Educational Intervention Improves Compliance With AAN Guidelines for Return Epilepsy Visits: A Quality Improvement Project.

PubMed

Nelson, Gary R; Filloux, Francis M; Kerr, Lynne M

2016-10-01

In 2011, the American Academy of Neurology (AAN) released guidelines for return seizure visits detailing 8 points that should be addressed during such visits. These guidelines are designed to improve routine follow-up care for epilepsy patients. The authors performed a quality improvement project aimed at increasing compliance with these guidelines after educating providers about them. The authors performed a chart review before and after an intervention which included: education regarding the guidelines, providing materials to remind providers of the guidelines, and templates to facilitate compliance. The authors reviewed charts at 2 and 6 months after the intervention. Significant improvement in documentation of 4 of the 8 measures was observed after this educational intervention. This suggests that simple educational interventions may help providers change practice and can improve compliance with new guidelines while requiring minimal time and resources to implement. © The Author(s) 2016.

Continuing education for performance improvement: a creative approach.

PubMed

Collins, Patti-Ann; Hardesty, Ilana; White, Julie L; Zisblatt, Lara

2012-10-01

In an effort to improve patient safety and health care outcomes, continuing medical education has begun to focus on performance improvement initiatives for physician practices. Boston University School of Medicine's (BUSM) Continuing Nursing Education Accredited Provider Unit has begun a creative project to award nursing contact hours for nurses' participation in performance improvement activities. This column highlights its initial efforts. Copyright 2012, SLACK Incorporated.

Modifying the Toyota Production System for continuous performance improvement in an academic children's hospital.

PubMed

Stapleton, F Bruder; Hendricks, James; Hagan, Patrick; DelBeccaro, Mark

2009-08-01

The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

Meeting the Challenge: Providing High-Quality School Environments through Energy Performance Contracting.

ERIC Educational Resources Information Center

Birr, David

2000-01-01

Energy performance contracting allows schools to pay for needed new energy equipment and modernization improvements with savings from reduced utility and maintenance costs. Improved energy efficiency reduces demand for burning fossil fuels, which reduces air pollution, leading to improved learning environments and budgets (through improved average…

Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

NASA Astrophysics Data System (ADS)

Jardim, Kevin P.

Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis

PubMed Central

Dalkin, Sonia; Gibbons, Elizabeth; Wright, Judy; Valderas, Jose Maria; Meads, David; Black, Nick

2017-01-01

Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine ‘if then’ propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how aggregated patient-reported outcome measures data stimulate quality improvement, several lessons emerge from interventions sharing the same programme theories to help guide the increasing use of these measures. PMID:29260592

Effect of Performance Feedback on Community Health Workers’ Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial

PubMed Central

Matheke-Fischer, Michael; Lesh, Neal

2016-01-01

Background Small-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years. Objective The paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change. Methods In a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention. Results We found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass’s delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass’s delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results. Conclusions Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation. PMID:27927607

MSR performance enhancements and modifications at St. Lucie Power Plant

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

Rubano, V.F.; Ugelow, A.G.; Menocal, A.G.

1989-01-01

The St. Lucie Power Plant provides an excellent historical prospective on various moisture separator/reheater improvements. Between the two essentially identical units there is a total of 14 years of operating experience with various moisture separator/reheater configurations, with a combination of four different heat transfer surfaces and three moisture removal configurations. Through various modifications and enhancements, the performance and the reliability of the moisture separator/reheaters at the St. Lucie Power Plant and consequently the overall plant performance has been improved. This improvement has taken place over several years and involves changes in both the heat transfer and moisture removal areas. Thismore » paper provides an overview of the history and description of moisture separator/reheater modifications at the St. Lucie Power Plant with the resulting performance improvements.« less

Computational Fluid Dynamics Simulation Study of Active Power Control in Wind Plants

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

Fleming, Paul; Aho, Jake; Gebraad, Pieter

2016-08-01

This paper presents an analysis performed on a wind plant's ability to provide active power control services using a high-fidelity computational fluid dynamics-based wind plant simulator. This approach allows examination of the impact on wind turbine wake interactions within a wind plant on performance of the wind plant controller. The paper investigates several control methods for improving performance in waked conditions. One method uses wind plant wake controls, an active field of research in which wind turbine control systems are coordinated to account for their wakes, to improve the overall performance. Results demonstrate the challenge of providing active power controlmore » in waked conditions but also the potential methods for improving this performance.« less

Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories.

PubMed

Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine

2011-04-01

A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

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

PubMed

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

2018-04-01

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

Self-Study Guide for Florida VPK Provider Improvement Plan Development

ERIC Educational Resources Information Center

Phillips, Beth M.; Mazzeo, Debbie; Smith, Kevin

2016-01-01

This Self-Study Guide has been developed to support Florida Voluntary Prekindergarten Providers (VPK) who are required to complete an improvement plan process (i.e., low-performing providers). The guide has sections that can be used during both the process of selecting target areas for an improvement plan and the process of implementing new or…

Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels

PubMed Central

Rankin, Kristin M.; Gavin, Loretta; Moran, John W.; Kroelinger, Charlan D.; Vladutiu, Catherine J.; Goodman, David A.; Sappenfield, William M.

2018-01-01

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists’ contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes. PMID:27423235

Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels.

PubMed

Rankin, Kristin M; Gavin, Loretta; Moran, John W; Kroelinger, Charlan D; Vladutiu, Catherine J; Goodman, David A; Sappenfield, William M

2016-11-01

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes.

Taking stock of pay-for-performance: a candid assessment from the front lines.

PubMed

Damberg, Cheryl L; Raube, Kristiana; Teleki, Stephanie S; Dela Cruz, Erin

2009-01-01

Pay-for-performance (P4P) has been widely adopted, but it remains unclear how providers are responding and whether results are meeting expectations. Physician organizations involved in the California Integrated Healthcare Association's (IHA) P4P program reported having increased physician-level performance feedback and accountability, speeded up information technology adoption, and sharpened their organizational focus and support for improvement in response to P4P; however, after three years of investment, these changes had not translated into breakthrough quality improvements. Continued monitoring is required to determine whether early investments made by physician organizations provide a basis for greater improvements in the future.

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

PubMed

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

2014-08-01

Prior research has examined clinical effects of performance measurement systems. To the extent that non-clinical effects have been researched, the focus has been on negative unintended consequences. Yet, these same systems may also have ancillary benefits for patients and providers--that is, benefits that extend beyond improvements on clinical measures. The purpose of this study is to identify and describe potential ancillary benefits of performance measures as perceived by primary care staff and facility leaders in a large US healthcare system. In-person individual semistructured interviews were conducted with 59 primary care staff and facility leaders at four Veterans Health Administration facilities. Transcribed interviews were coded and organised into thematic categories. Interviewed staff observed that local performance measurement implementation practices can result in increased patient knowledge and motivation. These effects on patients can lead to improved performance scores and additional ancillary benefits. Performance measurement implementation can also directly result in ancillary benefits for the patients and providers. Patients may experience greater satisfaction with care and psychosocial benefits associated with increased provider-patient communication. Ancillary benefits of performance measurement for providers include increased pride in individual or organisational performance and greater confidence that one's practice is grounded in evidence-based medicine. A comprehensive understanding of the effects of performance measurement systems needs to incorporate ancillary benefits as well as effects on clinical performance scores and negative unintended consequences. Although clinical performance has been the focus of most evaluations of performance measurement to date, both patient care and provider satisfaction may improve more rapidly if all three categories of effects are considered when designing and evaluating performance measurement systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Impact of Time-of-Flight on PET Tumor Detection

PubMed Central

Kadrmas, Dan J.; Casey, Michael E.; Conti, Maurizio; Jakoby, Bjoern W.; Lois, Cristina; Townsend, David W.

2009-01-01

Time-of-flight (TOF) PET uses very fast detectors to improve localization of events along coincidence lines-of-response. This information is then utilized to improve the tomographic reconstruction. This work evaluates the effect of TOF upon an observer's performance for detecting and localizing focal warm lesions in noisy PET images. Methods An advanced anthropomorphic lesion-detection phantom was scanned 12 times over 3 days on a prototype TOF PET/CT scanner (Siemens Medical Solutions). The phantom was devised to mimic whole-body oncologic 18F-FDG PET imaging, and a number of spheric lesions (diameters 6–16 mm) were distributed throughout the phantom. The data were reconstructed with the baseline line-of-response ordered-subsets expectation-maximization algorithm, with the baseline algorithm plus point spread function model (PSF), baseline plus TOF, and with both PSF+TOF. The lesion-detection performance of each reconstruction was compared and ranked using localization receiver operating characteristics (LROC) analysis with both human and numeric observers. The phantom results were then subjectively compared to 2 illustrative patient scans reconstructed with PSF and with PSF+TOF. Results Inclusion of TOF information provides a significant improvement in the area under the LROC curve compared to the baseline algorithm without TOF data (P = 0.002), providing a degree of improvement similar to that obtained with the PSF model. Use of both PSF+TOF together provided a cumulative benefit in lesion-detection performance, significantly outperforming either PSF or TOF alone (P < 0.002). Example patient images reflected the same image characteristics that gave rise to improved performance in the phantom data. Conclusion Time-of-flight PET provides a significant improvement in observer performance for detecting focal warm lesions in a noisy background. These improvements in image quality can be expected to improve performance for the clinical tasks of detecting lesions and staging disease. Further study in a large clinical population is warranted to assess the benefit of TOF for various patient sizes and count levels, and to demonstrate effective performance in the clinical environment. PMID:19617317

Progress Toward Adaptive Integration and Optimization of Automated and Neural Processing Systems: Establishing Neural and Behavioral Benchmarks of Optimized Performance

DTIC Science & Technology

2014-11-01

Paradigm ............................................................................19 3.4 Collaborative BCI for Improving Overall Performance...interfaces ( BCIs ) provide the biggest improvement in performance? Can we demonstrate clear advantages with BCIs ? 2 2. Simulator Development and...stimuli in real time. Fig. 18 ROC curves for each subject after the combination of 2 trials 3.4 Collaborative BCI for Improving Overall

Testing the Limits of Optimizing Dual-Task Performance in Younger and Older Adults

PubMed Central

Strobach, Tilo; Frensch, Peter; Müller, Herrmann Josef; Schubert, Torsten

2012-01-01

Impaired dual-task performance in younger and older adults can be improved with practice. Optimal conditions even allow for a (near) elimination of this impairment in younger adults. However, it is unknown whether such (near) elimination is the limit of performance improvements in older adults. The present study tests this limit in older adults under conditions of (a) a high amount of dual-task training and (b) training with simplified component tasks in dual-task situations. The data showed that a high amount of dual-task training in older adults provided no evidence for an improvement of dual-task performance to the optimal dual-task performance level achieved by younger adults. However, training with simplified component tasks in dual-task situations exclusively in older adults provided a similar level of optimal dual-task performance in both age groups. Therefore through applying a testing the limits approach, we demonstrated that older adults improved dual-task performance to the same level as younger adults at the end of training under very specific conditions. PMID:22408613

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities: results and lessons learned.

PubMed

Kols, Adrienne; Kim, Young-Mi; Bazant, Eva; Necochea, Edgar; Banda, Joseph; Stender, Stacie

2015-07-01

The Zambia Defence Force adopted the Standards-Based Management and Recognition approach to improve the quality of the HIV-related services at its health facilities. This quality improvement intervention relies on comprehensive, detailed assessment tools to communicate and verify adherence to national standards of care, and to test and implement changes to improve performance. A quasi-experimental evaluation of the intervention was conducted at eight Zambia Defence Force primary health facilities (four facilities implemented the intervention and four did not). Data from three previous analyses are combined to assess the effect of Standards-Based Management and Recognition on three domains: facility readiness to provide services; observed provider performance during antiretroviral therapy (ART) and antenatal care consultations; and provider perceptions of the work environment. Facility readiness scores for ART improved on four of the eight standards at intervention sites, and one standard at comparison sites. Facility readiness scores for prevention of mother-to-child transmission (PMTCT) of HIV increased by 15 percentage points at intervention sites and 7 percentage points at comparison sites. Provider performance improved significantly at intervention sites for both ART services (from 58 to 84%; P < 0.01) and PMTCT services (from 58 to 73%; P = 0.003); there was no significant change at comparison sites. Providers' perceptions of the work environment generally improved at intervention sites and declined at comparison sites; differences in trends between study groups were significant for eight items. A standards-based approach to quality improvement proved effective in supporting healthcare managers and providers to deliver ART and PMTCT services in accordance with evidence-based standards in a health system suffering from staff shortages.

Recent progress towards predicting aircraft ground handling performance

NASA Technical Reports Server (NTRS)

Yager, T. J.; White, E. J.

1981-01-01

Capability implemented in simulating aircraft ground handling performance is reviewed and areas for further expansion and improvement are identified. Problems associated with providing necessary simulator input data for adequate modeling of aircraft tire/runway friction behavior are discussed and efforts to improve tire/runway friction definition, and simulator fidelity are described. Aircraft braking performance data obtained on several wet runway surfaces are compared to ground vehicle friction measurements. Research to improve methods of predicting tire friction performance are discussed.

Improved Performance via the Inverted Classroom

ERIC Educational Resources Information Center

Weinstein, Randy D.

2015-01-01

This study examined student performance in an inverted thermodynamics course (lectures provided by video outside of class) compared to a traditional lecture class. Students in the inverted class performed better on their exams. Students in the bottom third of the inverted course showed the greatest improvement. These bottom third students had a C…

Interacting multiple model forward filtering and backward smoothing for maneuvering target tracking

NASA Astrophysics Data System (ADS)

Nandakumaran, N.; Sutharsan, S.; Tharmarasa, R.; Lang, Tom; McDonald, Mike; Kirubarajan, T.

