GI diseases. © 2014 American Society for Parenteral and Enteral Nutrition.

Proposed Requirements-driven User-scenario Development Protocol for the Belmont Forum E-Infrastructure and Data Management Cooperative Research Agreement

NASA Astrophysics Data System (ADS)

Wee, B.; Car, N.; Percivall, G.; Allen, D.; Fitch, P. G.; Baumann, P.; Waldmann, H. C.

2014-12-01

The Belmont Forum E-Infrastructure and Data Management Cooperative Research Agreement (CRA) is designed to foster a global community to collaborate on e-infrastructure challenges. One of the deliverables is an implementation plan to address global data infrastructure interoperability challenges and align existing domestic and international capabilities. Work package three (WP3) of the CRA focuses on the harmonization of global data infrastructure for sharing environmental data. One of the subtasks under WP3 is the development of user scenarios that guide the development of applicable deliverables. This paper describes the proposed protocol for user scenario development. It enables the solicitation of user scenarios from a broad constituency, and exposes the mechanisms by which those solicitations are evaluated against requirements that map to the Belmont Challenge. The underlying principle of traceability forms the basis for a structured, requirements-driven approach resulting in work products amenable to trade-off analyses and objective prioritization. The protocol adopts the ISO Reference Model for Open Distributed Processing (RM-ODP) as a top level framework. User scenarios are developed within RM-ODP's "Enterprise Viewpoint". To harmonize with existing frameworks, the protocol utilizes the conceptual constructs of "scenarios", "use cases", "use case categories", and use case templates as adopted by recent GEOSS Architecture Implementation Project (AIP) deliverables and CSIRO's eReefs project. These constructs are encapsulated under the larger construct of "user scenarios". Once user scenarios are ranked by goodness-of-fit to the Belmont Challenge, secondary scoring metrics may be generated, like goodness-of-fit to FutureEarth science themes. The protocol also facilitates an assessment of the ease of implementing given user scenario using existing GEOSS AIP deliverables. In summary, the protocol results in a traceability graph that can be extended to coordinate across research programmes. If implemented using appropriate technologies and harmonized with existing ontologies, this approach enables queries, sensitivity analyses, and visualization of complex relationships.

Barriers and enablers to implementing clinical treatment protocols for fever, hyperglycaemia, and swallowing dysfunction in the Quality in Acute Stroke Care (QASC) Project--a mixed methods study.

PubMed

Dale, Simeon; Levi, Christopher; Ward, Jeanette; Grimshaw, Jeremy M; Jammali-Blasi, Asmara; D'Este, Catherine; Griffiths, Rhonda; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique; Cheung, N Wah; Middleton, Sandy

2015-02-01

The Quality in Acute Stroke Care (QASC) trial evaluated systematic implementation of clinical treatment protocols to manage fever, sugar, and swallow (FeSS protocols) in acute stroke care. This cluster-randomised controlled trial was conducted in 19 stroke units in Australia. To describe perceived barriers and enablers preimplementation to the introduction of the FeSS protocols and, postimplementation, to determine which of these barriers eventuated as actual barriers. Preimplementation: Workshops were held at the intervention stroke units (n = 10). The first workshop involved senior clinicians who identified perceived barriers and enablers to implementation of the protocols, the second workshop involved bedside clinicians. Postimplementation, an online survey with stroke champions from intervention sites was conducted. A total of 111 clinicians attended the preimplementation workshops, identifying 22 barriers covering four main themes: (a) need for new policies, (b) limited workforce (capacity), (c) lack of equipment, and (d) education and logistics of training staff. Preimplementation enablers identified were: support by clinical champions, medical staff, nursing management and allied health staff; easy adaptation of current protocols, care-plans, and local policies; and presence of specialist stroke unit staff. Postimplementation, only five of the 22 barriers identified preimplementation were reported as actual barriers to adoption of the FeSS protocols, namely, no previous use of insulin infusions; hyperglycaemic protocols could not be commenced without written orders; medical staff reluctance to use the ASSIST swallowing screening tool; poor level of engagement of medical staff; and doctors' unawareness of the trial. The process of identifying barriers and enablers preimplementation allowed staff to take ownership and to address barriers and plan for change. As only five of the 22 barriers identified preimplementation were reported to be actual barriers at completion of the trial, this suggests that barriers are often overcome whilst some are only ever perceived rather than actual barriers. © 2015 Sigma Theta Tau International.

Implementation and audit of 'Fast-Track Surgery' in gynaecological oncology surgery.

PubMed

Sidhu, Verinder S; Lancaster, Letitia; Elliott, David; Brand, Alison H

2012-08-01

Fast-track surgery is a multidisciplinary approach to surgery that results in faster recovery from surgery and decreased length of stay (LOS). The aims of this study were as follows: (i) to report on the processes required for the introduction of fast-track surgery to a gynaecological oncology unit and (ii) to report the results of a clinical audit conducted after the protocol's implementation. A fast-track protocol, specific to our unit, was developed after a series of multidisciplinary meetings. The protocol, agreed upon by those involved in the care of women in our unit, was then introduced into clinical practice. An audit was conducted of all women undergoing laparotomy, with known or suspected malignancy. Information on LOS, complication and readmission rates was collected. Descriptive statistics and Poisson regression were used for statistical analysis. The developed protocol involved a multidisciplinary approach to pre-, intra- and postoperative care. The audit included 104 consecutive women over a 6-month period, who were followed for 6 weeks postoperatively. The median LOS was 4 days. The readmission rate was 7% and the complication rate was 19% (1% intraoperative, 4% major and 14% minor). Multivariate analysis revealed that increased duration of surgery and increasing age were predictors of longer LOS. The development of a fast-track protocol is achievable in a gynaecological oncology unit, with input from a multidisciplinary team. Effective implementation of the protocol can result in a short LOS, with acceptable complication and readmission rates when applied non-selectively to gynaecological oncology patients. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis.

PubMed

Jordan, Joanne; Rose, Louise; Dainty, Katie N; Noyes, Jane; Blackwood, Bronagh

2016-10-04

Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions. 1. To locate, appraise and synthesize qualitative evidence concerning the barriers and facilitators of the use of protocols for weaning critically-ill adults and children from mechanical ventilation;2. To integrate this synthesis with two Cochrane effectiveness reviews of protocolized weaning to help explain observed heterogeneity by identifying contextual factors that impact on the use of protocols for weaning critically-ill adults and children from mechanical ventilation;3. To use the integrated body of evidence to suggest the circumstances in which weaning protocols are most likely to be used. We used a range of search terms identified with the help of the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) mnemonic. Where available, we used appropriate methodological filters for specific databases. We searched the following databases: Ovid MEDLINE, Embase, OVID, PsycINFO, CINAHL Plus, EBSCOHost, Web of Science Core Collection, ASSIA, IBSS, Sociological Abstracts, ProQuest and LILACS on the 26th February 2015. In addition, we searched: the grey literature; the websites of professional associations for relevant publications; and the reference lists of all publications reviewed. We also contacted authors of the trials included in the effectiveness reviews as well as of studies (potentially) included in the qualitative synthesis, conducted citation searches of the publications reporting these studies, and contacted content experts.We reran the search on 3rd July 2016 and found three studies, which are awaiting classification. We included qualitative studies that described: the circumstances in which protocols are designed, implemented or used, or both, and the views and experiences of healthcare professionals either involved in the design, implementation or use of weaning protocols or involved in the weaning of critically-ill adults and children from mechanical ventilation not using protocols. We included studies that: reflected on any aspect of the use of protocols, explored contextual factors relevant to the development, implementation or use of weaning protocols, and reported contextual phenomena and outcomes identified as relevant to the effectiveness of protocolized weaning from mechanical ventilation. At each stage, two review authors undertook designated tasks, with the results shared amongst the wider team for discussion and final development. We independently reviewed all retrieved titles, abstracts and full papers for inclusion, and independently extracted selected data from included studies. We used the findings of the included studies to develop a new set of analytic themes focused on the barriers and facilitators to the use of protocols, and further refined them to produce a set of summary statements. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to arrive at a final assessment of the overall confidence of the evidence used in the synthesis. We included all studies but undertook two sensitivity analyses to determine how the removal of certain bodies of evidence impacted on the content and confidence of the synthesis. We deployed a logic model to integrate the findings of the qualitative evidence synthesis with those of the Cochrane effectiveness reviews. We included 11 studies in our synthesis, involving 267 participants (one study did not report the number of participants). Five more studies are awaiting classification and will be dealt with when we update the review.The quality of the evidence was mixed; of the 35 summary statements, we assessed 17 as 'low', 13 as 'moderate' and five as 'high' confidence. Our synthesis produced nine analytical themes, which report potential barriers and facilitators to the use of protocols. The themes are: the need for continual staff training and development; clinical experience as this promotes felt and perceived competence and confidence to wean; the vulnerability of weaning to disparate interprofessional working; an understanding of protocols as militating against a necessary proactivity in clinical practice; perceived nursing scope of practice and professional risk; ICU structure and processes of care; the ability of protocols to act as a prompt for shared care and consistency in weaning practice; maximizing the use of protocols through visibility and ease of implementation; and the ability of protocols to act as a framework for communication with parents. There is a clear need for weaning protocols to take account of the social and cultural environment in which they are to be implemented. Irrespective of its inherent strengths, a protocol will not be used if it does not accommodate these complexities. In terms of protocol development, comprehensive interprofessional input will help to ensure broad-based understanding and a sense of 'ownership'. In terms of implementation, all relevant ICU staff will benefit from general weaning as well as protocol-specific training; not only will this help secure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is in place. In order to maximize relevance and acceptability, protocols should be designed with the patient profile and requirements of the target ICU in mind. Predictably, an under-resourced ICU will impact adversely on protocol implementation, as staff will prioritize management of acutely deteriorating and critically-ill patients.