2009-08-01

The Interacting Multiple Model (IMM) estimator has been proven to be effective in tracking agile targets. Smoothing or retrodiction, which uses measurements beyond the current estimation time, provides better estimates of target states. Various methods have been proposed for multiple model smoothing in the literature. In this paper, a new smoothing method, which involves forward filtering followed by backward smoothing while maintaining the fundamental spirit of the IMM, is proposed. The forward filtering is performed using the standard IMM recursion, while the backward smoothing is performed using a novel interacting smoothing recursion. This backward recursion mimics the IMM estimator in the backward direction, where each mode conditioned smoother uses standard Kalman smoothing recursion. Resulting algorithm provides improved but delayed estimates of target states. Simulation studies are performed to demonstrate the improved performance with a maneuvering target scenario. The comparison with existing methods confirms the improved smoothing accuracy. This improvement results from avoiding the augmented state vector used by other algorithms. In addition, the new technique to account for model switching in smoothing is a key in improving the performance.

Performance improvement CME for quality: challenges inherent to the process.

PubMed

Vakani, Farhan Saeed; O'Beirne, Ronan

2015-01-01

The purpose of this paper is to discuss the perspective debates upon the real-time challenges for a three-staged Performance Improvement Continuing Medical Education (PI-CME) model, an innovative and potential approach for future CME, to inform providers to think, prepare and to act proactively. In this discussion, the challenges associated for adopting the American Medical Association's three-staged PI-CME model are reported. Not many institutions in USA are using a three-staged performance improvement model and then customizing it to their own healthcare context for the specific targeted audience. They integrate traditional CME methods with performance and quality initiatives, and linking with CME credits. Overall the US health system is interested in a structured PI-CME model with the potential to improve physicians practicing behaviors. Knowing the dearth of evidence for applying this structured performance improvement methodology into the design of CME activities, and the lack of clarity on challenges inherent to the process that learners and providers encounter. This paper establishes all-important first step to render the set of challenges for a three-staged PI-CME model.

Exhaust emission reduction for intermittent combustion aircraft engines

NASA Technical Reports Server (NTRS)

Moffett, R. N.

1979-01-01

Three concepts for optimizing the performance, increasing the fuel economy, and reducing exhaust emission of the piston aircraft engine were investigated. High energy-multiple spark discharge and spark plug tip penetration, ultrasonic fuel vaporization, and variable valve timing were evaluated individually. Ultrasonic fuel vaporization did not demonstrate sufficient improvement in distribution to offset the performance loss caused by the additional manifold restriction. High energy ignition and revised spark plug tip location provided no change in performance or emissions. Variable valve timing provided some performance benefit; however, even greater performance improvement was obtained through induction system tuning which could be accomplished with far less complexity.

Tough high performance composite matrix

NASA Technical Reports Server (NTRS)

Pater, Ruth H. (Inventor); Johnston, Norman J. (Inventor)

1994-01-01

This invention is a semi-interpentrating polymer network which includes a high performance thermosetting polyimide having a nadic end group acting as a crosslinking site and a high performance linear thermoplastic polyimide. Provided is an improved high temperature matrix resin which is capable of performing in the 200 to 300 C range. This resin has significantly improved toughness and microcracking resistance, excellent processability, mechanical performance, and moisture and solvent resistances.

Projecting technology change to improve space technology planning and systems management

NASA Astrophysics Data System (ADS)

Walk, Steven Robert

2011-04-01

Projecting technology performance evolution has been improving over the years. Reliable quantitative forecasting methods have been developed that project the growth, diffusion, and performance of technology in time, including projecting technology substitutions, saturation levels, and performance improvements. These forecasts can be applied at the early stages of space technology planning to better predict available future technology performance, assure the successful selection of technology, and improve technology systems management strategy. Often what is published as a technology forecast is simply scenario planning, usually made by extrapolating current trends into the future, with perhaps some subjective insight added. Typically, the accuracy of such predictions falls rapidly with distance in time. Quantitative technology forecasting (QTF), on the other hand, includes the study of historic data to identify one of or a combination of several recognized universal technology diffusion or substitution patterns. In the same manner that quantitative models of physical phenomena provide excellent predictions of system behavior, so do QTF models provide reliable technological performance trajectories. In practice, a quantitative technology forecast is completed to ascertain with confidence when the projected performance of a technology or system of technologies will occur. Such projections provide reliable time-referenced information when considering cost and performance trade-offs in maintaining, replacing, or migrating a technology, component, or system. This paper introduces various quantitative technology forecasting techniques and illustrates their practical application in space technology and technology systems management.

The potential application of behavior-based safety in the trucking industry

DOT National Transportation Integrated Search

2000-04-01

Behavior-based safety (BBS) is a set of methods to improve safety performance in the workplace by engaging workers in the improvement process, identifying critical safety behaviors, performing observations to gather data, providing feedback to encour...

Assessing BMP Performance Using Microtox Toxicity Analysis

EPA Science Inventory

Best Management Practices (BMPs) have been shown to be effective in reducing runoff and pollutants from urban areas and thus provide a mechanism to improve downstream water quality. Currently, BMP performance regarding water quality improvement is assessed through measuring each...

Continuous quality improvement for continuity of care.

PubMed

Kibbe, D C; Bentz, E; McLaughlin, C P

1993-03-01

Continuous quality improvement (CQI) techniques have been used most frequently in hospital operations such as pharmaceutical ordering, patient admitting, and billing of insurers, and less often to analyze and improve processes that are close to the clinical interaction of physicians and their patients. This paper describes a project in which CQI was implemented in a family practice setting to improve continuity of care. A CQI study team was assembled in response to patients' complaints about not being able to see their regular physician providers when they wanted. Following CQI methods, the performance of the practice in terms of provider continuity was measured. Two "customer" groups were surveyed: physician faculty members were surveyed to assess their attitudes about continuity, and patients were surveyed about their preferences for provider continuity and convenience factors. Process improvements were selected in the critical pathways that influence provider continuity. One year after implementation of selected process improvements, repeat chart audit showed that provider continuity levels had improved from .45 to .74, a 64% increase from 1 year earlier. The project's main accomplishment was to establish the practicality of using CQI methods in a primary care setting to identify a quality issue of value to both providers and patients, in this case, continuity of provider care, and to identify processes that linked the performance of health care delivery procedures with patient expectations.

Amplifier improvement circuit

NASA Technical Reports Server (NTRS)

Sturman, J.

1968-01-01

Stable input stage was designed for the use with a integrated circuit operational amplifier to provide improved performance as an instrumentation-type amplifier. The circuit provides high input impedance, stable gain, good common mode rejection, very low drift, and low output impedance.

What role does performance information play in securing improvement in healthcare? a conceptual framework for levers of change

PubMed Central

Levesque, Jean-Frederic; Sutherland, Kim

2017-01-01

Objective Across healthcare systems, there is consensus on the need for independent and impartial assessment of performance. There is less agreement about how measurement and reporting performance improves healthcare. This paper draws on academic theories to develop a conceptual framework—one that classifies in an integrated manner the ways in which change can be leveraged by healthcare performance information. Methods A synthesis of published frameworks. Results The framework identifies eight levers for change enabled by performance information, spanning internal and external drivers, and emergent and planned processes: (1) cognitive levers provide awareness and understanding; (2) mimetic levers inform about the performance of others to encourage emulation; (3) supportive levers provide facilitation, implementation tools or models of care to actively support change; (4) formative levers develop capabilities and skills through teaching, mentoring and feedback; (5) normative levers set performance against guidelines, standards, certification and accreditation processes; (6) coercive levers use policies, regulations incentives and disincentives to force change; (7) structural levers modify the physical environment or professional cultures and routines; (8) competitive levers attract patients or funders. Conclusion This framework highlights how performance measurement and reporting can contribute to eight different levers for change. It provides guidance into how to align performance measurement and reporting into quality improvement programme. PMID:28851769

Identifying Key Performance Indicators for Holistic Hospital Management with a Modified DEMATEL Approach.

PubMed

Si, Sheng-Li; You, Xiao-Yue; Liu, Hu-Chen; Huang, Jia

2017-08-19

Performance analysis is an important way for hospitals to achieve higher efficiency and effectiveness in providing services to their customers. The performance of the healthcare system can be measured by many indicators, but it is difficult to improve them simultaneously due to the limited resources. A feasible way is to identify the central and influential indicators to improve healthcare performance in a stepwise manner. In this paper, we propose a hybrid multiple criteria decision making (MCDM) approach to identify key performance indicators (KPIs) for holistic hospital management. First, through integrating evidential reasoning approach and interval 2-tuple linguistic variables, various assessments of performance indicators provided by healthcare experts are modeled. Then, the decision making trial and evaluation laboratory (DEMATEL) technique is adopted to build an interactive network and visualize the causal relationships between the performance indicators. Finally, an empirical case study is provided to demonstrate the proposed approach for improving the efficiency of healthcare management. The results show that "accidents/adverse events", "nosocomial infection", ''incidents/errors", "number of operations/procedures" are significant influential indicators. Also, the indicators of "length of stay", "bed occupancy" and "financial measures" play important roles in performance evaluation of the healthcare organization. The proposed decision making approach could be considered as a reference for healthcare administrators to enhance the performance of their healthcare institutions.

Good, better, best? A comprehensive comparison of healthcare providers' performance: An application to physiotherapy practices in primary care.

PubMed

Steenhuis, Sander; Groeneweg, Niels; Koolman, Xander; Portrait, France

2017-12-01

Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care. We merged these datasets at the patient-level and compared the performances of these practices using case-mix corrected linear regression models. Several significant differences in performance were detected between practices. These results can be used by both physiotherapists, to improve treatment given, and insurers to support their purchasing decisions. The study demonstrates that it is feasible to compare the performance of providers using PROMs and PREMs. However, it would take an extra effort to increase usefulness and it remains unclear under which conditions this effort is cost-effective. Healthcare providers need to be aware of the added value of registering outcomes to improve their quality. Insurers need to facilitate this by designing value-based contracts with the right incentives. Only then can payment methods contribute to value-based healthcare and increase value for patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Propulsive-lift concepts for improved low-speed performance of supersonic cruise arrow-wing configurations

NASA Technical Reports Server (NTRS)

Coe, P. L., Jr.

1976-01-01

Low-aspect-ratio highly swept arrow-wing supersonic aircraft possess high levels of aerodynamic efficiency at supersonic cruising speeds, however, their inherently poor low-speed lift characteristics require design constraints that compromise supersonic performance. The data discussed in this paper were obtained in wind tunnel tests with supersonic crusing configurations, in which propulsive-lift concepts were used to improve low-speed performance. The data show that the increased low-speed lift provided by propulsive-lift permits reduction of both wing size and installed thrust. This yields a batter engine/airframe match for improved supersonic cruise efficiency and range, while still providing acceptable take-off field lengths.

The Impact of Providing Performance Feedback to Teachers and Principals. NCEE 2018-4001

ERIC Educational Resources Information Center

Garet, Michael S.; Wayne, Andrew J.; Brown, Seth; Rickles, Jordan; Song, Mengli; Manzeske, David

2017-01-01

Educator performance evaluation systems are a potential tool for improving student achievement by increasing the effectiveness of the educator workforce. For example, recent research suggests that giving more frequent, specific feedback on classroom practice may lead to improvements in teacher performance and student achievement. This report is…

The Impact of Providing Performance Feedback to Teachers and Principals. Executive Summary. NCEE 2018-4000

ERIC Educational Resources Information Center

Garet, Michael S.; Wayne, Andrew J.; Brown, Seth; Rickles, Jordan; Song, Mengli; Manzeske, David

2017-01-01

Educator performance evaluation systems are a potential tool for improving student achievement by increasing the effectiveness of the educator workforce. For example, recent research suggests that giving more frequent, specific feedback on classroom practice may lead to improvements in teacher performance and student achievement. This report is…

Evaluating the Implementation of Performance Improvement Training: The E[superscript 3] Process for Success

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.; Moseley, James L.

2008-01-01

This article provides a comprehensive approach to careful review and evaluation of the implementation of performance training intervention. It discusses the E[superscript 3] process for success, a basic framework for evaluating the implementation phase of a training program implemented as a broad-based performance improvement strategy. The intent…

Influence of Integration of Information Communication Technology in Teaching on Students' Academic Performance

ERIC Educational Resources Information Center

Mbugua, Stephen Ngugi; Kiboss, Joel; Tanui, Edward

2015-01-01

Teachers must understand the context within which students' performance improvement takes place. Operational effectiveness and strategy are both essential to superior performance and strategy execution is crucial for quality and better students' academic result. ICT can be a catalyst by providing tools which teachers use to improve teaching and…

Modeling and investigation of refrigeration system performance with two-phase fluid injection in a scroll compressor

NASA Astrophysics Data System (ADS)

Gu, Rui

Vapor compression cycles are widely used in heating, refrigerating and air-conditioning. A slight performance improvement in the components of a vapor compression cycle, such as the compressor, can play a significant role in saving energy use. However, the complexity and cost of these improvements can block their application in the market. Modifying the conventional cycle configuration can offer a less complex and less costly alternative approach. Economizing is a common modification for improving the performance of the refrigeration cycle, resulting in decreasing the work required to compress the gas per unit mass. Traditionally, economizing requires multi-stage compressors, the cost of which has restrained the scope for practical implementation. Compressors with injection ports, which can be used to inject economized refrigerant during the compression process, introduce new possibilities for economization with less cost. This work focuses on computationally investigating a refrigeration system performance with two-phase fluid injection, developing a better understanding of the impact of injected refrigerant quality on refrigeration system performance as well as evaluating the potential COP improvement that injection provides based on refrigeration system performance provided by Copeland.

An Evaluation of Performance Thresholds in Nursing Home Pay-for-Performance.

PubMed

Werner, Rachel M; Skira, Meghan; Konetzka, R Tamara

2016-12-01

Performance thresholds are commonly used in pay-for-performance (P4P) incentives, where providers receive a bonus payment for achieving a prespecified target threshold but may produce discontinuous incentives, with providers just below the threshold having the strongest incentive to improve and providers either far below or above the threshold having little incentive. We investigate the effect of performance thresholds on provider response in the setting of nursing home P4P. The Minimum Data Set (MDS) and Online Survey, Certification, and Reporting (OSCAR) datasets. Difference-in-differences design to test for changes in nursing home performance in three states that implemented threshold-based P4P (Colorado, Georgia, and Oklahoma) versus three comparator states (Arizona, Tennessee, and Arkansas) between 2006 and 2009. We find that those farthest below the threshold (i.e., the worst-performing nursing homes) had the largest improvements under threshold-based P4P while those farthest above the threshold worsened. This effect did not vary with the percentage of Medicaid residents in a nursing home. Threshold-based P4P may provide perverse incentives for nursing homes above the performance threshold, but we do not find evidence to support concerns about the effects of performance thresholds on low-performing nursing homes. © Health Research and Educational Trust.

Flight assessment of the onboard propulsion system model for the Performance Seeking Control algorithm on an F-15 aircraft

NASA Technical Reports Server (NTRS)

Orme, John S.; Schkolnik, Gerard S.

1995-01-01

Performance Seeking Control (PSC), an onboard, adaptive, real-time optimization algorithm, relies upon an onboard propulsion system model. Flight results illustrated propulsion system performance improvements as calculated by the model. These improvements were subject to uncertainty arising from modeling error. Thus to quantify uncertainty in the PSC performance improvements, modeling accuracy must be assessed. A flight test approach to verify PSC-predicted increases in thrust (FNP) and absolute levels of fan stall margin is developed and applied to flight test data. Application of the excess thrust technique shows that increases of FNP agree to within 3 percent of full-scale measurements for most conditions. Accuracy to these levels is significant because uncertainty bands may now be applied to the performance improvements provided by PSC. Assessment of PSC fan stall margin modeling accuracy was completed with analysis of in-flight stall tests. Results indicate that the model overestimates the stall margin by between 5 to 10 percent. Because PSC achieves performance gains by using available stall margin, this overestimation may represent performance improvements to be recovered with increased modeling accuracy. Assessment of thrust and stall margin modeling accuracy provides a critical piece for a comprehensive understanding of PSC's capabilities and limitations.

A tough high performance composite matrix

NASA Technical Reports Server (NTRS)

Pater, Ruth H. (Inventor); Johnston, Norman J. (Inventor)

1992-01-01

This invention is a semi-interpenetrating polymer network which includes a high performance thermosetting polyimide having a nadic end group acting as a crosslinking site and a high performance linear thermoplastic polyimide. An improved high temperature matrix resin is provided which is capable of performing in the 200 to 300 C range. This resin has significantly improved toughness and microcracking resistance, excellent processability, mechanical performance and moisture and solvent resistances.

Assessing BMP Performance Using Microtox Toxicity Analysis - Rhode Island

EPA Science Inventory

Best Management Practices (BMPs) have been shown to be effective in reducing runoff and pollutants from urban areas and thus provide a mechanism to improve downstream water quality. Currently, BMP performance regarding water quality improvement is assessed through measuring each...

Assessing BMP Performance Using Microtox® Toxicity Analysis

EPA Science Inventory

Best Management Practices (BMPs) have been shown to be effective in reducing runoff and pollutants from urban areas and thus provide a mechanism to improve downstream water quality. Currently, BMP performance regarding water quality improvement is assessed through measuring each...

Recent Progress Towards Predicting Aircraft Ground Handling Performance

NASA Technical Reports Server (NTRS)

Yager, T. J.; White, E. J.

1981-01-01

The significant progress which has been achieved in development of aircraft ground handling simulation capability is reviewed and additional improvements in software modeling identified. The problem associated with providing necessary simulator input data for adequate modeling of aircraft tire/runway friction behavior is discussed and efforts to improve this complex model, and hence simulator fidelity, are described. Aircraft braking performance data obtained on several wet runway surfaces is compared to ground vehicle friction measurements and, by use of empirically derived methods, good agreement between actual and estimated aircraft braking friction from ground vehilce data is shown. The performance of a relatively new friction measuring device, the friction tester, showed great promise in providing data applicable to aircraft friction performance. Additional research efforts to improve methods of predicting tire friction performance are discussed including use of an instrumented tire test vehicle to expand the tire friction data bank and a study of surface texture measurement techniques.

Synergistic Effects on the Elderly People's Motor Control by Wearable Skin-Stretch Device Combined with Haptic Joystick

PubMed Central

Yoon, Han U.; Anil Kumar, Namita; Hur, Pilwon

2017-01-01

Cutaneous sensory feedback can be used to provide additional sensory cues to a person performing a motor task where vision is a dominant feedback signal. A haptic joystick has been widely used to guide a user by providing force feedback. However, the benefit of providing force feedback is still debatable due to performance dependency on factors such as the user's skill-level, task difficulty. Meanwhile, recent studies have shown the feasibility of improving a motor task performance by providing skin-stretch feedback. Therefore, a combination of two aforementioned feedback types is deemed to be promising to promote synergistic effects to consistently improve the person's motor performance. In this study, we aimed at identifying the effect of the combined haptic and skin-stretch feedbacks on the aged person's driving motor performance. For the experiment, 15 healthy elderly subjects (age 72.8 ± 6.6 years) were recruited and were instructed to drive a virtual power-wheelchair through four different courses with obstacles. Four augmented sensory feedback conditions were tested: no feedback, force feedback, skin-stretch feedback, and a combination of both force and skin-stretch feedbacks. While the haptic force was provided to the hand by the joystick, the skin-stretch was provided to the steering forearm by a custom-designed wearable skin-stretch device. We tested two hypotheses: (i) an elderly individual's motor control would benefit from receiving information about a desired trajectory from multiple sensory feedback sources, and (ii) the benefit does not depend on task difficulty. Various metrics related to skills and safety were used to evaluate the control performance. Repeated measure ANOVA was performed for those metrics with two factors: task scenario and the type of the augmented sensory feedback. The results revealed that elderly subjects' control performance significantly improved when the combined feedback of both haptic force and skin-stretch feedback was applied. The proposed approach suggest the feasibility to improve people's task performance by the synergistic effects of multiple augmented sensory feedback modalities. PMID:28690514

Using Six Sigma for Performance Improvement in Business Curriculum: A Case Study

ERIC Educational Resources Information Center

Kukreja, Anil; Ricks, Joe M., Jr.; Meyer, Jean A.

2009-01-01

During the last few decades, a number of quality improvement methodologies have been used by organizations. This article provides a brief review of the quality improvement literature related to academia and a case study using Six Sigma methodology to analyze students' performance in a standardized examination. We found Six Sigma to be an effective…

Are Low-Performing Schools Adopting Practices Promoted by School Improvement Grants? NCEE Evaluation Brief. NCEE 2015-4001

ERIC Educational Resources Information Center

Herrmann, Mariesa; Dragoset, Lisa; James-Burdumy, Susanne

2014-01-01

The federal School Improvement Grants (SIG) program aims to improve student achievement by promoting the implementation of four school intervention models: transformation, turnaround, restart, and closure. Previous research provides evidence that low-performing schools adopt some practices promoted by the four models, but little is known about how…

Study Abroad Field Trip Improves Test Performance through Engagement and New Social Networks

ERIC Educational Resources Information Center

Houser, Chris; Brannstrom, Christian; Quiring, Steven M.; Lemmons, Kelly K.

2011-01-01

Although study abroad trips provide an opportunity for affective and cognitive learning, it is largely assumed that they improve learning outcomes. The purpose of this study is to determine whether a study abroad field trip improved cognitive learning by comparing test performance between the study abroad participants (n = 20) and their peers who…

Providing the Answers Does Not Improve Performance on a College Final Exam

ERIC Educational Resources Information Center

Glass, Arnold Lewis; Sinha, Neha

2013-01-01

In the context of an upper-level psychology course, even when students were given an opportunity to refer to text containing the answers and change their exam responses in order to improve their exam scores, their performance on these questions improved slightly or not at all. Four experiments evaluated competing explanations for the students'…

Improving Student Performance Using Nudge Analytics

ERIC Educational Resources Information Center

Feild, Jacqueline

2015-01-01

Providing students with continuous and personalized feedback on their performance is an important part of encouraging self regulated learning. As part of our higher education platform, we built a set of data visualizations to provide feedback to students on their assignment performance. These visualizations give students information about how they…

A business case for quality improvement in addiction treatment: evidence from the NIATx collaborative.

PubMed

Quanbeck, Andrew R; Madden, Lynn; Edmundson, Eldon; Ford, James H; McConnell, K John; McCarty, Dennis; Gustafson, David H

2012-01-01

The Network for the Improvement of Addiction Treatment (NIATx) promotes treatment access and retention through a customer-focused quality improvement model. This paper explores the issue of the "business case" for quality improvement in addiction treatment from the provider's perspective. The business case model developed in this paper is based on case examples of early NIATx participants coupled with a review of the literature. Process inefficiencies indicated by long waiting times, high no-show rates, and low continuation rates cause underutilization of capacity and prevent optimal financial performance. By adopting customer-focused practices aimed at removing barriers to treatment access and retention, providers may be able to improve financial performance, increase staff retention, and gain long-term strategic advantage.

42 CFR 460.138 - Committees with community input.

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.138 Committees with... following: (a) Evaluate data collected pertaining to quality outcome measures. (b) Address the implementation of, and results from, the quality assessment and performance improvement plan. (c) Provide input...

42 CFR 460.138 - Committees with community input.

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.138 Committees with... following: (a) Evaluate data collected pertaining to quality outcome measures. (b) Address the implementation of, and results from, the quality assessment and performance improvement plan. (c) Provide input...

42 CFR 460.138 - Committees with community input.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.138 Committees with... following: (a) Evaluate data collected pertaining to quality outcome measures. (b) Address the implementation of, and results from, the quality assessment and performance improvement plan. (c) Provide input...

42 CFR 460.138 - Committees with community input.

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.138 Committees with... following: (a) Evaluate data collected pertaining to quality outcome measures. (b) Address the implementation of, and results from, the quality assessment and performance improvement plan. (c) Provide input...

42 CFR 460.138 - Committees with community input.

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.138 Committees with... following: (a) Evaluate data collected pertaining to quality outcome measures. (b) Address the implementation of, and results from, the quality assessment and performance improvement plan. (c) Provide input...

State Strategies to Improve Low-Performing Schools: California's High Priority School Grants Program

ERIC Educational Resources Information Center

Timar, Thomas; Rodriguez, Gloria; Simon, Virginia Adams; Ferrario, Kim; Kim, Kris

2006-01-01

Central to California's school accountability system are programs to engage low-performing schools in improvement efforts. One of these is the High Priority Schools Program (HPSGP), created by Assembly Bill 961 (Chapter 747, "Statutes of 2001") to provide funds to the lowest performing schools in the state. To be eligible for funding,…

Business intelligence: using insight to improve the value and performance of your practice.

PubMed

Coan, Tim

2007-01-01

Using information to improve the value of your practice can be a great way to create leverage and improve the performance of your practice. Business intelligence (BI) is the result of a complete system that produces meaningful insights by providing the information necessary to make business decisions. Changes made from these insights improve both the performance and value of your practice. It is important to identify the key elements required of a good BI system and the areas within a practice that can directly benefit from an effective BI system.

Using quality experts from manufacturing to transform primary care.

PubMed

Steiner, Rose M; Walsworth, David T

2010-01-01

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

Recent Niobium Developments for High Strength Steel Energy Applications

NASA Astrophysics Data System (ADS)

Jansto, Steven G.

Niobium-containing high strength steel materials have been developed for oil and gas pipelines, offshore platforms, nuclear plants, boilers and alternative energy applications. Recent research and the commercialization of alternative energy applications such as windtower structural supports and power transmission gear components provide enhanced performance. Through the application of these Nb-bearing steels in demanding energy-related applications, the designer and end user experience improved toughness at low temperature, excellent fatigue resistance and fracture toughness and excellent weldability. These enhancements provide structural engineers the opportunity to further improve the structural design and performance. For example, through the adoption of these Nb-containing structural materials, several design-manufacturing companies are initiating new windtower designs operating at higher energy efficiency, lower cost, and improved overall material design performance.

Using technology-enhanced, cooperative, group-project learning for student comprehension and academic performance

NASA Astrophysics Data System (ADS)

Tlhoaele, Malefyane; Suhre, Cor; Hofman, Adriaan

2016-05-01

Cooperative learning may improve students' motivation, understanding of course concepts, and academic performance. This study therefore enhanced a cooperative, group-project learning technique with technology resources to determine whether doing so improved students' deep learning and performance. A sample of 118 engineering students, randomly divided into two groups, participated in this study and provided data through questionnaires issued before and after the experiment. The results, obtained through analyses of variance and structural equation modelling, reveal that technology-enhanced, cooperative, group-project learning improves students' comprehension and academic performance.

Improved Adaptive LSB Steganography Based on Chaos and Genetic Algorithm

NASA Astrophysics Data System (ADS)

Yu, Lifang; Zhao, Yao; Ni, Rongrong; Li, Ting

2010-12-01

We propose a novel steganographic method in JPEG images with high performance. Firstly, we propose improved adaptive LSB steganography, which can achieve high capacity while preserving the first-order statistics. Secondly, in order to minimize visual degradation of the stego image, we shuffle bits-order of the message based on chaos whose parameters are selected by the genetic algorithm. Shuffling message's bits-order provides us with a new way to improve the performance of steganography. Experimental results show that our method outperforms classical steganographic methods in image quality, while preserving characteristics of histogram and providing high capacity.

78 FR 36547 - Technological Advisory Council Recommendation for Improving Receiver Performance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... Council Recommendation for Improving Receiver Performance AGENCY: Federal Communications Commission... of receivers in ensuring the efficient use of spectrum and to provide recommendations on avoiding... Advisory Council (``TAC'') White Paper. OET invited comment on the TAC white paper and its recommendations...

Physician Self-Audit: A Scoping Review

ERIC Educational Resources Information Center

Gagliardi, Anna R.; Brouwers, Melissa C.; Finelli, Antonio; Campbell, Craig E.; Marlow, Bernard A.; Silver, Ivan L.

2011-01-01

Introduction: Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The…

Natural cork agglomerate employed as an environmentally friendly solution for quiet sandwich composites.