A Simple XML Producer-Consumer Protocol

NASA Technical Reports Server (NTRS)

Smith, Warren; Gunter, Dan; Quesnel, Darcy

2000-01-01

This document describes a simple XML-based protocol that can be used for producers of events to communicate with consumers of events. The protocol described here is not meant to be the most efficient protocol, the most logical protocol, or the best protocol in any way. This protocol was defined quickly and it's intent is to give us a reasonable protocol that we can implement relatively easily and then use to gain experience in distributed event services. This experience will help us evaluate proposals for event representations, XML-based encoding of information, and communication protocols. The next section of this document describes how we represent events in this protocol and then defines the two events that we choose to use for our initial experiments. These definitions are made by example so that they are informal and easy to understand. The following section then proceeds to define the producer-consumer protocol we have agreed upon for our initial experiments.

Implementing drought early warning systems: policy lessons and future needs

NASA Astrophysics Data System (ADS)

Iglesias, Ana; Werner, Micha; Maia, Rodrigo; Garrote, Luis; Nyabeze, Washington

2014-05-01

Drought forecasting and Warning provides the potential of reducing impacts to society due to drought events. The implementation of effective drought forecasting and warning, however, requires not only science to support reliable forecasting, but also adequate policy and societal response. Here we propose a protocol to develop drought forecasting and early warning based in the international cooperation of African and European institutions in the DEWFORA project (EC, 7th Framework Programme). The protocol includes four major phases that address the scientific knowledge and the social capacity to use the knowledge: (a) What is the science available? Evaluating how signs of impending drought can be detected and predicted, defining risk levels, and analysing of the signs of drought in an integrated vulnerability approach. (b) What are the societal capacities? In this the institutional framework that enables policy development is evaluated. The protocol gathers information on vulnerability and pending hazard in advance so that early warnings can be declared at sufficient lead time and drought mitigation planning can be implemented at an early stage. (c) How can science be translated into policy? Linking science indicators into the actions/interventions that society needs to implement, and evaluating how policy is implemented. Key limitations to planning for drought are the social capacities to implement early warning systems. Vulnerability assessment contributes to identify these limitations and therefore provides crucial information to policy development. Based on the assessment of vulnerability we suggest thresholds for management actions to respond to drought forecasts and link predictive indicators to relevant potential mitigation strategies. Vulnerability assessment is crucial to identify relief, coping and management responses that contribute to a more resilient society. (d) How can society benefit from the forecast? Evaluating how information is provided to potentially affected groups, and how mitigation strategies can be taken in response. This paper presents an outline of the protocol that was developed in the DEWFORA project, outlining the complementary roles of science, policy and societal uptake in effective drought forecasting and warning. A consensus on the need to emphasise the social component of early warning was reached when testing the DEWFORA early warning system protocol among experts from 18 countries.

A four-phase strategy for the implementation of reflectance confocal microscopy in dermatology.

PubMed

Hoogedoorn, L; Gerritsen, M J P; Wolberink, E A W; Peppelman, M; van de Kerkhof, P C M; van Erp, P E J

2016-08-01

Reflectance confocal microscopy (RCM) is gradually implemented in dermatology. Strategies for further implementation and practical 'hands on' guidelines are lacking. The primary outcome was to conduct a general strategy for further implementation of RCM. The secondary outcome was the diagnosis of psoriasis and differentiation of stable from unstable psoriatic plaques by means of the 'hands on' protocol, derived from the strategy. We used a four-phased model; an exploring phase, a systematic literature search, a clinical approach and, finally, an integration phase to develop a clinical guideline for RCM in psoriasis. Receiver operating characteristic curve statistics was applied to define the accuracy for the diagnosis of unstable psoriasis. A general strategy for further implementation of RCM and practical approach was developed to examine psoriasis by RCM and to distinguish stable from unstable psoriasis. Unstable psoriasis was diagnosed by epidermal inflammatory cell counts with a sensitivity and specificity of 91.7% and 98.3%, respectively, and with an accuracy of 0.92 (area under the curve). In addition, a monitoring model was proposed. This is the first study that shows a method for implementation of RCM in dermatology. The strategy and hands on protocol for psoriasis may serve as a model for other dermatological entities and additionally may lead to specialized ready-to-use RCM protocols for clinical dermatological practice. © 2016 European Academy of Dermatology and Venereology.

Effectiveness of implementing a wake up and breathe program on sedation and delirium in the ICU.

PubMed

Khan, Babar A; Fadel, William F; Tricker, Jason L; Carlos, W Graham; Farber, Mark O; Hui, Siu L; Campbell, Noll L; Ely, E Wesley; Boustani, Malaz A

2014-12-01

Mechanically ventilated critically ill patients receive significant amounts of sedatives and analgesics that increase their risk of developing coma and delirium. We evaluated the impact of a "Wake-up and Breathe Protocol" at our local ICU on sedation and delirium. A pre/post implementation study design. A 22-bed mixed surgical and medical ICU. Seven hundred two consecutive mechanically ventilated ICU patients from June 2010 to January 2013. Implementation of daily paired spontaneous awakening trials (daily sedation vacation plus spontaneous breathing trials) as a quality improvement project. After implementation of our program, there was an increase in the mean Richmond Agitation Sedation Scale scores on weekdays of 0.88 (p < 0.0001) and an increase in the mean Richmond Agitation Sedation Scale scores on weekends of 1.21 (p < 0.0001). After adjusting for age, race, gender, severity of illness, primary diagnosis, and ICU, the incidence and prevalence of delirium did not change post implementation of the protocol (incidence: 23% pre vs 19.6% post; p = 0.40; prevalence: 66.7% pre vs 55.3% post; p = 0.06). The combined prevalence of delirium/coma decreased from 90.8% pre protocol implementation to 85% postimplementation (odds ratio, 0.505; 95% CI, 0.299-0.853; p = 0.01). Implementing a "Wake Up and Breathe Program" resulted in reduced sedation among critically ill mechanically ventilated patients but did not change the incidence or prevalence of delirium.

A data transmission method for particle physics experiments based on Ethernet physical layer

NASA Astrophysics Data System (ADS)

Huang, Xi-Ru; Cao, Ping; Zheng, Jia-Jun

2015-11-01

Due to its advantages of universality, flexibility and high performance, fast Ethernet is widely used in readout system design for modern particle physics experiments. However, Ethernet is usually used together with the TCP/IP protocol stack, which makes it difficult to implement readout systems because designers have to use the operating system to process this protocol. Furthermore, TCP/IP degrades the transmission efficiency and real-time performance. To maximize the performance of Ethernet in physics experiment applications, a data readout method based on the physical layer (PHY) is proposed. In this method, TCP/IP is replaced with a customized and simple protocol, which makes it easier to implement. On each readout module, data from the front-end electronics is first fed into an FPGA for protocol processing and then sent out to a PHY chip controlled by this FPGA for transmission. This kind of data path is fully implemented by hardware. From the side of the data acquisition system (DAQ), however, the absence of a standard protocol causes problems for the network related applications. To solve this problem, in the operating system kernel space, data received by the network interface card is redirected from the traditional flow to a specified memory space by a customized program. This memory space can easily be accessed by applications in user space. For the purpose of verification, a prototype system has been designed and implemented. Preliminary test results show that this method can meet the requirements of data transmission from the readout module to the DAQ with an efficient and simple manner. Supported by National Natural Science Foundation of China (11005107) and Independent Projects of State Key Laboratory of Particle Detection and Electronics (201301)

Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres.

PubMed

Stipulante, Samuel; Tubes, Rebecca; El Fassi, Mehdi; Donneau, Anne-Francoise; Van Troyen, Barbara; Hartstein, Gary; D'Orio, Vincent; Ghuysen, Alexandre

2014-02-01

Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area. We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation. At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p<0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42.3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253s in 2009 and 168s in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p=0.09). From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The "ComPAS Trial" combined treatment model for acute malnutrition: study protocol for the economic evaluation.