PubMed

Sargianis, James; Kim, Hyung-ick; Suhr, Jonghwan

2012-01-01

Carbon fiber-synthetic foam core sandwich composites are widely used for many structural applications due to their superior mechanical performance and low weight. Unfortunately these structures typically have very poor acoustic performance. There is increasingly growing demand in mitigating this noise issue in sandwich composite structures. This study shows that marrying carbon fiber composites with natural cork in a sandwich structure provides a synergistic effect yielding a noise-free sandwich composite structure without the sacrifice of mechanical performance or weight. Moreover the cork-core sandwich composites boast a 250% improvement in damping performance, providing increased durability and lifetime operation. Additionally as the world seeks environmentally friendly materials, the harvesting of cork is a natural, renewable process which reduces subsequent carbon footprints. Such a transition from synthetic foam cores to natural cork cores could provide unprecedented improvements in acoustic and vibrational performance in applications such as aircraft cabins or wind turbine blades.

Twelve tips to promote successful development of a learner performance dashboard within a medical education program.

PubMed

Boscardin, Christy; Fergus, Kirkpatrick B; Hellevig, Bonnie; Hauer, Karen E

2017-11-09

Easily accessible and interpretable performance data constitute critical feedback for learners that facilitate informed self-assessment and learning planning. To provide this feedback, there has been a proliferation of educational dashboards in recent years. An educational (learner) dashboard systematically delivers timely and continuous feedback on performance and can provide easily visualized and interpreted performance data. In this paper, we provide practical tips for developing a functional, user-friendly individual learner performance dashboard and literature review of dashboard development, assessment theory, and users' perspectives. Considering key design principles and maximizing current technological advances in data visualization techniques can increase dashboard utility and enhance the user experience. By bridging current technology with assessment strategies that support learning, educators can continue to improve the field of learning analytics and design of information management tools such as dashboards in support of improved learning outcomes.

Identifying Key Performance Indicators for Holistic Hospital Management with a Modified DEMATEL Approach

PubMed Central

Si, Sheng-Li; You, Xiao-Yue; Huang, Jia

2017-01-01

Performance analysis is an important way for hospitals to achieve higher efficiency and effectiveness in providing services to their customers. The performance of the healthcare system can be measured by many indicators, but it is difficult to improve them simultaneously due to the limited resources. A feasible way is to identify the central and influential indicators to improve healthcare performance in a stepwise manner. In this paper, we propose a hybrid multiple criteria decision making (MCDM) approach to identify key performance indicators (KPIs) for holistic hospital management. First, through integrating evidential reasoning approach and interval 2-tuple linguistic variables, various assessments of performance indicators provided by healthcare experts are modeled. Then, the decision making trial and evaluation laboratory (DEMATEL) technique is adopted to build an interactive network and visualize the causal relationships between the performance indicators. Finally, an empirical case study is provided to demonstrate the proposed approach for improving the efficiency of healthcare management. The results show that “accidents/adverse events”, “nosocomial infection”, ‘‘incidents/errors”, “number of operations/procedures” are significant influential indicators. Also, the indicators of “length of stay”, “bed occupancy” and “financial measures” play important roles in performance evaluation of the healthcare organization. The proposed decision making approach could be considered as a reference for healthcare administrators to enhance the performance of their healthcare institutions. PMID:28825613

Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations

PubMed Central

Ketelaar, Nicole ABM; Faber, Marjan J; Flottorp, Signe; Rygh, Liv Helen; Deane, Katherine HO; Eccles, Martin P

2014-01-01

Background It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. Objectives To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. Selection criteria We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. Data collection and analysis Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). Main results We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found. One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. Authors’ conclusions The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking. PMID:22071813

Response to ProPublica's Rebuttal of Our Critique of the Surgeon Scorecard

PubMed Central

Friedberg, Mark W.; Bilimoria, Karl Y.; Pronovost, Peter J.; Shahian, David M.; Damberg, Cheryl L.; Zaslavsky, Alan M.

2016-01-01

Abstract In the summer of 2015, ProPublica published its Surgeon Scorecard, which displays “Adjusted Complication Rates” for individual, named surgeons for eight surgical procedures performed in hospitals. Public reports of provider performance have the potential to improve the quality of health care that patients receive. A valid performance report can drive quality improvement and usefully inform patients' choices of providers. However, performance reports with poor validity and reliability are potentially damaging to all involved. In September 2015, RAND released a critique of the Scorecard authored by a group of health policy researchers from RAND and other institutions, and on October 7, 2015 ProPublica published a rebuttal of our critique. In this follow-on Perspective, we revisit the main points in our initial critique, summarize ProPublica's rebuttal, explain why this rebuttal fails to address our methodological concerns, provide suggestions on how to validate and improve the Scorecard, and explain why we continue to advise potential users of the Scorecard, as it is currently constructed, not to consider it a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide. PMID:28083432

Future capabilities for the Deep Space Network

NASA Technical Reports Server (NTRS)

Berner, J. B.; Bryant, S. H.; Andrews, K. S.

2004-01-01

This paper will look at three new capabilities that are in different stages of development. First, turbo decoding, which provides improved telemetry performance for data rates up to about 1 Mbps, will be discussed. Next, pseudo-noise ranging will be presented. Pseudo-noise ranging has several advantages over the current sequential ranging, anmely easier operations, improved performance, and the capability to be used in a regenerative implementation on a spacecraft. Finally, Low Density Parity Check decoding will be discussed. LDPC codes can provide performance that matches or slightly exceed turbo codes, but are designed for use in the 10 Mbps range.

Methods for operating parallel computing systems employing sequenced communications

DOEpatents

Benner, Robert E.; Gustafson, John L.; Montry, Gary R.

1999-01-01

A parallel computing system and method having improved performance where a program is concurrently run on a plurality of nodes for reducing total processing time, each node having a processor, a memory, and a predetermined number of communication channels connected to the node and independently connected directly to other nodes. The present invention improves performance of performance of the parallel computing system by providing a system which can provide efficient communication between the processors and between the system and input and output devices. A method is also disclosed which can locate defective nodes with the computing system.

Method for simultaneous overlapped communications between neighboring processors in a multiple

DOEpatents

Benner, Robert E.; Gustafson, John L.; Montry, Gary R.

1991-01-01

A parallel computing system and method having improved performance where a program is concurrently run on a plurality of nodes for reducing total processing time, each node having a processor, a memory, and a predetermined number of communication channels connected to the node and independently connected directly to other nodes. The present invention improves performance of performance of the parallel computing system by providing a system which can provide efficient communication between the processors and between the system and input and output devices. A method is also disclosed which can locate defective nodes with the computing system.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

PubMed

Bazant, Eva; Sarkar, Supriya; Banda, Joseph; Kanjipite, Webby; Reinhardt, Stephanie; Shasulwe, Hildah; Mulilo, Joyce Monica Chongo; Kim, Young Mi

2014-12-20

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

Nicotinic agonist-induced improvement of vigilance in mice in the 5-choice continuous performance test

PubMed Central

YOUNG, Jared W; MEVES, Jessica M; GEYER, Mark A

2012-01-01

Impaired attentional processing is prevalent in numerous neuropsychiatric disorders and may negatively impact other cognitive and functional domains. Nicotine – a nonspecific nicotinic acetylcholine receptor (nAChR) agonist – improves vigilance in healthy subjects and schizophrenia patients as measured by continuous performance tests (CPTs), but the nAChR mediating this effect remains unclear. Here we examine the effects of: a) nicotine; b) the selective α7 nAChR agonist PNU 282987; and c) the selective α4β2 nAChR agonist ABT-418 alone and in combination with scopolamine-induced disruption of mouse 5-choice (5C-)CPT performance. This task requires the inhibition of responses to non-target stimuli as well as active responses to target stimuli, consistent with human CPTs. C57BL/6N mice were trained to perform the 5C-CPT. Drug effects were examined in extended session and variable stimulus-duration challenges of performance. Acute drug effects on scopolamine-induced disruption in performance were also investigated. Nicotine and ABT-418 subtly but significantly improved performance of normal mice and attenuated scopolamine-induced disruptions in the 5C-CPT. PNU 282–987 had no effects on performance. The similarity of nicotine and ABT-418 effects provides support for an α4β2 nAChR mechanism of action for nicotine-induced improvement in attention/vigilance. Moreover, the data provide pharmacological predictive validation for the 5C-CPT because nicotine improved and scopolamine disrupted normal performance of the task, consistent with healthy humans in the CPT. Future studies using more selective agonists may result in more robust improvements in performance. PMID:23201359

Building Leadership Talent through Performance Evaluation

ERIC Educational Resources Information Center

Clifford, Matthew

2015-01-01

Most states and districts scramble to provide professional development to support principals, but "principal evaluation" is often lost amid competing priorities. Evaluation is an important method for supporting principal growth, communicating performance expectations to principals, and improving leadership practice. It provides leaders…

Improving Performance through Knowledge Translation in the Veterans Health Administration

ERIC Educational Resources Information Center

Francis, Joseph; Perlin, Jonathan B.

2006-01-01

The Veterans Health Administration (VA) provides a case study for linking performance measurement, information technology, and aligned research efforts to facilitate quality improvement in a large, complex health system. Dialogue between clinical researchers and VA leaders occurs through structured activities (e.g., the Quality Enhancement…

Competency-Based Performance Improvement: A Strategy for Organizational Change.

ERIC Educational Resources Information Center

Dubois, David D.

This book, which focuses on actual practitioners' experiences, outlines a systematic approach to improving individual workers' performance as part of an overall strategy for organizational change. Frameworks are provided for conceptualizing and implementing exemplary training practices. In addition, steps in achieving the practices and pitfalls to…

Who Repeats Algebra, and How Does Initial Performance Relate to Improvement When the Course Is Repeated?

ERIC Educational Resources Information Center

Fong, Anthony; Jaquet, Karina; Finkelstein, Neal

2016-01-01

The information provided in this report shows how students perform when they repeat algebra I and how the level of improvement varies depending on initial course performance and the academic measure (course grades or CST scores). This information can help inform decisions and policies regarding whether and under what circumstances students should…

Optimisation of active suspension control inputs for improved performance of active safety systems

NASA Astrophysics Data System (ADS)

Čorić, Mirko; Deur, Joško; Xu, Li; Tseng, H. Eric; Hrovat, Davor

2018-01-01

A collocation-type control variable optimisation method is used to investigate the extent to which the fully active suspension (FAS) can be applied to improve the vehicle electronic stability control (ESC) performance and reduce the braking distance. First, the optimisation approach is applied to the scenario of vehicle stabilisation during the sine-with-dwell manoeuvre. The results are used to provide insights into different FAS control mechanisms for vehicle performance improvements related to responsiveness and yaw rate error reduction indices. The FAS control performance is compared to performances of the standard ESC system, optimal active brake system and combined FAS and ESC configuration. Second, the optimisation approach is employed to the task of FAS-based braking distance reduction for straight-line vehicle motion. Here, the scenarios of uniform and longitudinally or laterally non-uniform tyre-road friction coefficient are considered. The influences of limited anti-lock braking system (ABS) actuator bandwidth and limit-cycle ABS behaviour are also analysed. The optimisation results indicate that the FAS can provide competitive stabilisation performance and improved agility when compared to the ESC system, and that it can reduce the braking distance by up to 5% for distinctively non-uniform friction conditions.

Methods and Devices for Modifying Active Paths in a K-Delta-1-Sigma Modulator

NASA Technical Reports Server (NTRS)

Ardalan, Sasan (Inventor)

2017-01-01

The invention relates to an improved K-Delta-1-Sigma Modulators (KG1Ss) that achieve multi GHz sampling rates with 90 nm and 45 nm CMOS processes, and that provide the capability to balance performance with power in many applications. The improved KD1Ss activate all paths when high performance is needed (e.g. high bandwidth), and reduce the effective bandwidth by shutting down multiple paths when low performance is required. The improved KD1Ss can adjust the baseband filtering for lower bandwidth, and can provide large savings in power consumption while maintaining the communication link, which is a great advantage in space communications. The improved KD1Ss herein provides a receiver that adjusts to accommodate a higher rate when a packet is received at a low bandwidth, and at a initial lower rate, power is saved by turning off paths in the KD1S Analog to Digital Converter, and where when a higher rate is required, multiple paths are enabled in the KD1S to accommodate the higher band widths.

Classification accuracy of claims-based methods for identifying providers failing to meet performance targets.

PubMed

Hubbard, Rebecca A; Benjamin-Johnson, Rhondee; Onega, Tracy; Smith-Bindman, Rebecca; Zhu, Weiwei; Fenton, Joshua J

2015-01-15

Quality assessment is critical for healthcare reform, but data sources are lacking for measurement of many important healthcare outcomes. With over 49 million people covered by Medicare as of 2010, Medicare claims data offer a potentially valuable source that could be used in targeted health care quality improvement efforts. However, little is known about the operating characteristics of provider profiling methods using claims-based outcome measures that may estimate provider performance with error. Motivated by the example of screening mammography performance, we compared approaches to identifying providers failing to meet guideline targets using Medicare claims data. We used data from the Breast Cancer Surveillance Consortium and linked Medicare claims to compare claims-based and clinical estimates of cancer detection rate. We then demonstrated the performance of claim-based estimates across a broad range of operating characteristics using simulation studies. We found that identification of poor performing providers was extremely sensitive to algorithm specificity, with no approach identifying more than 65% of poor performing providers when claims-based measures had specificity of 0.995 or less. We conclude that claims have the potential to contribute important information on healthcare outcomes to quality improvement efforts. However, to achieve this potential, development of highly accurate claims-based outcome measures should remain a priority. Copyright © 2014 John Wiley & Sons, Ltd.

Real-time video communication improves provider performance in a simulated neonatal resuscitation.

PubMed

Fang, Jennifer L; Carey, William A; Lang, Tara R; Lohse, Christine M; Colby, Christopher E

2014-11-01

To determine if a real-time audiovisual link with a neonatologist, termed video-assisted resuscitation or VAR, improves provider performance during a simulated neonatal resuscitation scenario. Using high-fidelity simulation, 46 study participants were presented with a neonatal resuscitation scenario. The control group performed independently, while the intervention group utilized VAR. Time to effective ventilation was compared using Wilcoxon rank sum tests. Providers' use of the corrective steps for ineffective ventilation per the NRP algorithm was compared using Cochran-Armitage trend tests. The time needed to establish effective ventilation was significantly reduced in the intervention group when compared to the control group (mean time 2 min 42 s versus 4 min 11 s, p<0.001). In the setting of ineffective ventilation, only 35% of control subjects used three or more of the first five corrective steps and none of them used all five steps. Providers in the control group most frequently neglected to open the mouth and increase positive pressure. In contrast, all of those in the intervention group used all of the first five corrective steps, p<0.001. All participants in the control group decided to intubate the infant to establish effective ventilation, compared to none in the intervention group, p<0.001. Using VAR during a simulated neonatal resuscitation scenario significantly reduces the time to establish effective ventilation and improves provider adherence to NRP guidelines. This technology may be a means for regional centers to support local providers during a neonatal emergency to improve patient safety and improve neonatal outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Optimization of an Active Twist Rotor Blade Planform for Improved Active Response and Forward Flight Performance

NASA Technical Reports Server (NTRS)

Sekula, Martin K; Wilbur, Matthew L.

2014-01-01

A study was conducted to identify the optimum blade tip planform for a model-scale active twist rotor. The analysis identified blade tip design traits which simultaneously reduce rotor power of an unactuated rotor while leveraging aeromechanical couplings to tailor the active response of the blade. Optimizing the blade tip planform for minimum rotor power in forward flight provided a 5 percent improvement in performance compared to a rectangular blade tip, but reduced the vibration control authority of active twist actuation by 75 percent. Optimizing for maximum blade twist response increased the vibration control authority by 50 percent compared to the rectangular blade tip, with little effect on performance. Combined response and power optimization resulted in a blade tip design which provided similar vibration control authority to the rectangular blade tip, but with a 3.4 percent improvement in rotor performance in forward flight.

The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments.

PubMed

Bass, Ellen J; Baumgart, Leigh A; Shepley, Kathryn Klein

2013-03-01

Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance.

Perceptual Learning in the Absence of Task or Stimulus Specificity

PubMed Central

Webb, Ben S.; Roach, Neil W.; McGraw, Paul V.

2007-01-01

Performance on most sensory tasks improves with practice. When making particularly challenging sensory judgments, perceptual improvements in performance are tightly coupled to the trained task and stimulus configuration. The form of this specificity is believed to provide a strong indication of which neurons are solving the task or encoding the learned stimulus. Here we systematically decouple task- and stimulus-mediated components of trained improvements in perceptual performance and show that neither provides an adequate description of the learning process. Twenty-four human subjects trained on a unique combination of task (three-element alignment or bisection) and stimulus configuration (vertical or horizontal orientation). Before and after training, we measured subjects' performance on all four task-configuration combinations. What we demonstrate for the first time is that learning does actually transfer across both task and configuration provided there is a common spatial axis to the judgment. The critical factor underlying the transfer of learning effects is not the task or stimulus arrangements themselves, but rather the recruitment of commons sets of neurons most informative for making each perceptual judgment. PMID:18094748

EFFECTS OF VERTICAL-LAYER STRUCTURE AND BOUNDARY CONDITIONS ON CMAQ-V4.5 AND V4.6 MODELS

EPA Science Inventory

This work is aimed at determining whether the increased vertical layers in CMAQ provides substantially improved model performance and assess whether using the spatially and temporally varying boundary conditions from GEOS-CHEM offer improved model performance as compared to the d...

42 CFR 485.917 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2014 CFR

2014-10-01

...: SPECIALIZED PROVIDERS Conditions of Participation: Community Mental Health Centers (CMHCs) § 485.917 Condition... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Quality assessment and performance improvement. 485.917 Section 485.917 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES...

Techniques for Improving Spelling Performance.

ERIC Educational Resources Information Center

Saylor, Paul

Improving spelling performance of college students is a question of insuring that the correct information is in long-term memory and readily retrievable. Any system of spelling instruction should recognize the capacity limits of the sensory register and short-term memory; provide for identification of and concentration on the distinctive features…

PCR thermocycler

DOEpatents

Benett, William J.; Richards, James B.

2003-01-01

A sleeve-type silicon polymerase chain reaction (PCR) chamber or thermocycler having improved thermal performance. The silicon sleeve reaction chamber is improved in thermal performance by etched features therein that reduce thermal mass and increase the surface area of the sleeve for cooling. This improved thermal performance of the thermocycler enables an increase in speed and efficiency of the reaction chamber. The improvement is accomplished by providing grooves in the faces of the sleeve and a series of grooves on the interior surfaces that connect with grooves on the faces of the sleeve. The grooves can be anisotropically etched in the silicon sleeve simultaneously with formation of the chamber.

PCR thermocycler

DOEpatents

Benett, William J.; Richards, James B.

2005-05-17

A sleeve-type silicon polymerase chain reaction (PCR) chamber or thermocycler having improved thermal performance. The silicon sleeve reaction chamber is improved in thermal performance by etched features therein that reduce thermal mass and increase the surface area of the sleeve for cooling. This improved thermal performance of the thermocycler enables an increase in speed and efficiency of the reaction chamber. The improvement is accomplished by providing grooves in the faces of the sleeve and a series of grooves on the interior surfaces that connect with grooves on the faces of the sleeve. The grooves can be anisotropically etched in the silicon sleeve simultaneously with formation of the chamber.

Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples.

PubMed

Bailie, Ross; Si, Damin; Shannon, Cindy; Semmens, James; Rowley, Kevin; Scrimgeour, David J; Nagel, Tricia; Anderson, Ian; Connors, Christine; Weeramanthri, Tarun; Thompson, Sandra; McDermott, Robyn; Burke, Hugh; Moore, Elizabeth; Leon, Dallas; Weston, Richard; Grogan, Haylene; Stanley, Andrew; Gardner, Karen

2010-05-19

Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

Performance Measurement and Target-Setting in California's Safety Net Health Systems.

PubMed

Hemmat, Shirin; Schillinger, Dean; Lyles, Courtney; Ackerman, Sara; Gourley, Gato; Vittinghoff, Eric; Handley, Margaret; Sarkar, Urmimala

Health policies encourage implementing quality measurement with performance targets. The 2010-2015 California Medicaid waiver mandated quality measurement and reporting. In 2013, California safety net hospitals participating in the waiver set a voluntary performance target (the 90th percentile for Medicare preferred provider organization plans) for mammography screening and cholesterol control in diabetes. They did not reach the target, and the difference-in-differences analysis suggested that there was no difference for mammography ( P = .39) and low-density lipoprotein control ( P = .11) performance compared to measures for which no statewide quality improvement initiative existed. California's Medicaid waiver was associated with improved performance on a number of metrics, but this performance was not attributable to target setting on specific health conditions. Performance may have improved because of secular trends or systems improvements related to waiver funding. Relying on condition-specific targets to measure performance may underestimate improvements and disadvantage certain health systems. Achieving ambitious targets likely requires sustained fiscal, management, and workforce investments.

Performance-Based Logistics Contracts: A Basic Overview

DTIC Science & Technology

2005-11-01

world. The Navy began using PBL contracts in 1999, and since then, contract managers have reported improved availability and reduced customer wait...4825 Mark Center Drive • Alexandria, Virginia 22311-1850 CRM D0012881.A2/Final November 2005 Performance-Based Logistics Contracts: A Basic Overview...Performance-Based Logistics (PBL) contracts provide services or sup- port where the provider is held to customer -oriented performance requirements

AIB-OR: improving onion routing circuit construction using anonymous identity-based cryptosystems.

PubMed

Wang, Changji; Shi, Dongyuan; Xu, Xilei

2015-01-01

The rapid growth of Internet applications has made communication anonymity an increasingly important or even indispensable security requirement. Onion routing has been employed as an infrastructure for anonymous communication over a public network, which provides anonymous connections that are strongly resistant to both eavesdropping and traffic analysis. However, existing onion routing protocols usually exhibit poor performance due to repeated encryption operations. In this paper, we first present an improved anonymous multi-receiver identity-based encryption (AMRIBE) scheme, and an improved identity-based one-way anonymous key agreement (IBOWAKE) protocol. We then propose an efficient onion routing protocol named AIB-OR that provides provable security and strong anonymity. Our main approach is to use our improved AMRIBE scheme and improved IBOWAKE protocol in onion routing circuit construction. Compared with other onion routing protocols, AIB-OR provides high efficiency, scalability, strong anonymity and fault tolerance. Performance measurements from a prototype implementation show that our proposed AIB-OR can achieve high bandwidths and low latencies when deployed over the Internet.

AIB-OR: Improving Onion Routing Circuit Construction Using Anonymous Identity-Based Cryptosystems

PubMed Central

Wang, Changji; Shi, Dongyuan; Xu, Xilei

2015-01-01

The rapid growth of Internet applications has made communication anonymity an increasingly important or even indispensable security requirement. Onion routing has been employed as an infrastructure for anonymous communication over a public network, which provides anonymous connections that are strongly resistant to both eavesdropping and traffic analysis. However, existing onion routing protocols usually exhibit poor performance due to repeated encryption operations. In this paper, we first present an improved anonymous multi-receiver identity-based encryption (AMRIBE) scheme, and an improved identity-based one-way anonymous key agreement (IBOWAKE) protocol. We then propose an efficient onion routing protocol named AIB-OR that provides provable security and strong anonymity. Our main approach is to use our improved AMRIBE scheme and improved IBOWAKE protocol in onion routing circuit construction. Compared with other onion routing protocols, AIB-OR provides high efficiency, scalability, strong anonymity and fault tolerance. Performance measurements from a prototype implementation show that our proposed AIB-OR can achieve high bandwidths and low latencies when deployed over the Internet. PMID:25815879

Merit-Based Incentive Payment System (MIPS): Harsh Choices For Interventional Pain Management Physicians.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2016-01-01

The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score. Additionally, Clinical Practice Improvement Activities (CPIA), contributing 15% of the composite score, create multiple strategic goals to design incentives that drive movement toward delivery system reform principles with inclusion of Advanced Alternative Payment Models (APMs). Under the present proposal, the Centers for Medicare and Medicaid Services (CMS) has estimated approximately 30,000 to 90,000 providers from a total of over 761,000 providers will be exempt from MIPS. About 87% of solo practitioners and 70% of practitioners in groups of less than 10 will be subjected to negative payments or penalties ranging from 4% to 9%. In addition, MIPS also will affect a provider's reputation by making performance measures accessible to consumers and third-party physician rating Web sites.The MIPS composite performance scoring method, at least in theory, utilizes weights for each performance category, exceptional performance factors to earn bonuses, and incorporates the special circumstances of small practices.In conclusion, MIPS has the potential to affect practitioners negatively. Interventional Pain Medicine practitioners must understand the various MIPS measures and how they might participate in order to secure a brighter future. Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, clinical practice improvement activities, advancing care information performance category.

Sentinel-3 SAR Altimetry over Coastal and Open Ocean: performance assessment and improved retrieval methods in the ESA SCOOP Project.

NASA Astrophysics Data System (ADS)

Benveniste, J.; Cotton, D.; Moreau, T.; Raynal, M.; Varona, E.; Cipollini, P.; Cancet, M.; Martin, F.; Fenoglio-Marc, L.; Naeije, M.; Fernandes, J.; Lazaro, C.; Restano, M.; Ambrózio, A.

2017-12-01

The ESA Sentinel-3 satellite, launched in February 2016 as a part of the Copernicus programme, is the second satellite to operate a SAR mode altimeter. The Sentinel 3 Synthetic Aperture Radar Altimeter (SRAL) is based on the heritage from Cryosat-2, but this time complemented by a Microwave Radiometer (MWR) to provide a wet troposphere correction, and operating at Ku and C-Bands to provide an accurate along-track ionospheric correction. The SRAL is operated in SAR mode over the whole ocean and promises increased performance w.r.t. conventional altimetry. SCOOP (SAR Altimetry Coastal & Open Ocean Performance) is a project funded under the ESA SEOM (Scientific Exploitation of Operational Missions) Programme Element, started in September 2015, to characterise the expected performance of Sentinel-3 SRAL SAR mode altimeter products, in the coastal zone and open-ocean, and then to develop and evaluate enhancements to the baseline processing scheme in terms of improvements to ocean measurements. There is also a work package to develop and evaluate an improved Wet Troposphere correction for Sentinel-3, based on the measurements from the on-board MWR, further enhanced mostly in the coastal and polar regions using third party data, and provide recommendations for use. In this presentation we present results from the SCOOP project that demonstrate the excellent performance of SRAL in terms of measurement precision, and we illustrate the development and testing of new processing approaches designed specifically to improve performance close to the coast. The SCOOP test data sets and relevant documentation are available to external researchers on application to the project team. At the end of the project recommendations for further developments and implementations will be provided through a scientific roadmap.

Method of improving fuel cell performance by removing at least one metal oxide contaminant from a fuel cell electrode

DOEpatents

Kim, Yu Seung [Los Alamos, NM; Choi, Jong-Ho [Los Alamos, NM; Zelenay, Piotr [Los Alamos, NM

2009-08-18

A method of removing contaminants from a fuel cell catalyst electrode. The method includes providing a getter electrode and a fuel cell catalyst electrode having at least one contaminant to a bath and applying a voltage sufficient to drive the contaminant from the fuel cell catalyst electrode to the getter electrode. Methods of removing contaminants from a membrane electrode assembly of a fuel cell and of improving performance of a fuel cell are also provided.

Improving performance on core processes of care.

PubMed

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

Evaluating health service quality: using importance performance analysis.

PubMed

Izadi, Azar; Jahani, Younes; Rafiei, Sima; Masoud, Ali; Vali, Leila

2017-08-14

Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item's importance from the patients' perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients' viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

Using a quality improvement model to enhance providers' performance in maternal and newborn health care: a post-only intervention and comparison design.

PubMed

Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle

2017-04-12

The Standards Based Management and Recognition (SBM-R © ) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services. A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups. There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn and health check for the mother. The SBM-R quality improvement intervention made a significant positive impact on MNH providers' performance during labor and delivery and immediate PNC services, but not during ANC services. Scaling up the intervention to other facilities and regions may increase the availability of good quality MNH services across Ethiopia. The findings will also guide implementation of the government's five-year (2015-2020) health sector transformation plan and health care quality strategies needed to meet the country's MNH goals.