PubMed

Lelijveld, Natasha; Bailey, Jeanette; Mayberry, Amy; Trenouth, Lani; N'Diaye, Dieynaba S; Haghparast-Bidgoli, Hassan; Puett, Chloe

2018-04-24

Acute malnutrition is currently divided into severe (SAM) and moderate (MAM) based on level of wasting. SAM and MAM currently have separate treatment protocols and products, managed by separate international agencies. For SAM, the dose of treatment is allocated by the child's weight. A combined and simplified protocol for SAM and MAM, with a standardised dose of ready-to-use therapeutic food (RUTF), is being trialled for non-inferior recovery rates and may be more cost-effective than the current standard protocols for treating SAM and MAM. This is the protocol for the economic evaluation of the ComPAS trial, a cluster-randomised controlled, non-inferiority trial that compares a novel combined protocol for treating uncomplicated acute malnutrition compared to the current standard protocol in South Sudan and Kenya. We will calculate the total economic costs of both protocols from a societal perspective, using accounting data, interviews and survey questionnaires. The incremental cost of implementing the combined protocol will be estimated, and all costs and outcomes will be presented as a cost-consequence analysis. Incremental cost-effectiveness ratio will be calculated for primary and secondary outcome, if statistically significant. We hypothesise that implementing the combined protocol will be cost-effective due to streamlined logistics at clinic level, reduced length of treatment, especially for MAM, and reduced dosages of RUTF. The findings of this economic evaluation will be important for policymakers, especially given the hypothesised non-inferiority of the main health outcomes. The publication of this protocol aims to improve rigour of conduct and transparency of data collection and analysis. It is also intended to promote inclusion of economic evaluation in other nutrition intervention studies, especially for MAM, and improve comparability with other studies. ISRCTN 30393230 , date: 16/03/2017.

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial.

PubMed

Karády, Júlia; Panajotu, Alexisz; Kolossváry, Márton; Szilveszter, Bálint; Jermendy, Ádám L; Bartykowszki, Andrea; Károlyi, Mihály; Celeng, Csilla; Merkely, Béla; Maurovich-Horvat, Pál

2017-11-01

Contrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA. Patients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol. 2,445 consecutive patients were enrolled (mean age 60.6 ± 12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p = 0.034). Four-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA. • Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. • The saline pacer bolus substantially reduces the risk of CM extravasation. • The implementation of four-phasic injection-protocol is at no cost.

Advanced-Retarded Differential Equations in Quantum Photonic Systems

NASA Astrophysics Data System (ADS)

Alvarez-Rodriguez, Unai; Perez-Leija, Armando; Egusquiza, Iñigo L.; Gräfe, Markus; Sanz, Mikel; Lamata, Lucas; Szameit, Alexander; Solano, Enrique

2017-02-01

We propose the realization of photonic circuits whose dynamics is governed by advanced-retarded differential equations. Beyond their mathematical interest, these photonic configurations enable the implementation of quantum feedback and feedforward without requiring any intermediate measurement. We show how this protocol can be applied to implement interesting delay effects in the quantum regime, as well as in the classical limit. Our results elucidate the potential of the protocol as a promising route towards integrated quantum control systems on a chip.

Packet Controller For Wireless Headset

NASA Technical Reports Server (NTRS)

Christensen, Kurt K.; Swanson, Richard J.

1993-01-01

Packet-message controller implements communications protocol of network of wireless headsets. Designed for headset application, readily adapted to other uses; slight modification enables controller to implement Integrated Services Digital Network (ISDN) X.25 protocol, giving far-reaching applications in telecommunications. Circuit converts continuous voice signals into digital packets of data and vice versa. Operates in master or slave mode. Controller reduced to single complementary metal oxide/semiconductor integrated-circuit chip. Occupies minimal space in headset and consumes little power, extending life of headset battery.

Fiber-Optic Terahertz Data-Communication Networks

NASA Technical Reports Server (NTRS)

Chua, Peter L.; Lambert, James L.; Morookian, John M.; Bergman, Larry A.

1994-01-01

Network protocols implemented in optical domain. Fiber-optic data-communication networks utilize fully available bandwidth of single-mode optical fibers. Two key features of method: use of subpicosecond laser pulses as carrier signals and spectral phase modulation of pulses for optical implementation of code-division multiple access as multiplexing network protocol. Local-area network designed according to concept offers full crossbar functionality, security of data in transit through network, and capacity about 100 times that of typical fiber-optic local-area network in current use.

Advanced-Retarded Differential Equations in Quantum Photonic Systems

PubMed Central

Alvarez-Rodriguez, Unai; Perez-Leija, Armando; Egusquiza, Iñigo L.; Gräfe, Markus; Sanz, Mikel; Lamata, Lucas; Szameit, Alexander; Solano, Enrique

2017-01-01

We propose the realization of photonic circuits whose dynamics is governed by advanced-retarded differential equations. Beyond their mathematical interest, these photonic configurations enable the implementation of quantum feedback and feedforward without requiring any intermediate measurement. We show how this protocol can be applied to implement interesting delay effects in the quantum regime, as well as in the classical limit. Our results elucidate the potential of the protocol as a promising route towards integrated quantum control systems on a chip. PMID:28230090

Implementation of safety checklists in surgery: a realist synthesis of evidence.

PubMed

Gillespie, Brigid M; Marshall, Andrea

2015-09-28

The aim of this review is to present a realist synthesis of the evidence of implementation interventions to improve adherence to the use of safety checklists in surgery. Surgical safety checklists have been shown to improve teamwork and patient safety in the operating room. Yet, despite the benefits associated with their use, universal implementation of and compliance with these checklists has been inconsistent. An overview of the literature from 2008 is examined in relation to checklist implementation, compliance, and sustainability. Pawson's and Rycroft-Malone's realist synthesis methodology was used to explain the interaction between context, mechanism, and outcome. This approach incorporated the following: defining the scope of the review, searching and appraising the evidence, extracting and synthesising the findings, and disseminating, implementing, and evaluating the evidence. We identified two theories a priori that explained contextual nuances associated with implementation and evaluation of checklists in surgery: the Normalisation Process Theory and Responsive Regulation Theory. We identified four a priori propositions: (1) Checklist protocols that are prospectively tailored to the context are more likely to be used and sustained in practice, (2) Fidelity and sustainability is increased when checklist protocols can be seamlessly integrated into daily professional practice, (3) Routine embedding of checklist protocols in practice is influenced by factors that promote or inhibit clinicians' participation, and (4) Regulation reinforcement mechanisms that are more contextually responsive should lead to greater compliance in using checklist protocols. The final explanatory model suggests that the sustained use of surgical checklists is discipline-specific and is more likely to occur when medical staff are actively engaged and leading the process of implementation. Involving clinicians in tailoring the checklist to better fit their context of practice and giving them the opportunity to reflect and evaluate the implementation intervention enables greater participation and ownership of the process. A major limitation in the surgical checklist literature is the lack of robust descriptions of intervention methods and implementation strategies. Despite this, two consequential findings have emerged through this realist synthesis: First, the sustained use of surgical checklists is discipline-specific and is more successful when physicians are actively engaged and leading implementation. Second, involving clinicians in tailoring the checklist to their context and encouraging them to reflect on and evaluate the implementation process enables greater participation and ownership.

Spectral transform and orthogonality relations for the Kadomtsev-Petviashvili I equation

NASA Astrophysics Data System (ADS)

Boiti, M.; Leon, J. J.-P.; Pempinelli, F.

1989-10-01

We define a new spectral transform r(k, l) of the potential u in the time dependent Schrödinger equation (associated to the KPI equation). Orthogonality relations for the sectionally holomorphic eigenfunctions of the Schrödinger equation are used to express the spectral transform f( k, l) previously introduced by Manakov and Fokas and Ablowitz in terms of r( k, l). The main advantage of the new spectral transform r( k, l) is that its definition does not require to introduce an additional nonanalytic eigenfunction N. Characterization equations for r( k, l) are also obtained.

Decay properties of Bk 97 243 and Bk 97 244

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

Ahmad, I.; Kondev, F. G.; Greene, J. P.

2018-01-01

Electron capture decays of Bk-243 and Bk-244 have been studied by measuring the gamma-ray spectra of mass-separated sources and level structures of Cm-243 and Cm-244 have been deduced. In Cm-243, the electron capture population to the ground state, 1/2(+)[631], and 1/2(+)[620] Nilsson states have been observed. The octupole K-pi = 2(-) band was identified in Cm-244 at 933.6 keV. In addition, spins and parities were deduced for several other states and two-quasiparticle configurations have been tentatively assigned to them

Emulation Platform for Cyber Analysis of Wireless Communication Network Protocols

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

Van Leeuwen, Brian P.; Eldridge, John M.