Method for improving fuel cell performance

DOEpatents

Uribe, Francisco A.; Zawodzinski, Thomas

2003-10-21

A method is provided for operating a fuel cell at high voltage for sustained periods of time. The cathode is switched to an output load effective to reduce the cell voltage at a pulse width effective to reverse performance degradation from OH adsorption onto cathode catalyst surfaces. The voltage is stepped to a value of less than about 0.6 V to obtain the improved and sustained performance.

Innovative and Successful Approaches to Improving Care Transitions From Hospital to Home

PubMed Central

Labson, Margherita C.

2015-01-01

Abstract Effective transitions to home care have been identified as among the factors leading to reducing hospital readmissions within 30 days of discharge and improvements on various other quality measures. Innovative applications of published evidence-based models and best practices designed to improve care transitions have been implemented in various settings across the country in an effort to enhance quality performance. For this article, The Joint Commission collected a series of case examples to examine how evidence-based innovations in care transitions are reducing readmissions and improving other quality outcomes. The organizations providing the case examples were interviewed and asked to provide performance data demonstrating quality improvement, as well as information about their care processes and data-gathering techniques. Their innovative approaches are reducing hospital readmissions; improving patient safety, satisfaction, and engagement; and contributing to other positive outcomes. PMID:25654457

What role does performance information play in securing improvement in healthcare? a conceptual framework for levers of change.

PubMed

Levesque, Jean-Frederic; Sutherland, Kim

2017-08-28

Across healthcare systems, there is consensus on the need for independent and impartial assessment of performance. There is less agreement about how measurement and reporting performance improves healthcare. This paper draws on academic theories to develop a conceptual framework-one that classifies in an integrated manner the ways in which change can be leveraged by healthcare performance information. A synthesis of published frameworks. The framework identifies eight levers for change enabled by performance information, spanning internal and external drivers, and emergent and planned processes: (1) cognitive levers provide awareness and understanding; (2) mimetic levers inform about the performance of others to encourage emulation; (3) supportive levers provide facilitation, implementation tools or models of care to actively support change; (4) formative levers develop capabilities and skills through teaching, mentoring and feedback; (5) normative levers set performance against guidelines, standards, certification and accreditation processes; (6) coercive levers use policies, regulations incentives and disincentives to force change; (7) structural levers modify the physical environment or professional cultures and routines; (8) competitive levers attract patients or funders. This framework highlights how performance measurement and reporting can contribute to eight different levers for change. It provides guidance into how to align performance measurement and reporting into quality improvement programme. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Westinghouse Hanford Company health and safety performance report. Fourth quarter calendar year 1994

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

Lansing, K.A.

1995-03-01

Detailed information pertaining to As Low As Reasonably Achievable/Contamination Control Improvement Project (ALARA/CCIP) activities are outlined. Improved commitment to the WHC ALARA/CCIP Program was experienced throughout FY 1994. During CY 1994, 17 of 19 sitewide ALARA performance goals were completed on or ahead of schedule. Estimated total exposure by facility for CY 1994 is listed in tables by organization code for each dosimeter frequency. Facilities/areas continue to utilize the capabilities of the RPR tracking system in conjunction with the present site management action-tracking system to manage deficiencies, trend performance, and develop improved preventive efforts. Detailed information pertaining to occupational injuries/illnessesmore » are provided. The Industrial Safety and Hygiene programs are described which have generated several key initiatives that are believed responsible for improved safety performance. A breakdown of CY 1994 occupational injuries/illnesses by type, affected body group, cause, job type, age/gender, and facility is provided. The contributing experience of each WHC division/department in attaining this significant improvement is described along with tables charting specific trends. The Radiological Control Program is on schedule to meet all RL Site Management System milestones and program commitments.« less

External quality assessment studies for laboratory performance of molecular and serological diagnosis of Chikungunya virus infection.

PubMed

Jacobsen, Sonja; Patel, Pranav; Schmidt-Chanasit, Jonas; Leparc-Goffart, Isabelle; Teichmann, Anette; Zeller, Herve; Niedrig, Matthias

2016-03-01

Since the re-emergence of Chikungunya virus (CHIKV) in Reunion in 2005 and the recent outbreak in the Caribbean islands with an expansion to the Americas the CHIK diagnostic became very important. We evaluate the performance of laboratories regarding molecular and serological diagnostic of CHIK worldwide. A panel of 12 samples for molecular and 13 samples for serology were provided to 60 laboratories in 40 countries for evaluating the sensitivity and specificity of molecular and serology testing. The panel for molecular diagnostic testing was analysed by 56 laboratories returning 60 data sets of results whereas the 56 and 60 data sets were returned for IgG and IgM diagnostic from the participating laboratories. Twenty-three from 60 data sets performed optimal, 7 acceptable and 30 sets of results require improvement. From 50 data sets only one laboratory shows an optimal performance for IgM detection, followed by 9 data sets with acceptable and the rest need for improvement. From 46 IgG serology data sets 20 provide an optimal, 2 an acceptable and 24 require improvement performance. The evaluation of some of the diagnostic performances allows linking the quality of results to the in-house methods or commercial assays used. The external quality assurance for CHIK diagnostics provides a good overview on the laboratory performance regarding sensitivity and specificity for the molecular and serology diagnostic required for the quick and reliable analysis of suspected CHIK patients. Nearly half of the laboratories have to improve their diagnostic profile to achieve a better performance. Copyright © 2016 Z. Published by Elsevier B.V. All rights reserved.

Audit feedback on reading performance of screening mammograms: An international comparison.

PubMed

Hofvind, S; Bennett, R L; Brisson, J; Lee, W; Pelletier, E; Flugelman, A; Geller, B

2016-09-01

Providing feedback to mammography radiologists and facilities may improve interpretive performance. We conducted a web-based survey to investigate how and why such feedback is undertaken and used in mammographic screening programmes. The survey was sent to representatives in 30 International Cancer Screening Network member countries where mammographic screening is offered. Seventeen programmes in 14 countries responded to the survey. Audit feedback was aimed at readers in 14 programmes, and facilities in 12 programmes. Monitoring quality assurance was the most common purpose of audit feedback. Screening volume, recall rate, and rate of screen-detected cancers were typically reported performance measures. Audit reports were commonly provided annually, but more frequently when target guidelines were not reached. The purpose, target audience, performance measures included, form and frequency of the audit feedback varied amongst mammographic screening programmes. These variations may provide a basis for those developing and improving such programmes. © The Author(s) 2016.

Corporatization as a means of improving water quality: the experience in Victoria, Australia.

PubMed

Martin, Narelle

Factors including fragmentation, a lack of direction, poor accountability, poor water quality, and a sizable state government subsidy contributed to the rural water industry in Victoria, Australia, in 1993. In 1993 the state government set out parameters for reform to change the size, structure, performance, and culture of the water industry. The path taken was not privatization, but corporatization. Tools used included amalgamation of organizations; separating water provisions from local government; changing the composition and reporting mechanisms of the boards; establishing clear benchmarks and performance criteria; making information publicly available; and providing a commercial orientation. The outcomes of the reforms were to be a focus on water quality and effluent management. In 2001, 15 water authorities were in place. There were significant improvements in accountability, finances, and performance. The authorities provided information on performance to both the state and the public. Reductions of operating costs have been in the range of 20-35%, with savings put back into new infrastructure. Water quality has significantly improved in a number of parameters and effluent management has also improved. This paper describes the challenges faced before the reform process, the reforms initiated, and the outcomes. It argues that privatization is not the only path to improvement: Developing a corporate structure and accountability can also deliver substantial improvements.

Patients' satisfaction: customer relationship management as a new opportunity for quality improvement in thoracic surgery.

PubMed

Rocco, Gaetano; Brunelli, Alessandro

2012-11-01

Clinical and nonclinical indicators of performance are meant to provide the surgeon with tools to identify weaknesses to be improved. The World Health Organization's Performance Evaluation Systems represent a multidimensional approach to quality measurement based on several categories made of different indicators. Indicators for patient satisfaction may include overall perceived quality, accessibility, humanization and patient involvement, communication, and trust in health care providers. Patient satisfaction is included among nonclinical indicators of performance in thoracic surgery and is increasingly recognized as one of the outcome measures for delivered quality of care. Copyright © 2012 Elsevier Inc. All rights reserved.

Governing Healthcare through Performance Measurement in Massachusetts and the Netherlands

PubMed Central

Van der Wees, Philip J.; der Sanden, Maria W.G. Nijhuis-van; van Ginneken, Ewout; Ayanian, John Z.; Schneider, Eric C.; Westert, Gert P.

2016-01-01

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of institutes to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care. In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives. PMID:24138729

Semi-interpenetrating polymer network for tougher and more microcracking resistant high temperature polymers

NASA Technical Reports Server (NTRS)

Pater, Ruth H. (Inventor)

1992-01-01

This invention is a semi-interpenetrating polymer network which includes a high performance thermosetting polyimide having a nadic end group acting as a crosslinking site and a high performance linear thermoplastic polyimide. An improved high temperature matrix resin is provided which is capable of performing at 316 C in air for several hundreds of hours. This resin has significantly improved toughness and microcracking resistance, excellent processability and mechanical performance, and cost effectiveness.

CF6 jet engine performance improvement program. Short core exhaust nozzle performance improvement concept. [specific fuel consumption reduction

NASA Technical Reports Server (NTRS)

Fasching, W. A.

1979-01-01

The short core exhaust nozzle was evaluated in CF6-50 engine ground tests including performance, acoustic, and endurance tests. The test results verified the performance predictions from scale model tests. The short core exhaust nozzle provides an internal cruise sfc reduction of 0.9 percent without an increase in engine noise. The nozzle hardware successfully completed 1000 flight cycles of endurance testing without any signs of distress.

Peer video review and feedback improve performance in basic surgical skills.

PubMed

Vaughn, Carolyn J; Kim, Edward; O'Sullivan, Patricia; Huang, Emily; Lin, Matthew Y C; Wyles, Susannah; Palmer, Barnard J A; Pierce, Jonathan L; Chern, Hueylan

2016-02-01

Incorporation of home-video assessments allows flexibility in feedback but requires faculty time. Peer feedback (PF) may provide additional benefits while avoiding these constraints. Twenty-four surgical interns completed a 12-week skills curriculum with home-video assignments focused on knot tying and suturing. Interns were randomized into 2 groups: PF or faculty feedback (FF). Peers and faculty provided feedback on home videos with checklists, global rating, and comments. Learners' skills were assessed at baseline, during, and at the conclusion of the curriculum. Performance of the 2 groups as rated by experts was compared. FF and PF were compared. Both groups improved from baseline, and the highest rated scores were seen on their home-video assessments. The PF group performed better at the final assessment than the FF group (effect size, .84). When using a checklist, there was no significant difference between scores given by peers and faculty. The PF group performed better at the final assessment, suggesting reviewing and analyzing another's performance may improve one's own performance. With checklists as guidance, peers can serve as raters comparable to faculty. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of a psychophysiological system for adaptive automation on performance, workload, and the event-related potential P300 component

NASA Technical Reports Server (NTRS)

Prinzel, Lawrence J 3rd; Freeman, Frederick G.; Scerbo, Mark W.; Mikulka, Peter J.; Pope, Alan T.

2003-01-01

The present study examined the effects of an electroencephalographic- (EEG-) based system for adaptive automation on tracking performance and workload. In addition, event-related potentials (ERPs) to a secondary task were derived to determine whether they would provide an additional degree of workload specificity. Participants were run in an adaptive automation condition, in which the system switched between manual and automatic task modes based on the value of each individual's own EEG engagement index; a yoked control condition; or another control group, in which task mode switches followed a random pattern. Adaptive automation improved performance and resulted in lower levels of workload. Further, the P300 component of the ERP paralleled the sensitivity to task demands of the performance and subjective measures across conditions. These results indicate that it is possible to improve performance with a psychophysiological adaptive automation system and that ERPs may provide an alternative means for distinguishing among levels of cognitive task demand in such systems. Actual or potential applications of this research include improved methods for assessing operator workload and performance.

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

NASA Technical Reports Server (NTRS)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

On the tip of the tongue: learning typing and pointing with an intra-oral computer interface.

PubMed

Caltenco, Héctor A; Breidegard, Björn; Struijk, Lotte N S Andreasen

2014-07-01

To evaluate typing and pointing performance and improvement over time of four able-bodied participants using an intra-oral tongue-computer interface for computer control. A physically disabled individual may lack the ability to efficiently control standard computer input devices. There have been several efforts to produce and evaluate interfaces that provide individuals with physical disabilities the possibility to control personal computers. Training with the intra-oral tongue-computer interface was performed by playing games over 18 sessions. Skill improvement was measured through typing and pointing exercises at the end of each training session. Typing throughput improved from averages of 2.36 to 5.43 correct words per minute. Pointing throughput improved from averages of 0.47 to 0.85 bits/s. Target tracking performance, measured as relative time on target, improved from averages of 36% to 47%. Path following throughput improved from averages of 0.31 to 0.83 bits/s and decreased to 0.53 bits/s with more difficult tasks. Learning curves support the notion that the tongue can rapidly learn novel motor tasks. Typing and pointing performance of the tongue-computer interface is comparable to performances of other proficient assistive devices, which makes the tongue a feasible input organ for computer control. Intra-oral computer interfaces could provide individuals with severe upper-limb mobility impairments the opportunity to control computers and automatic equipment. Typing and pointing performance of the tongue-computer interface is comparable to performances of other proficient assistive devices, but does not cause fatigue easily and might be invisible to other people, which is highly prioritized by assistive device users. Combination of visual and auditory feedback is vital for a good performance of an intra-oral computer interface and helps to reduce involuntary or erroneous activations.

The Effect of Formative Assessments on Language Performance

ERIC Educational Resources Information Center

Radford, Brian W.

2014-01-01

This study sought to improve the language learning outcomes at the Missionary Training Center in Provo, Utah. Young men and women between the ages of 19-24 are taught a foreign language in an accelerated environment. In an effort to improve learning outcomes, computer-based practice and teaching of language performance criteria were provided to…

Driving Performance Improvements by Integrating Competencies with Human Resource Practices

ERIC Educational Resources Information Center

Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

2010-01-01

This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

Enhancing Effective Chemistry Learning through Hypermedia Instructional Mode of Delivery

ERIC Educational Resources Information Center

Abanikannda, Mutahir Oluwafemi

2016-01-01

This study provides a framework for the production of Hypermedia Instructional package. It also assessed the effectiveness of hypermedia instructional mode of delivery on students? performance in Chemistry. This is with a view of improving the learning of Chemistry which may eventually help to improve students? performance. The developmental study…

Relationship between Study Habits and Student Attitudes towards Science and Technology

ERIC Educational Resources Information Center

Bowman, Charles Robert

2012-01-01

Improving student performance is the goal of any chemistry educator. With the proliferation of internet technologies in recent years, educators have been struggling with providing effective learning materials to students online. These materials also have not always had the intended effect of improving student performance. Either students do not…

Improving Achievement in Low-Performing Schools: Key Results for School Leaders

ERIC Educational Resources Information Center

Ward, Randolph E.; Burke, Mary Ann

2004-01-01

As accountability in schools becomes more crucial, educators are looking for comprehensive and innovative management practices that respond to challenges and realities of student academic achievement. In order to improve academic performance and the quality of instruction, the entire school community needs to be involved. This book provides six…

Performance measurement in cancer care: uses and challenges.

PubMed

Lazar, G S; Desch, C E

1998-05-15

Unnecessary, inappropriate, and futile care are given in all areas of health care including cancer care. Not only does such care increase costs and waste precious resources, but patients may have adverse outcomes when the wrong care is given. One of the ways to address this issue is to measure performance with the use of administrative data sets. Through performance measurement, the best providers can be chosen, providers can be rewarded on the basis of the quality of their performance, opportunities for improvement can be identified, and variation in practice can be minimized. Purchasers should take leadership role in creating data sets that will enhance, clinical performance. Specifically, purchasers should require the following from payers: 1) staging information; 2) requirements and/or incentives for proper International Classification of Diseases coding, including other important (comorbid) conditions; 3) incentives or requirements for proper data collection if the payer is using a reimbursement strategy that places the risk on the provider; and 4) a willingness to collect and report information to providers of care, with a view toward increasing quality and decreasing the costs of cancer care. Demanding better clinical performance can lead to better outcomes. Once good data is presented to patients and providers, better clinical behavior and improved cancer care systems will quickly follow.

Develop feedback system for intelligent dynamic resource allocation to improve application performance.

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

Gentile, Ann C.; Brandt, James M.; Tucker, Thomas

2011-09-01

This report provides documentation for the completion of the Sandia Level II milestone 'Develop feedback system for intelligent dynamic resource allocation to improve application performance'. This milestone demonstrates the use of a scalable data collection analysis and feedback system that enables insight into how an application is utilizing the hardware resources of a high performance computing (HPC) platform in a lightweight fashion. Further we demonstrate utilizing the same mechanisms used for transporting data for remote analysis and visualization to provide low latency run-time feedback to applications. The ultimate goal of this body of work is performance optimization in the facemore » of the ever increasing size and complexity of HPC systems.« less

Sales management coaching: a model for improved insurance company performance.

PubMed

Carter, Tony

2006-01-01

Of all the things sales managers do to develop salespeople, many people believe the most important one is coaching. Coaching is defined as using skills, experience, and direction to help someone improve their performance. Coaching consists primarily of giving people feedback to reinforce what they do well while suggesting ways and means to improve. Coaching implies that everybody can improve and hopefully everybody wants to get better at what they do. Many sales managers erroneously believe that they have to be better than the person they are coaching at the skill set they are discussing in order to be a useful coaching resource to that person. To be a good coach requires an understanding of the skills being discussed and a desire to help someone improve in the performance of their job. The sales manager who knows how to provide that feedback will have more productive, effective, satisfied, and motivated salespeople. This paper provides an overview of the coaching sequence and the skills required to make it work with some comment on how this was successfully applied to a major national insurance company. Sales Management styles vary, and what works for one person may not work for another. Effective Sales Management Coaching can provide sales managers with the skills to help salespeople grow and develop professionally.

The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands

PubMed Central

2014-01-01

Background Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome. Methods/Design The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups. Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers. Conclusion The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers. Trial registration The Netherlands National Trial Register, http://www.trialregister.nl/NTR4576, registered June 1, 2014 PMID:25145317

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

PubMed

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

2017-01-01

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs).Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category.

Dashboard report on performance on select quality indicators to cancer care providers.

PubMed

Stattin, Pär; Sandin, Fredrik; Sandbäck, Torsten; Damber, Jan-Erik; Franck Lissbrant, Ingela; Robinson, David; Bratt, Ola; Lambe, Mats

2016-01-01

Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, "What''s Going On, Prostate Cancer" provides rapid, at-a-glance performance feedback to care providers. The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.

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

Perrin, Tess E.; Davis, Robert G.; Wilkerson, Andrea M.

This GATEWAY project evaluated four field installations to better understand the long-term performance of a number of LED products, which can hopefully stimulate improvements in designing, manufacturing, specifying, procuring, and installing LED products. Field studies provide the opportunity to discover and investigate issues that cannot be simulated or uncovered in a laboratory, but the installed performance over time of commercially available LED products has not been well documented. Improving long-term performance can provide both direct energy savings by reducing the need to over-light to account for light loss and indirect energy savings through better market penetration due to SSL’s competitivemore » advantages over less-efficient light source technologies. The projects evaluated for this report illustrate that SSL use is often motivated by advantages other than energy savings, including maintenance savings, easier integration with control systems, and improved lighting quality.« less

Use of Provider-Level Dashboards and Pay-for-Performance in Venous Thromboembolism Prophylaxis*

PubMed Central

Michtalik, Henry J.; Carolan, Howard T.; Haut, Elliott R.; Lau, Brandyn D.; Streiff, Michael B.; Finkelstein, Joseph; Pronovost, Peter J.; Durkin, Nowella; Brotman, Daniel J.

2014-01-01

Background Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance, and payment incentives through programs to pay-for-performance. Objective To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates amongst hospitalists. Design Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. Setting 1060-bed tertiary care medical center. Participants 38 part- and full-time academic hospitalists. Interventions A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80-100%. Measurements Prescription of American College of Chest Physicians guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Results Monthly VTE prophylaxis compliance rates were 86% (95% CI: 85, 88), 90% (95% CI: 88, 93), and 94% (95% CI: 93, 96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (p=0.01) and addition of the pay-for-performance program (p=0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; p=0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; SD ±350). Conclusions Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. PMID:25545690

Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.

PubMed

Michtalik, Henry J; Carolan, Howard T; Haut, Elliott R; Lau, Brandyn D; Streiff, Michael B; Finkelstein, Joseph; Pronovost, Peter J; Durkin, Nowella; Brotman, Daniel J

2015-03-01

Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay-for-performance programs. To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates among hospitalists. Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. A 1060-bed tertiary care medical center. Thirty-eight part-time and full-time academic hospitalists. A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80% to 100%. Prescription of American College of Chest Physicians' guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Monthly VTE prophylaxis compliance rates were 86% (95% confidence interval [CI]: 85-88), 90% (95% CI: 88-93), and 94% (95% CI: 93-96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (P = 0.01) and addition of the pay-for-performance program (P = 0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; P = 0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; standard deviation ±$350). Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. © 2014 Society of Hospital Medicine.

Niobium Application, Metallurgy and Global Trends in Pressure Vessel Steels

NASA Astrophysics Data System (ADS)

Jansto, Steven G.

Niobium-containing high strength steel materials have been developed for a variety of pressure vessel applications. Through the application of these Nb-bearing steels in demanding applications, the designer and end user experience improved toughness at low temperature, excellent fatigue resistance and fracture toughness and excellent weldability. These enhancements provide structural engineers the opportunity to further improve the pressure vessel design and performance. The Nb-microalloy alloy designs also result in reduced operational production cost at the steel operation, thereby embracing the value-added attribute Nb provides to both the producer and the end user throughout the supply chain. For example, through the adoption of these Nb-containing structural materials, several design-manufacturing companies are considering improved designs which offer improved manufacturability, lower overall cost and better life cycle performance.

Building a Foundation of Continuous Improvement in a Rapidly Changing Environment: The Dartmouth-Hitchcock Value Institute Experience.

PubMed

McGrath, Susan P; Blike, George T

2015-10-01

A performance improvement competency development program, known as the Value Institute (VI), was established at Dartmouth-Hitchcock (D-H; Lebanon, New Hampshire) in 2011 to develop a performance improvement-focused workforce and systems capable of meeting the challenges of creating a sustainable health system. A tiered competency development program that provides patient safety, health care quality, and improvement science education, and an execution support infrastructure that enables access to performance improvement tools for all employees, comprise the core of the VI. At 20 months after the launch of the first VI classes, more than 10% of all employees were trained to the Yellow Belt level, and approximately 1.5% of all employees became advanced practitioners (Green Belts or Black Belts). Improvement projects have focused on both clinical and business process optimization, as well as regulatory and accreditation compliance and patient safety. Project savings during the two years of operation have exceeded the investment of resources to establish this long-term performance improvement capability by 2.5 times. The D-H VI model promotes multidisciplinary team-based learning, incremental skill development, and access to a common continuous improvement vocabulary and method for all employees-all key to building the teams and momentum needed for successful execution of improvement work and to maintain outcomes. Initial outcomes, represented by organizational spread, project execution status, participants' feedback scores, and return on investment estimates, suggest that robust team-based learning combined with coaching provides sufficient depth and breadth of learning and effective opportunities to gain practical experience in continuous improvement.

Behavioral Systems Analysis in Health and Human Services

ERIC Educational Resources Information Center

McGee, Heather M.; Diener, Lori H.

2010-01-01

This article provides a behavioral systems approach to improve operational performance in health and human service organizations. This article provides six performance truths that are relevant to any organization and a case study from a community mental health network of agencies. A comprehensive analysis, as described here, will help health and…

Effective Practices for Mentoring Beginning Middle School Teachers: Mentor's Perspectives

ERIC Educational Resources Information Center

Sowell, Marsha

2017-01-01

In order to improve student achievement, school systems must provide new teachers with support to become effective teachers more quickly. Educators frequently use mentoring to support new teachers and reach the goals of improved classroom performance as well as teacher retention. The intention in this study was to provide insights into the…

Quality Assurance Through Quality Improvement and Professional Development in the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Siegl, Elvira J.; Miller, Jacqueline W.; Khan, Kris; Harris, Susan E.

2015-01-01

Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report. PMID:25099901

Naval sensor data database (NSDD)

NASA Astrophysics Data System (ADS)

Robertson, Candace J.; Tubridy, Lisa H.

1999-08-01

The Naval Sensor Data database (NSDD) is a multi-year effort to archive, catalogue, and disseminate data from all types of sensors to the mine warfare, signal and image processing, and sensor development communities. The purpose is to improve and accelerate research and technology. Providing performers with the data required to develop and validate improvements in hardware, simulation, and processing will foster advances in sensor and system performance. The NSDD will provide a centralized source of sensor data in its associated ground truth, which will support an improved understanding will be benefited in the areas of signal processing, computer-aided detection and classification, data compression, data fusion, and geo-referencing, as well as sensor and sensor system design.

Evaluating Internal Model Strength and Performance of Myoelectric Prosthesis Control Strategies.

PubMed

Shehata, Ahmed W; Scheme, Erik J; Sensinger, Jonathon W

2018-05-01

On-going developments in myoelectric prosthesis control have provided prosthesis users with an assortment of control strategies that vary in reliability and performance. Many studies have focused on improving performance by providing feedback to the user but have overlooked the effect of this feedback on internal model development, which is key to improve long-term performance. In this paper, the strength of internal models developed for two commonly used myoelectric control strategies: raw control with raw feedback (using a regression-based approach) and filtered control with filtered feedback (using a classifier-based approach), were evaluated using two psychometric measures: trial-by-trial adaptation and just-noticeable difference. The performance of both strategies was also evaluated using Schmidt's style target acquisition task. Results obtained from 24 able-bodied subjects showed that although filtered control with filtered feedback had better short-term performance in path efficiency ( ), raw control with raw feedback resulted in stronger internal model development ( ), which may lead to better long-term performance. Despite inherent noise in the control signals of the regression controller, these findings suggest that rich feedback associated with regression control may be used to improve human understanding of the myoelectric control system.

The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments

PubMed Central

Bass, Ellen J.; Baumgart, Leigh A.; Shepley, Kathryn Klein

2014-01-01

Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance. PMID:24847184

Respectful maternity care in Ethiopian public health facilities.

PubMed

Sheferaw, Ephrem D; Bazant, Eva; Gibson, Hannah; Fenta, Hone B; Ayalew, Firew; Belay, Tsigereda B; Worku, Maria M; Kebebu, Aelaf E; Woldie, Sintayehu A; Kim, Young-Mi; van den Akker, T; Stekelenburg, Jelle

2017-05-16

Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services. This study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers' RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment. We present percentages of the nine RMC indicators, mean score of providers' RMC performance and the adjusted multilevel model regression coefficients to determine the association with a quality improvement program and other facility and provider characteristics. Women on average received 5.9 (66%) of the nine recommended RMC practices. Health centers demonstrated higher RMC performance than hospitals. At least one form of mistreatment of women was committed in 36% of the observations (38% in health centers and 32% in hospitals). Higher likelihood of performing high level of RMC was found among male vs. female providers ([Formula: see text], p = 0.012), midwives vs. other cadres ([Formula: see text], p = 0.002), facilities implementing a quality improvement approach, Standards-based Management and Recognition (SBM-R © ) ([Formula: see text], p = 0.003), and among laboring women accompanied by a companion [Formula: see text], p = 0.003). No factor was associated with observed mistreatment of women. Quality improvement using SBM-R © and having a companion during labor and delivery were associated with RMC. Policy makers need to consider the role of quality improvement approaches and accommodating companions in promoting RMC. More research is needed to identify the reason for superior RMC performance of male providers over female providers and midwives compared to other professional cadre, as are longitudinal studies of quality improvement on RMC and mistreatment of women during labor and childbirth services in public health facilities.