Wireless networking and mobile communications is increasing around the world and in all sectors of our lives. With increasing use, the density and complexity of the systems increase with more base stations and advanced protocols to enable higher data throughputs. The security of data transported over wireless networks must also evolve with the advances in technologies enabling more capable wireless networks. However, means for analysis of the effectiveness of security approaches and implementations used on wireless networks are lacking. More specifically a capability to analyze the lower-layer protocols (i.e., Link and Physical layers) is a major challenge. An analysis approachmore » that incorporates protocol implementations without the need for RF emissions is necessary. In this research paper several emulation tools and custom extensions that enable an analysis platform to perform cyber security analysis of lower layer wireless networks is presented. A use case of a published exploit in the 802.11 (i.e., WiFi) protocol family is provided to demonstrate the effectiveness of the described emulation platform.« less

Reducing sick leave of Dutch vocational school students: adaptation of a sick leave protocol using the intervention mapping process.

PubMed

de Kroon, Marlou L A; Bulthuis, Jozien; Mulder, Wico; Schaafsma, Frederieke G; Anema, Johannes R

2016-12-01

Since the extent of sick leave and the problems of vocational school students are relatively large, we aimed to tailor a sick leave protocol at Dutch lower secondary education schools to the particular context of vocational schools. Four steps of the iterative process of Intervention Mapping (IM) to adapt this protocol were carried out: (1) performing a needs assessment and defining a program objective, (2) determining the performance and change objectives, (3) identifying theory-based methods and practical strategies and (4) developing a program plan. Interviews with students using structured questionnaires, in-depth interviews with relevant stakeholders, a literature research and, finally, a pilot implementation were carried out. A sick leave protocol was developed that was feasible and acceptable for all stakeholders. The main barriers for widespread implementation are time constraints in both monitoring and acting upon sick leave by school and youth health care. The iterative process of IM has shown its merits in the adaptation of the manual 'A quick return to school is much better' to a sick leave protocol for vocational school students.

Agents Based e-Commerce and Securing Exchanged Information

NASA Astrophysics Data System (ADS)

Al-Jaljouli, Raja; Abawajy, Jemal

Mobile agents have been implemented in e-Commerce to search and filter information of interest from electronic markets. When the information is very sensitive and critical, it is important to develop a novel security protocol that can efficiently protect the information from malicious tampering as well as unauthorized disclosure or at least detect any malicious act of intruders. In this chapter, we describe robust security techniques that ensure a sound security of information gathered throughout agent’s itinerary against various security attacks, as well as truncation attacks. A sound security protocol is described, which implements the various security techniques that would jointly prevent or at least detect any malicious act of intruders. We reason about the soundness of the protocol usingSymbolic Trace Analyzer (STA), a formal verification tool that is based on symbolic techniques. We analyze the protocol in key configurations and show that it is free of flaws. We also show that the protocol fulfils the various security requirements of exchanged information in MAS, including data-integrity, data-confidentiality, data-authenticity, origin confidentiality and data non-repudiability.

Modeling the leadership attributes of top management in green innovation implementation

NASA Astrophysics Data System (ADS)

Ishak, Noormaizatul Akmar; Ramli, Mohammad Fadzli

2015-05-01

The implementation of green innovation in the companies is the interest of the governments all over the world. This has been the main focus of the Copenhagen Protocol and Kyoto Protocol that require all governments to preserve the nature through green initiatives. This paper proposes a mathematical model on the leadership attributes of the top management in ensuring green innovation implementation in their companies' strategies to reduce operational cost. With green innovation implementation in the Government-Linked Companies (GLCs), we identify the leadership attributes are tied up to the leadership style of the top managers in the companies. Through this model we have proved that green type leadership always contributes better in cost saving, therefore it is a more efficient leadership attribute for the GLCs especially.

Finite-key analysis for the 1-decoy state QKD protocol

NASA Astrophysics Data System (ADS)

Rusca, Davide; Boaron, Alberto; Grünenfelder, Fadri; Martin, Anthony; Zbinden, Hugo

2018-04-01

It has been shown that in the asymptotic case of infinite-key length, the 2-decoy state Quantum Key Distribution (QKD) protocol outperforms the 1-decoy state protocol. Here, we present a finite-key analysis of the 1-decoy method. Interestingly, we find that for practical block sizes of up to 108 bits, the 1-decoy protocol achieves for almost all experimental settings higher secret key rates than the 2-decoy protocol. Since using only one decoy is also easier to implement, we conclude that it is the best choice for QKD, in most common practical scenarios.

An Examination of the Design, Development, and Implementation of an Internet Protocol Version 6 Network: The ADTRAN Inc. Case Study

ERIC Educational Resources Information Center

Perigo, Levi

2013-01-01

In this dissertation, the author examined the capabilities of Internet Protocol version 6 (IPv6) in regard to replacing Internet Protocol version 4 (IPv4) as the internetworking technology for Medium-sized Businesses (MBs) in the Information Systems (IS) field. Transition to IPv6 is inevitable, and, thus, organizations are adopting this protocol…

A Technique for Presenting a Deceptive Dynamic Network Topology

DTIC Science & Technology

2013-03-01

Comment RIP Routing Information Protocol SNOS Systemic Network Obfuscation System SSH Secure Shell TCP Transmission Control Protocol TTL time to live...because it sacrifices elements available in Transmission Control Protocol ( TCP ) such as ordered delivery of packets, delivery confirmation and duplication...avoidance [4]. Of note, some traceroute implementations use TCP packets since they are able to pass through firewalls which are typically configured

Operational Implementation of a 2-Hour Prebreathe Protocol for International Space Station

NASA Technical Reports Server (NTRS)

Waligora, James M.; Conkin, J.; Foster, P. P.; Schneider, S.; Loftin, Karin C.; Gernhardt, Michael L.; Vann, R.

2000-01-01

Procedures, equipment, and analytical techniques were developed to implement the ground tested 2-hour protocol in-flight operations. The methods are: 1) The flight protocol incorporates additional safety margin over the ground tested protocol. This includes up to 20 min of additional time on enriched O2 during suit purge and pressure check, increased duration of extravehicular activity (EVA) preparation exercise during O2 prebreathing (up to 90 min vs; the tested 24 min), and reduced rates of depressurization. The ground test observations were combined with model projections of the conservative measures (using statistical models from Duke University and NASA JSQ to bound the risk of Type I and Type II decompression sickness (DCS). 2) An inflight exercise device using the in-flight ergometer and elastic tubes for upper body exercise was developed to replicate the dual cycle exercise in the ground trials. 3) A new in-flight breathing system was developed and man-tested. 4) A process to monitor inflight experience with the protocol, including the use of an in-suit Doppler bubble monitor when available, was developed. The results are: 1) The model projections of the conservative factors of the operational protocol were shown to reduce the risk of DCS to levels consistent with the observations of no DCS to date in the shuttle program. 2) Cross over trials of the dual cycle ergometer used in ground tests and the in-flight exercise system verified that02consumption and the % division of work between upper and lower body was not significantly different at the p= 0.05 level. 3) The in-flight breathing system was demonstrated to support work rates generating 75% O2(max) in 95 percentile subjects. 4) An in-flight monitoring plan with acceptance criteria was put in place for the 2-hour prebreathe protocol. And the conclusions are: The 2-hour protocol has been approved for flight, and all implementation efforts are in place to allow use of the protocol as early as flight ISS 7A, now scheduled in November of 2000.

Association of Rapid Care Process Implementation on Reperfusion Times Across Multiple ST-Segment-Elevation Myocardial Infarction Networks.

PubMed

Fordyce, Christopher B; Al-Khalidi, Hussein R; Jollis, James G; Roettig, Mayme L; Gu, Joan; Bagai, Akshay; Berger, Peter B; Corbett, Claire C; Dauerman, Harold L; Fox, Kathleen; Garvey, J Lee; Henry, Timothy D; Rokos, Ivan C; Sherwood, Matthew W; Wilson, B Hadley; Granger, Christopher B

2017-01-01

The Mission: Lifeline STEMI Systems Accelerator program, implemented in 16 US metropolitan regions, resulted in more patients receiving timely reperfusion. We assessed whether implementing key care processes was associated with system performance improvement. Hospitals (n=167 with 23 498 ST-segment-elevation myocardial infarction patients) were surveyed before (March 2012) and after (July 2014) program intervention. Data were merged with patient-level clinical data over the same period. For reperfusion, hospitals were grouped by whether a specific process of care was implemented, preexisting, or never implemented. Uptake of 4 key care processes increased after intervention: prehospital catheterization laboratory activation (62%-91%; P<0.001), single call transfer protocol from an outside facility (45%-70%; P<0.001), and emergency department bypass for emergency medical services direct presenters (48%-59%; P=0.002) and transfers (56%-79%; P=0.001). There were significant differences in median first medical contact-to-device times among groups implementing prehospital activation (88 minutes implementers versus 89 minutes preexisting versus 98 minutes nonimplementers; P<0.001 for comparisons). Similarly, patients treated at hospitals implementing single call transfer protocols had shorter median first medical contact-to-device times (112 versus 128 versus 152 minutes; P<0.001). Emergency department bypass was also associated with shorter median first medical contact-to-device times for emergency medical services direct presenters (84 versus 88 versus 94 minutes; P<0.001) and transfers (123 versus 127 versus 167 minutes; P<0.001). The Accelerator program increased uptake of key care processes, which were associated with improved system performance. These findings support efforts to implement regional ST-segment-elevation myocardial infarction networks focused on prehospital catheterization laboratory activation, single call transfer protocols, and emergency department bypass. © 2017 American Heart Association, Inc.

Implementation of a baby doll therapy protocol for people with dementia: Innovative practice.

PubMed

Braden, Barbara A; Gaspar, Phyllis M

2015-09-01

Dementia is exhibited by both emotional and physical states such as agitation. Chemical restraints, often used for agitated behaviors, are not always effective and produce untoward effects. Baby doll therapy is a nonpharmacologic therapy that can affect agitated behavior in dementia patients, yet a protocol for the therapy did not exist. An implementation protocol for doll therapy for those with dementia was developed and implemented with 16 residents in a dementia care center. Outcomes were measurements of the impact of the dolls on six areas of the resident's behavior and their reactions to the doll. Participants had an increase in level of happiness, activity/liveliness, interaction with staff and others, and ease of giving care. There was also a reduction in the level of anxiety. The increase in happiness was a statistically significant outcome. Baby doll therapy is an effective nonpharmacological approach for improving the well-being of patients with moderate to severe dementia. © The Author(s) 2014.

Darbepoetin alfa therapeutic interchange protocol for anemia in dialysis.

PubMed

Brophy, Donald F; Ripley, Elizabeth Bd; Kockler, Denise R; Lee, Seina; Proeschel, Lori A

2005-11-01

Erythropoiesis-stimulating proteins, such as erythropoietin alfa and darbepoetin alfa, have positively impacted anemia management. These medications improve patient outcomes and quality of life. Their costs, however, remain a major barrier for health systems. To evaluate the development, implementation, and cost-effectiveness of an inpatient therapeutic interchange protocol for erythropoiesis-stimulating proteins at a large, tertiary care, university-affiliated health system. Virginia Commonwealth University Health System (VCUHS) developed and implemented a therapeutic interchange program to convert therapy for all inpatients undergoing dialysis from erythropoietin alfa to darbepoetin alfa for treatment of chronic kidney disease-related anemia. An evaluation of the economic impact of this program on drug expenditures over a fiscal quarter (2003) was conducted using historical comparator data (2002). Preliminary evaluation of the program demonstrated cost-savings and reduced drug utilization of erythropoiesis-stimulating proteins in hospitalized dialysis patients. For the first quarter of 2003 compared with the first quarter of 2002, VCUHS realized a cost-savings of nearly 10,000 US dollars, which was related to the program's aggressive screening procedure. When these data were normalized for equal numbers of patients in each group receiving one of the drugs, the actual cost-savings was over 2000 US dollars. These cost-savings are largely due to reduced utilization of these expensive biotechnology products with implementation of a dosing protocol. VCUHS has successfully developed and implemented a darbepoetin alfa therapeutic interchange protocol for hospitalized dialysis patients. This has translated into reduced use of erythropoiesis-stimulating proteins, resulting in cost-savings for the health system.

EON: a component-based approach to automation of protocol-directed therapy.

PubMed Central

Musen, M A; Tu, S W; Das, A K; Shahar, Y

1996-01-01

Provision of automated support for planning protocol-directed therapy requires a computer program to take as input clinical data stored in an electronic patient-record system and to generate as output recommendations for therapeutic interventions and laboratory testing that are defined by applicable protocols. This paper presents a synthesis of research carried out at Stanford University to model the therapy-planning task and to demonstrate a component-based architecture for building protocol-based decision-support systems. We have constructed general-purpose software components that (1) interpret abstract protocol specifications to construct appropriate patient-specific treatment plans; (2) infer from time-stamped patient data higher-level, interval-based, abstract concepts; (3) perform time-oriented queries on a time-oriented patient database; and (4) allow acquisition and maintenance of protocol knowledge in a manner that facilitates efficient processing both by humans and by computers. We have implemented these components in a computer system known as EON. Each of the components has been developed, evaluated, and reported independently. We have evaluated the integration of the components as a composite architecture by implementing T-HELPER, a computer-based patient-record system that uses EON to offer advice regarding the management of patients who are following clinical trial protocols for AIDS or HIV infection. A test of the reuse of the software components in a different clinical domain demonstrated rapid development of a prototype application to support protocol-based care of patients who have breast cancer. PMID:8930854

Breast reconstruction with tissue expanders: implementation of a standardized best-practices protocol to reduce infection rates.

PubMed

Khansa, Ibrahim; Hendrick, Russell G; Shore, Alison; Meyerson, Joseph; Yang, Maelee; Boehmler, James H

2014-07-01

Periprosthetic infection remains a frustrating and costly complication of breast reconstruction with tissue expanders. Although some specific steps have been previously shown to reduce periprosthetic infections, no comprehensive protocol addressing all aspects of preoperative, intraoperative, and postoperative patient management has been evaluated in the literature. The authors' goal was to evaluate the effectiveness of their protocol at reducing periprosthetic infections. A comprehensive, best-practices protocol was introduced and implemented in November of 2010. All patients undergoing breast reconstruction using tissue expanders at the authors' institution in the 5 years before the protocol, and in the 2 years after, were analyzed. Three hundred five patients underwent 456 tissue expander reconstructions in the 5 years before the protocol, and 198 patients underwent 313 reconstructions in the 2 years after. Significantly fewer patients developed periprosthetic infection after protocol (11.6 percent versus 18.4 percent; p=0.042), and the number of infected tissue expanders trended toward a decrease (9.3 percent versus 13.2 percent; p=0.097). On multivariate analysis, the protocol significantly reduced the odds of periprosthetic infection (OR, 0.45; p=0.022). Predictors of infection included obesity (OR, 2.01; p=0.045) and preoperative breast size larger than C cup (OR, 2.83; p=0.006). The authors' comprehensive, best-practices protocol allowed them to reduce the odds of tissue expander infections by 55 percent (OR, 0.45; p=0.022). The authors were able to identify several potential areas of improvement that may help them lower the rate of infection further in the future. Therapeutic, III.

Real time UNIX in embedded control-a case study within the context of LynxOS

NASA Astrophysics Data System (ADS)

Kleines, H.; Zwoll, K.

1996-02-01

Intelligent communication controllers for a layered protocol profile are a typical example of an embedded control application, where the classical approach for the software development is based on a proprietary real-time operating system kernel under which the individual layers are implemented as tasks. Based on the exemplary implementation of a derivative of MAP 3.0, an unusual and innovative approach is presented, where the protocol software is implemented under the UNIX-compatible real-time operating system LynxOS. The overall design of the embedded control application is presented under a more general view and economical implications as well as aspects of the development environment and performance are discussed

[Fewer breech deliveries after implementation of a modified cephalic version protocol].

PubMed

Kuppens, Simone M I; Francois, Anne M H; Hasaart, Tom H M; van der Donk, Maria W P; Pop, Victor J M

2010-01-01

To investigate the effect of implementation of a number of process policy guidelines (protocol), on the success rate of external cephalic version (ECV) for breech presentation. Prospective study. During a 3-year period (2004-2006) a standardized protocol for an ECV consultation was developed, evaluated and adapted. After implementing this modified protocol as 'process policy guidelines', the effect on the rate of successful ECV was prospectively evaluated during the period 1 January 2007-31 July 2008. Success was defined as cephalic presentation (ultrasound) immediately after ECV. A secondary outcome measure was the elective caesarean section rate for breech presentation. The rate of successful ECV increased significantly from 47% (110/236 pregnant women) in the period January 2004-December 2006 to 61% (85/139, p = 0.006) in the period January 2007-July 2008. Patient characteristics were similar in both groups, with the exception of 2 subgroups of term of version. The increase was preferentially found in nulliparous and multiparous women with frank breech. Nulliparity, frank breech, anterior placenta and low birth weight were associated with a lower success rate of ECV. The term of pregnancy at which ECV was performed did not seem to affect the success rate. Implementing the process policy guidelines increased the number of cephalic presentations at delivery and decreased the rate of elective caesarean sections for breech presentation from 39% to 27% (p = 0.03). The number needed to treat to prevent 1 elective caesarean section by ECV according to the process policy guidelines was 8. After implementation of the process policy guidelines, the success rate of ECV increased considerably. The rate of elective caesarean section for breech presentation declined. These findings are in favour of establishing specialized ECV centres in the Netherlands.

Oncologists and Breaking Bad News-From the Informed Patients' Point of View. The Evaluation of the SPIKES Protocol Implementation.

PubMed

Marschollek, Paweł; Bąkowska, Katarzyna; Bąkowski, Wojciech; Marschollek, Karol; Tarkowski, Radosław

2018-02-05

The way that bad news is disclosed to a cancer patient has a crucial impact on physician-patient cooperation and trust. Consensus-based guidelines provide widely accepted tools for disclosing unfavorable information. In oncology, the most popular one is called the SPIKES protocol. A 17-question survey was administered to a group of 226 patients with cancer (mean age 59.6 years) in order to determine a level of SPIKES implementation during first cancer disclosure. In our assessment, the patients felt that the highest compliance with the SPIKES protocol was with Setting up (70.6%), Knowledge (72.8%), and Emotions (75.3%). The lowest was with the Perception (27.7%), Invitation (30.4%), and Strategy & Summary (56.9%) parts. There could be improvement with each aspect of the protocol, but especially in Perception, Invitation, and Strategy & Summary. The latter is really important and must be done better. Older patients felt the doctors' language was more comprehensible (r = 0.17; p = 0.011). Patients' satisfaction of their knowledge about the disease and follow-up, regarded as an endpoint, was insufficient. Privacy was important in improving results (p < 0.01). In practice, the SPIKES protocol is implemented in a satisfactory standard, but it can be improved in each area, especially in Perception, Invitation, and Summary. It is suggested that more training should be done in undergraduate and graduate medical education and the effectiveness of the disclosure continue to be evaluated and improved.

Meaningful Use and Electronic Laboratory Reporting: Challenges Health Information Technology Vendors Face in Kentucky.

PubMed

Abisa, Michael

2017-01-01

To explore the challenges Health Information Technology (HIT) vendors face to satisfy the requirements for Meaningful Use (MU) and Electronic Laboratory Reporting (ELR) of reportable diseases to the public health departments in Kentucky. A survey was conducted of Health Information Exchange (HIE) vendors in Kentucky through the Kentucky Health Information Exchange (KHIE). The survey was cross-sectional. Data were collected between February and March 2014. Participants were recruited from KHIE vendors. Participants received online survey link and by email and asked to submit their responses. Vendors' feedback were summarized and analyzed to identify their challenges. Out of the 55 vendors who received the survey, 35(63.64%) responded. Of the seven transport protocol options for ELR, vendors selected virtual private network (VPN) as the most difficult to implement (31.7%). Secure File Transfer Protocol (SFTP) was selected as preferred ELR transport protocol (31.4%). Most of the respondents, 80% responded that they do not have any challenge with the Health Level 7 (HL7) standard implementation guide required by MU for 2014 ELR certification. The study found that the most difficult transport protocol to implement for ELR is VPN and if vendors have preference, they would use SFTP for ELR over KHIE choice of VPN and Simple Object Access Protocol (SOAP). KHIE vendors do not see any variability in what is reportable by different jurisdiction and also it is not difficult for them to detect what is reportable from one jurisdiction verse the other.

Implementing Diffie-Hellman key exchange using quantum EPR pairs

NASA Astrophysics Data System (ADS)

Mandal, Sayonnha; Parakh, Abhishek

2015-05-01

This paper implements the concepts of perfect forward secrecy and the Diffie-Hellman key exchange using EPR pairs to establish and share a secret key between two non-authenticated parties and transfer messages between them without the risk of compromise. Current implementations of quantum cryptography are based on the BB84 protocol, which is susceptible to siphoning attacks on the multiple photons emitted by practical laser sources. This makes BB84-based quantum cryptography protocol unsuitable for network computing environments. Diffie-Hellman does not require the two parties to be mutually authenticated to each other, yet it can provide a basis for a number of authenticated protocols, most notably the concept of perfect forward secrecy. The work proposed in this paper provides a new direction in utilizing quantum EPR pairs in quantum key exchange. Although, classical cryptography boasts of efficient and robust protocols like the Diffie-Hellman key exchange, in the current times, with the advent of quantum computing they are very much vulnerable to eavesdropping and cryptanalytic attacks. Using quantum cryptographic principles, however, these classical encryption algorithms show more promise and a more robust and secure structure for applications. The unique properties of quantum EPR pairs also, on the other hand, go a long way in removing attacks like eavesdropping by their inherent nature of one particle of the pair losing its state if a measurement occurs on the other. The concept of perfect forward secrecy is revisited in this paper to attribute tighter security to the proposed protocol.

Implementing a Pro-forma for Multidisciplinary Management of an Enterocutaneous Fistula: A Case Study.

PubMed

Samad, Sohel; Anele, Chukwuemeka; Akhtar, Mansoor; Doughan, Samer

2015-06-01

Optimal management of patients with an entercocutaneous fistula (ECF) requires utilization of the sepsis, nutrition, anatomy, and surgical procedure (SNAP) protocol. The protocol includes early detection and treatment of sepsis, optimizing patient nutrition through oral and parenteral routes, identifying the fistula anatomy, optimal fistula management, and proceeding to corrective surgery when appropriate. The protocol requires multidisciplinary team (MDT) coordination among surgeons, nurses, dietitians, stoma nurses, and physiotherapists. This case study describes a 70-year-old man who developed an ECF subsequent to a laparotomy for a small bowel obstruction. Following a period of ileus, 16 days post laparotomy the patient developed a high-output (2,000 mL per day) fistula. The patient also became pyrexial with raised inflammatory markers, requiring antibiotic treatment. Following development of his ECF, he was managed using the SNAP protocol for the duration of his admission; however, in implementing this protocol with this patient, clinicians noted fluid charts were inadequate to allow effective management of the variables. Thus, a new pro-forma was created that encompassed fluid balance, nutritional status, and pertinent blood test results, as well as perifistular skin condition, medication, and documentation of management plans from the MDT team. The pro-forma was recorded daily in the patient notes. Following implementation of the pro-forma and the SNAP protocol, the patient recovered well clinically over a period of 4 weeks with a decrease in his fistula output to 300-500 mL per day, and he was discharged with plans for further corrective surgery to resect the fistula and for bowel re-anastomoses. Although fluid charts are readily available, they do not include all pertinent variables for optimal management of patients with an ECF. Further research is needed to validate the pro-forma and evaluate its effect on patient outcomes.

Comparison of H.323 and SIP for IP telephony signaling

NASA Astrophysics Data System (ADS)

Dalgic, Ismail; Fang, Hanlin

1999-11-01

Two standards currently compete for the dominance of IP telephony signaling: the H.323 protocol suite by ITU-T, and the Session Initiation Protocol (SIP) by IETF. Both of these signaling protocols provide mechanisms for call establishment and teardown, call control and supplementary services, and capability exchange. We investigate and compare these two protocols in terms of Functionality, Quality of Service (QoS), Scalability, Flexibility, Interoperability, and Ease of Implementation. For fairness of comparison, we consider similar scenarios for both protocols. In particular, we focus on scenarios that involve a gatekeeper for H.323, and a Proxy/Redirect server for SIP. The reason is that medium-to-large IP Telephony systems are not manageable without a gatekeeper or proxy server. We consider all three versions of H.323. In terms of functionality and services that can be supported, H.323 version 2 and SIP are very similar. However, supplementary services in H.323 are more rigorously defined, and therefore fewer interoperability issues are expected among its implementations. Furthermore, H.323 has taken more steps to ensure compatibility among its different versions, and to interoperate with PSTN. The two protocols are comparable in their QoS support [similar call setup delays, no support for resource reservation or class of service (CoS) setting], but H.323 version 3 will allow signaling of the requested CoS. SIP's primary advantages are (1) flexibility to add new features, and (2) relative ease of implementation and debugging. Finally, we note that H.323 and SIP are improving themselves by learning from each other, and the differences between them are diminishing with each new version.

Impact on delay times and characteristics of patients undergoing primary percutaneous coronary intervention in the southern metropolitan area of Barcelona after implementation of the infarction code program.

PubMed

Gómez-Hospital, Joan Antoni; Dallaglio, Paolo Domenico; Sánchez-Salado, Jose Carlos; Ariza, Albert; Homs, Silvia; Lorente, Victoria; Ferreiro, Jose Luis; Gomez-Lara, Josep; Romaguera, Rafael; Salazar-Mendiguchía, Joel; Teruel, Luis; Cequier, Ángel

2012-10-01

A standardized protocol of emergent transfer for primary percutaneous coronary intervention for patients with ST elevation myocardial infarction, defined as the Infarction Code, was implemented in June 2009 in the Catalan regional health system. The objective of this study was to evaluate the impact of the new protocol on delay times, number of procedures and clinical characteristics compared with the previous period in the population of patients referred to our hospital. All consecutive patients undergoing primary percutaneous coronary intervention in our hospital were prospectively registered. The clinical characteristics, delay times and mortality in the follow-up of the protocol implementation period (June 2009-May 2010) were analyzed and compared with the previous year (June 2008-May 2009). During the protocol period, 514 patients were included, compared with 241 in the previous year. Age, cardiovascular risk factors, anterior myocardial infarction and procedure characteristics were similar in the 2 groups. The first medical contact to balloon time was lower in the protocol period (median time 120 min vs 88 min; P<.001). Patients in the protocol period showed a trend toward less severe disease (Killip III, rescue angioplasty). The multivariate regression analysis showed a significant association between 1-year mortality and age, Killip class ≥ III at admission, anterior infarction and 3-vessel disease. The introduction of the Infarction Code program increased the number of patients treated by primary percutaneous coronary intervention with a reduction in delay times and better clinical characteristics at presentation. Full English text available from:www.revespcardiol.org. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Organizational principles of cloud storage to support collaborative biomedical research.

PubMed

Kanbar, Lara J; Shalish, Wissam; Robles-Rubio, Carlos A; Precup, Doina; Brown, Karen; Sant'Anna, Guilherme M; Kearney, Robert E

2015-08-01

This paper describes organizational guidelines and an anonymization protocol for the management of sensitive information in interdisciplinary, multi-institutional studies with multiple collaborators. This protocol is flexible, automated, and suitable for use in cloud-based projects as well as for publication of supplementary information in journal papers. A sample implementation of the anonymization protocol is illustrated for an ongoing study dealing with Automated Prediction of EXtubation readiness (APEX).

Development of an alcohol withdrawal protocol: CNS collaborative exemplar.

PubMed

Phillips, Susan; Haycock, Camille; Boyle, Deborah

2006-01-01

The purpose of this process improvement project was to develop an Alcohol Withdrawal Syndrome (AWS) management protocol for acute care. The prevalence of alcohol abuse in our society presents challenges for health professionals, and few nurses have received formal education on the identification and treatment of AWS, which has frequently resulted in ineffective, nonstandardized care. However, nurses practicing in medical-surgical, emergency, trauma, and critical care settings must be astute in the assessment and management of AWS. DESIGN/BACKGROUND/RATIONALE: Following an analysis of existing management protocols, a behavioral health clinical nurse specialist was asked to lead a work team composed of physicians, pharmacists, and nurses to develop a new evidence-based alcohol withdrawal protocol for acute care. By implementing a standardized assessment tool and treatment protocol, clinical nurse specialists empowered nursing staff with strategies to prevent the serious medical complications associated with AWS. FINDINGS/OUTCOMES: The development and integration of a safe and effective treatment protocol to manage AWS was facilitated by collaborative, evidence-based decision making. Clinical experience and specialty expertise were integrated by clinical nurse specialists skilled in group dynamics, problem-solving, and the implementation of change. Improving care of patients in AWS is an exemplar for clinical nurse specialist roles as change agent and patient advocate.

Quality assurance of data collection in the multi-site community randomized trial and prevalence survey of the children's healthy living program.

PubMed

Yamanaka, Ashley; Fialkowski, Marie Kainoa; Wilkens, Lynne; Li, Fenfang; Ettienne, Reynolette; Fleming, Travis; Power, Julianne; Deenik, Jonathan; Coleman, Patricia; Leon Guerrero, Rachael; Novotny, Rachel

2016-09-02

Quality assurance plays an important role in research by assuring data integrity, and thus, valid study results. We aim to describe and share the results of the quality assurance process used to guide the data collection process in a multi-site childhood obesity prevalence study and intervention trial across the US Affiliated Pacific Region. Quality assurance assessments following a standardized protocol were conducted by one assessor in every participating site. Results were summarized to examine and align the implementation of protocol procedures across diverse settings. Data collection protocols focused on food and physical activity were adhered to closely; however, protocols for handling completed forms and ensuring data security showed more variability. Quality assurance protocols are common in the clinical literature but are limited in multi-site community-based studies, especially in underserved populations. The reduction in the number of QA problems found in the second as compared to the first data collection periods for the intervention study attest to the value of this assessment. This paper can serve as a reference for similar studies wishing to implement quality assurance protocols of the data collection process to preserve data integrity and enhance the validity of study findings. NIH clinical trial #NCT01881373.

Implementation and Analysis of Real-Time Streaming Protocols.

PubMed

Santos-González, Iván; Rivero-García, Alexandra; Molina-Gil, Jezabel; Caballero-Gil, Pino

2017-04-12

Communication media have become the primary way of interaction thanks to the discovery and innovation of many new technologies. One of the most widely used communication systems today is video streaming, which is constantly evolving. Such communications are a good alternative to face-to-face meetings, and are therefore very useful for coping with many problems caused by distance. However, they suffer from different issues such as bandwidth limitation, network congestion, energy efficiency, cost, reliability and connectivity. Hence, the quality of service and the quality of experience are considered the two most important issues for this type of communication. This work presents a complete comparative study of two of the most used protocols of video streaming, Real Time Streaming Protocol (RTSP) and the Web Real-Time Communication (WebRTC). In addition, this paper proposes two new mobile applications that implement those protocols in Android whose objective is to know how they are influenced by the aspects that most affect the streaming quality of service, which are the connection establishment time and the stream reception time. The new video streaming applications are also compared with the most popular video streaming applications for Android, and the experimental results of the analysis show that the developed WebRTC implementation improves the performance of the most popular video streaming applications with respect to the stream packet delay.

Efficacy of a hospital-wide environmental cleaning protocol on hospital-acquired methicillin-resistant Staphylococcus aureus rates.

PubMed

Watson, Paul Andrew; Watson, Luke Robert; Torress-Cook, Alfonso

2016-07-01

Environmental contamination has been associated with over half of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in hospitals. We explored if a hospital-wide environmental and patient cleaning protocol would lower hospital acquired MRSA rates and associated costs. This study evaluates the impact of implementing a hospital-wide environmental and patient cleaning protocol on the rate of MRSA infection and the potential cost benefit of the intervention. A retrospective, pre-post interventional study design was used. The intervention comprised a combination of enhanced environmental cleaning of high touch surfaces, daily washing of patients with benzalkonium chloride, and targeted isolation of patients with active infection. The rate of MRSA infection per 1000 patient days (PD) was compared with the rate after the intervention (Steiros Algorithm ® ) was implemented. A cost-benefit analysis based on the number of MRSA infections avoided was conducted. The MRSA rates decreased by 96% from 3.04 per 1000 PD to 0.11 per 1000 PD ( P <0.0001). This reduction in MRSA infections, avoided an estimated $1,655,143 in healthcare costs. Implementation of this hospital-wide protocol appears to be associated with a reduction in the rate of MRSA infection and therefore a reduction in associated healthcare costs.

Impersonation attack on a quantum secure direct communication and authentication protocol with improvement

NASA Astrophysics Data System (ADS)

Amerimehr, Ali; Hadain Dehkordi, Massoud

2018-03-01

We analyze the security of a quantum secure direct communication and authentication protocol based on single photons. We first give an impersonation attack on the protocol. The cryptanalysis shows that there is a gap in the authentication procedure of the protocol so that an opponent can reveal the secret information by an undetectable attempt. We then propose an improvement for the protocol and show it closes the gap by applying a mutual authentication procedure. In the improved protocol single photons are transmitted once in a session, so it is easy to implement as the primary protocol. Furthermore, we use a novel technique for secret order rearrangement of photons by which not only quantum storage is eliminated also a secret key can be reused securely. So the new protocol is applicable in practical approaches like embedded system devices.

Age and admission times as predictive factors for failure of admissions to discharge-stream short-stay units.

PubMed

Shetty, Amith L; Shankar Raju, Savitha Banagar; Hermiz, Arsalan; Vaghasiya, Milan; Vukasovic, Matthew

2015-02-01

Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates. We conducted a retrospective audit on 6703 (5522 inclusions) patients admitted to our discharge-stream short-stay unit. Patients were classified as appropriate or inappropriate admissions, and deemed successful if discharged out of the unit within 24 h; and failures if they needed inpatient admission into the hospital. We calculated short-stay unit length of stay for patients in each of these groups. A 15% failure rate was deemed as acceptable key performance indicator (KPI) for our unit. There were 197 out of 4621 (4.3%, 95% CI 3.7-4.9%) patients up to the age of 70 who failed admission to ESSU compared with 67 out of 901 (7.4%, 95% CI 5.9-9.3%, P < 0.01) of patients over the age of 70, reflecting an increased failure rate in geriatric population. When grouped according to times of admission to the ESSU (in-office 06.00-22.00 hours vs out-of-office 22.00-06.00 hours) no significant difference rates in discharge failure (4.7% vs 5.2%, P = 0.46) were noted. Patients >70 years of age have higher rates of failure after admission to discharge-stream ESSU. Although in appropriately selected discharge-stream patients, no age group or time-band of presentation was associated with increased failure rate beyond the stipulated KPI. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Prognostic role of ABO blood type in patients with extranodal natural killer/T cell lymphoma, nasal type: a triple-center study.

PubMed

Li, Ya-Jun; Yi, Ping-Yong; Li, Ji-Wei; Liu, Xian-Ling; Tang, Tian; Zhang, Pei-Ying; Jiang, Wen-Qi

2017-07-31

The prognostic significance of ABO blood type for lymphoma is largely unknown. We evaluated the prognostic role of ABO blood type in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL). We retrospectively analyzed clinical data of 697 patients with newly diagnosed ENKTL from three cancer centers. The prognostic value of ABO blood type was evaluated using Kaplan-Meier curves and Cox proportional hazard models. The prognostic values of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were also evaluated. Compared with patients with blood type O, those with blood type non-O tended to display elevated baseline serum C-reactive protein levels (P = 0.038), lower rate of complete remission (P = 0.005), shorter progression-free survival (PFS, P < 0.001), and shorter overall survival (OS, P = 0.001). Patients with blood type O/AB had longer PFS (P < 0.001) and OS (P = 0.001) compared with those with blood type A/B. Multivariate analysis demonstrated that age >60 years (P < 0.001), mass ≥5 cm (P = 0.001), stage III/IV (P < 0.001), elevated serum lactate dehydrogenase (LDH) levels (P = 0.001), and blood type non-O were independent adverse predictors of OS (P = 0.001). ABO blood type was found to be superior to both the IPI in discriminating patients with different outcomes in the IPI low-risk group and the KPI in distinguishing between the intermediate-to-low- and high-to-intermediate-risk groups. ABO blood type was an independent predictor of clinical outcome for patients with ENKTL.

The Importance of Strength and Power on Key Performance Indicators in Elite Youth Soccer.

PubMed

Wing, Christopher E; Turner, Anthony N; Bishop, Chris J

2018-01-24

The purpose of this investigation was to examine the importance of strength and power in relation to key performance indicators (KPI's) within competitive soccer match play. This was achieved through using an experimental approach where fifteen subjects were recruited from a professional soccer club's scholarship squad during the 2013/14 season. Following anthropometric measures, power and strength were assessed across a range of tests which included the squat jump (SJ), countermovement jump (CMJ), 20 metre (m) sprint and arrowhead change of direction test. A predicted 1-repetition maximum (RM) was also obtained for strength by performing a 3RM test for both the back squat and bench press and a total score of athleticism (TSA) was provided by summing z-scores for all fitness tests together, providing one complete score for athleticism. Performance analysis data was collected during 16 matches for the following KPIs: passing, shooting, dribbling, tackling and heading. Alongside this, data concerning player ball involvements (touches) was recorded. Results showed that there was a significant correlation (p < 0.05) between CMJ (r = 0.80), SJ (r = 0.79) and TSA (r = 0.64) in relation to heading success. Similarly, a significant correlation (p < 0.05) between predicted 1RM squat strength and tackle success (r = 0.61). These data supports the notion that strength and power training are important to soccer performance, particularly when players are required to win duels of a physical nature. There were no other relationships found between the fitness data and the KPI's recorded during match play which may indicate that other aspects of player's development such as technical skill, cognitive function and sensory awareness are more important for soccer-specific performance.

The challenge of sustainability in healthcare systems: Frequency and cost of inappropriate patterns of breast cancer care (the E.Pic.A study).

PubMed

Massa, Ilaria; Balzi, William; Burattini, Costanza; Gentili, Nicola; Bucchi, Lauro; Nanni, Oriana; Gallegati, Davide; Pierini, Andrea; Amadori, Dino; Falcini, Fabio; Altini, Mattia

2017-08-01

In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Identification and Characterization of the Lysine-Rich Matrix Protein Family in Pinctada fucata: Indicative of Roles in Shell Formation.

PubMed

Liang, Jian; Xie, Jun; Gao, Jing; Xu, Chao-Qun; Yan, Yi; Jia, Gan-Chu; Xiang, Liang; Xie, Li-Ping; Zhang, Rong-Qing

2016-12-01

Mantle can secret matrix proteins playing key roles in regulating the process of shell formation. The genes encoding lysine-rich matrix proteins (KRMPs) are one of the most highly expressed matrix genes in pearl oysters. However, the expression pattern of KRMPs is limited and the functions of them still remain unknown. In this study, we isolated and identified six new members of lysine-rich matrix proteins, rich in lysine, glycine and tyrosine, and all of them are basic matrix proteins. Combined with four members of the KRMPs previously reported, all these proteins can be divided into three subclasses according to the results of phylogenetic analyses: KRMP1-3 belong to subclass KPI, KRMP4-5 belong to KPII, and KRMP6-10 belong to KPIII. Three subcategories of lysine-rich matrix proteins are highly expressed in the D-phase, the larvae and adult mantle. Lysine-rich matrix proteins are involved in the shell repairing process and associated with the formation of the shell and pearl. What's more, they can cause abnormal shell growth after RNA interference. In detail, KPI subgroup was critical for the beginning formation of the prismatic layer; both KPII and KPIII subgroups participated in the formation of prismatic layer and nacreous layer. Compared with different temperatures and salinity stimulation treatments, the influence of changes in pH on KRMPs gene expression was the greatest. Recombinant KRMP7 significantly inhibited CaCO 3 precipitation, changed the morphology of calcite, and inhibited the growth of aragonite in vitro. Our results are beneficial to understand the functions of the KRMP genes during shell formation.

British Military surgical key performance indicators: time for an update?

PubMed

Marsden, Max Er; Sharrock, A E; Hansen, C L; Newton, N J; Bowley, D M; Midwinter, M

2016-10-01

Key performance indicators (KPIs) are metrics that compare actual care against an ideal structure, process or outcome standard. KPIs designed to assess performance in deployed military surgical facilities have previously been published. This study aimed to review the overall performance of surgical trauma care for casualties treated at Role 3 Camp Bastion, Medical Treatment Facility, Afghanistan, in light of the existing Defence Medical Services (DMS) KPIs. The secondary aims were to assess the utility of the surgical KPIs and make recommendations for future surgical trauma care review. Data on 22 surgical parameters were prospectively collected for 150 injured patients who had primary surgery at Camp Bastion between 1 May 2013 and 20 August 2013. Additional information for these patients was obtained using the Joint Theatre Trauma Register. The authors assessed data recording, applicability and compliance with the KPIs. Median data recording was 100% (IQR 98%-100%), median applicability was 56% (IQR 10%-99%) and median compliance was 78% (IQR 58%-93%). One KPI was not applicable to any patient in our population. Eleven KPIs achieved >80% compliance, five KPIs had 80%-60% compliance and five KPIs had <60% compliance. Recommendations are made for minor modifications to the current KPIs. 78% compliance with the DMS KPIs provides a snapshot of the performance of the surgical aspect of military trauma care in 2013. The KPIs highlight areas for improvement in service delivery. Individual KPI development should be driven by evidence and reflect advances in practice and knowledge. A method of stakeholder consultation, and sequential refinement following evidence review, may be the right process to develop the future set of DMS KPIs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Asynchronous Messaging and Data Transfer in a Spacecraft: An Implementation

NASA Technical Reports Server (NTRS)

Moholt, Joseph M.

2005-01-01

Data transfer and messaging is an important part of a spacecraft. Creating a standard protocol for messaging that can be used for a variety of applications is an extremely beneficial project at the Jet Propulsion Laboratory (JPL). The Asynchronous Messaging Service (AMS) is a protocol outlining how subsystems initialize and conduct communication between each other. There are currently two implementations of AMS in the works. At JPL, my task is to get a working implementation of AMS onto vxWorks as a proof of concept. An Autocoder, a program used to convert visually created state chart diagrams to C++, has also been created to accomplish a part of the implementation. I was assigned to make the program portable on any Unix type environment. Lastly, I was to develop a program to demonstrate messaging between two FireWire cards running vxworks.

CFDP for Interplanetary Overlay Network

NASA Technical Reports Server (NTRS)

Burleigh, Scott C.

2011-01-01

The CCSDS (Consultative Committee for Space Data Systems) File Delivery Protocol for Interplanetary Overlay Network (CFDP-ION) is an implementation of CFDP that uses IO' s DTN (delay tolerant networking) implementation as its UT (unit-data transfer) layer. Because the DTN protocols effect automatic, reliable transmission via multiple relays, CFDP-ION need only satisfy the requirements for Class 1 ("unacknowledged") CFDP. This keeps the implementation small, but without loss of capability. This innovation minimizes processing resources by using zero-copy objects for file data transmission. It runs without modification in VxWorks, Linux, Solaris, and OS/X. As such, this innovation can be used without modification in both flight and ground systems. Integration with DTN enables the CFDP implementation itself to be very simple; therefore, very small. Use of ION infrastructure minimizes consumption of storage and processing resources while maximizing safety.

Development of UV Testing Protocol and Recommendations

EPA Science Inventory

The goal of this effort is to develop and present new protocols for UV validation testing and analysis that leverage advances and may help to improve implementation and operation at PWSs. This document also provides for updated clarifications to the UVDGM based on evolving practi...