Greening America's Capitals - Baton Rouge, LA

EPA Pesticide Factsheets

The design options from this Greening America's Capitals project provide strategies that can improve environmental performance in Baton Rouge by increasing tree canopy, capturing and holding stormwater, and improving natural habitat.

A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional

PubMed Central

Karsh, B‐T; Holden, R J; Alper, S J; Or, C K L

2006-01-01

The goal of improving patient safety has led to a number of paradigms for directing improvement efforts. The main paradigms to date have focused on reducing injuries, reducing errors, or improving evidence based practice. In this paper a human factors engineering paradigm is proposed that focuses on designing systems to improve the performance of healthcare professionals and to reduce hazards. Both goals are necessary, but neither is sufficient to improve safety. We suggest that the road to patient and employee safety runs through the healthcare professional who delivers care. To that end, several arguments are provided to show that designing healthcare delivery systems to support healthcare professional performance and hazard reduction should yield significant patient safety benefits. The concepts of human performance and hazard reduction are explained. PMID:17142611

Test-Enhanced Learning in an Immunology and Infectious Disease Medicinal Chemistry/Pharmacology Course.

PubMed

Hernick, Marcy

2015-09-25

Objective. To develop a series of active-learning modules that would improve pharmacy students' performance on summative assessments. Design. A series of optional online active-learning modules containing questions with multiple formats for topics in a first-year (P1) course was created using a test-enhanced learning approach. A subset of module questions was modified and included on summative assessments. Assessment. Student performance on module questions improved with repeated attempts and was predictive of student performance on summative assessments. Performance on examination questions was higher for students with access to modules than for those without access to modules. Module use appeared to have the most impact on low performing students. Conclusion. Test-enhanced learning modules with immediate feedback provide pharmacy students with a learning tool that improves student performance on summative assessments and also may improve metacognitive and test-taking skills.

Test-Enhanced Learning in an Immunology and Infectious Disease Medicinal Chemistry/Pharmacology Course

PubMed Central

2015-01-01

Objective. To develop a series of active-learning modules that would improve pharmacy students’ performance on summative assessments. Design. A series of optional online active-learning modules containing questions with multiple formats for topics in a first-year (P1) course was created using a test-enhanced learning approach. A subset of module questions was modified and included on summative assessments. Assessment. Student performance on module questions improved with repeated attempts and was predictive of student performance on summative assessments. Performance on examination questions was higher for students with access to modules than for those without access to modules. Module use appeared to have the most impact on low performing students. Conclusion. Test-enhanced learning modules with immediate feedback provide pharmacy students with a learning tool that improves student performance on summative assessments and also may improve metacognitive and test-taking skills. PMID:27168610

The Effects of Preexercise Caffeinated Coffee Ingestion on Endurance Performance: An Evidence-Based Review.

PubMed

Higgins, Simon; Straight, Chad R; Lewis, Richard D

2016-06-01

Endurance athletes commonly ingest caffeine as a means to enhance training intensity and competitive performance. A widely-used source of caffeine is coffee, however conflicting evidence exists regarding the efficacy of coffee in improving endurance performance. In this context, the aims of this evidence-based review were threefold: 1) to evaluate the effects of preexercise coffee on endurance performance, 2) to evaluate the effects of coffee on perceived exertion during endurance performance, and 3) to translate the research into usable information for athletes to make an informed decision regarding the intake of caffeine via coffee as a potential ergogenic aid. Searches of three major databases were performed using terms caffeine and coffee, or coffee-caffeine, and endurance, or aerobic. Included studies (n = 9) evaluated the effects of caffeinated coffee on human subjects, provided the caffeine dose administered, administered caffeine ≥ 45 min before testing, and included a measure of endurance performance (e.g., time trial). Significant improvements in endurance performance were observed in five of nine studies, which were on average 24.2% over controls for time to exhaustion trials, and 3.1% for time to completion trials. Three of six studies found that coffee reduced perceived exertion during performance measures significantly more than control conditions (p < .05). Based on the reviewed studies there is moderate evidence supporting the use of coffee as an ergogenic aid to improve performance in endurance cycling and running. Coffee providing 3-8.1 mg/kg (1.36-3.68 mg/lb) of caffeine may be used as a safe alternative to anhydrous caffeine to improve endurance performance.

Improving Performance in Quantum Mechanics with Explicit Incentives to Correct Mistakes

ERIC Educational Resources Information Center

Brown, Benjamin R.; Mason, Andrew; Singh, Chandralekha

2016-01-01

An earlier investigation found that the performance of advanced students in a quantum mechanics course did not automatically improve from midterm to final exam on identical problems even when they were provided the correct solutions and their own graded exams. Here, we describe a study, which extended over four years, in which upper-level…

Training of Healthcare Personnel to Improve Performance of Community-Based Antenatal Care Program

ERIC Educational Resources Information Center

Ohnishi, Mayumi; Nakamura, Keiko; Takano, Takehito

2007-01-01

Background: The present study was performed to evaluate the effectiveness of a training course designed to improve the knowledge, skills, and attitudes of healthcare personnel to allow them to provide a comprehensive community-based antenatal care (ANC) program in rural Paraguay. Methods: Sixty-eight of 110 healthcare personnel in the Caazapa…

Effectiveness of Tutoring to Improve Academic Performance in Nursing Students at the University of Seville

ERIC Educational Resources Information Center

Guerra-Martín, María Dolores; Lima-Serrano, Marta; Lima-Rodríguez, Joaquín Salvador

2017-01-01

In response to the increase of Higher Education support provided to tutoring programs, this paper presents the design, implementation and evaluation of a tutoring program to improve the academic performance of at-risk students enrolled in the last year of a nursing degree characterized by academic failure (failed courses). A controlled…

Cancer Care Ontario and integrated cancer programs: portrait of a performance management system and lessons learned.

PubMed

Cheng, Siu Mee; Thompson, Leslee J

2006-01-01

A performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004-2005. The purpose of this paper is to address some of the key lessons learned. The paper provides an outline of the CCO performance management system. These lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable performance management system; performance indicators need to stand up to scrutiny by both parties; and providing comparative data across the province is valuable. Critical success factors which would help to ensure a successful performance management system include: corporate engagement from various parts of an organization in the review exercises; desire to focus on performance improvement and avoidance of blaming; and strong data management systems. The performance management system is a practical and sustainable system that allows for performance improvement of cancer care services. It can be a vital tool to enhance accountability within the health care system. The paper demonstrates that the performance management system supports accountability in the cancer care system for Ontario, and reflects the principles of the provincial governments commitment to continuous improvement of healthcare.

Module 1--Shared Leadership. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

Module 4--Effective Teaching. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

Module 2--Learning Culture. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

Tack Coat Performance and Materials Study

DOT National Transportation Integrated Search

2017-06-01

A good bond provided by a tack coat can improve performance of asphalt overlays. The objectives of this research were: (1) develop a method for testing the bond between pavement layers; (2) evaluate the bond performance and predict long-term performa...

Updating the Synchrotron Radiation Monitor at TLS

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

Kuo, C. H.; Hsu, S. Y.; Wang, C. J.

2007-01-19

The synchrotron radiation monitor provides useful information to support routine operation and physics experiments using the beam. Precisely knowing the profile of the beam helps to improve machine performance. The synchrotron radiation monitor at the Taiwan Light Source (TLS) was recently upgraded. The optics and modeling were improved to increase the accuracy of measurement in the small beam size. A high-performance IEEE-1394 digital CCD camera was used to improve the quality of images and extend the dynamic range of measurement. The image analysis is also improved. This report summarizes status and results.

Barriers to using eHealth data for clinical performance feedback in Malawi: A case study.

PubMed

Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S

2015-10-01

Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to support clinical learning and behavior change. An electronic medical record system (EMR) deployed in 66 antiretroviral therapy clinics in Malawi collects data that supervisors use to provide quarterly, clinic-level performance feedback. Understanding barriers to provision of eHealth-based performance feedback for individual healthcare providers in this setting could present a relatively low-cost opportunity to significantly improve the quality of care. The aims of this study were to identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriers. We conducted a qualitative study using interviews, observations, and informant feedback in eight public hospitals in Malawi where an EMR system is used. We interviewed 32 healthcare providers and conducted seven hours of observation of system use. We identified four key barriers to the use of EMR data for clinical performance feedback: provider rotations, disruptions to care processes, user acceptance of eHealth, and performance indicator lifespan. Each of these factors varied across sites and affected the quality of EMR data that could be used for the purpose of generating performance feedback for individual healthcare providers. Using routinely collected eHealth data to generate individualized performance feedback shows potential at large-scale for improving clinical performance in low-resource settings. However, technology used for this purpose must accommodate ongoing changes in barriers to eHealth data use. Understanding the clinical setting as a complex adaptive system (CAS) may enable designers of technology to effectively model change processes to mitigate these barriers. Copyright © 2015. Published by Elsevier Ireland Ltd.

Barriers to using eHealth data for clinical performance feedback in Malawi: A case study

PubMed Central

Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S

2016-01-01

Introduction Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to support clinical learning and behavior change. An electronic medical record system (EMR) deployed in 66 antiretroviral therapy clinics in Malawi collects data that supervisors use to provide quarterly, clinic-level performance feedback. Understanding barriers to provision of eHealth-based performance feedback for individual healthcare providers in this setting could present a relatively low-cost opportunity to significantly improve the quality of care. Objective The aims of this study were to identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriers. Methods We conducted a qualitative study using interviews, observations, and informant feedback in eight public hospitals in Malawi where an EMR is used. We interviewed 32 healthcare providers and conducted seven hours of observation of system use. Results We identified four key barriers to the use of EMR data for clinical performance feedback: provider rotations, disruptions to care processes, user acceptance of eHealth, and performance indicator lifespan. Each of these factors varied across sites and affected the quality of EMR data that could be used for the purpose of generating performance feedback for individual healthcare providers. Conclusion Using routinely collected eHealth data to generate individualized performance feedback shows potential at large-scale for improving clinical performance in low-resource settings. However, technology used for this purpose must accommodate ongoing changes in barriers to eHealth data use. Understanding the clinical setting as a complex adaptive system (CAS) may enable designers of technology to effectively model change processes to mitigate these barriers. PMID:26238704

Radar Performance Improvement. Angle Tracking Modification to Fire Control Radar System for Space Shuttle Rendezvous

NASA Technical Reports Server (NTRS)

Little, G. R.

1976-01-01

The AN/APQ-153 fire control radar modified to provide angle tracking was evaluated for improved performance. The frequency agile modifications are discussed along with the range-rate improvement modifications, and the radar to computer interface. A parametric design and comparison of noncoherent and coherent radar systems are presented. It is shown that the shuttle rendezvous range and range-rate requirements can be made by a Ku-Band noncoherent pulse radar.

[Public reporting of the Californian "pay for performance" conducted by the Integrated Healthcare Association (IHA)].

PubMed

Emmert, M; Schöffski, O

2007-01-01

In Germany, there is little transparency when it comes to quality of care of national health care providers. The population has hardly any opportunity to identify well-performing health-care providers. Therefore, the emerging quality improvement initiative "Pay for Performance (P4P)" developed in California, USA is examined with regard to an implementation into the German health care sector. This program wants to achieve higher levels of health care by setting both goal-oriented financial and non-financial incentives. Therefore, performance-based payment is combined with Public Reporting of the measured quality of care. As people can be influenced by the information provided, Public Reporting is supposed to have a positive effect on the quality of treatment. Published data to the American population will be highlighted as well as indications and examinations included in the P4P program. Also, it will be shown how the performance of health care providers is determined. Since published performance results can be considered not only for a specific indication but also as a whole, patients have the opportunity to choose a well-performing health-care provider, according to their specific requirements. Thus, Public Reporting might be regarded as an effective method in order to improve the quality of care provided by health-care providers. Public Reporting in P4P is already conducted in a differentiated but also in a broad context. In the development of this key success element, many stakeholders have been involved, including health-care providers. So, the presented way of Public Reporting can be regarded as a business case to learn from with regard to more transparency in the German health-care sector.

Sliding mode control method having terminal convergence in finite time

NASA Technical Reports Server (NTRS)

Venkataraman, Subramanian T. (Inventor); Gulati, Sandeep (Inventor)

1994-01-01

An object of this invention is to provide robust nonlinear controllers for robotic operations in unstructured environments based upon a new class of closed loop sliding control methods, sometimes denoted terminal sliders, where the new class will enforce closed-loop control convergence to equilibrium in finite time. Improved performance results from the elimination of high frequency control switching previously employed for robustness to parametric uncertainties. Improved performance also results from the dependence of terminal slider stability upon the rate of change of uncertainties over the sliding surface rather than the magnitude of the uncertainty itself for robust control. Terminal sliding mode control also yields improved convergence where convergence time is finite and is to be controlled. A further object is to apply terminal sliders to robot manipulator control and benchmark performance with the traditional computed torque control method and provide for design of control parameters.

Physical Therapist Students' Perceptions from Performing Strength and Conditioning Training: Academic, Professional, and Clinical Benefits.

PubMed

Meiners, Kelly M; Wisdom, Christina M

2017-01-01

The purpose of this qualitative study was to assess the perceptions of Doctor of Physical Therapy (DPT) students in performing collegiate athletes' strength and conditioning training. Four DPT students with the Certified Strength and Conditioning Specialist (CSCS) credential voluntarily provided collegiate athletes strength and conditioning training. Students were interviewed to obtain their perceptions of how the experience impacted performance in DPT school and perceptions of anticipated future benefits. Seven themes emerged from interviews: improved communication skills, movement analysis experience, improved time management/organization, increased understanding of exercises, attention to psychosocial aspects, interprofessional experience, and improved performance in coursework. DPT students with the CSCS credential perceived benefits from performing strength and conditioning training outside the standard DPT curriculum.

Recent developments in photodetection for medical applications

NASA Astrophysics Data System (ADS)

Llosá, Gabriela

2015-07-01

The use of the most advanced technology in medical imaging results in the development of high performance detectors that can significantly improve the performance of the medical devices employed in hospitals. Scintillator crystals coupled to photodetectors remain to be essential detectors in terms of performance and cost for medical imaging applications in different imaging modalities. Recent advances in photodetectors result in an increase of the performance of the medical scanners. Solid state detectors can provide substantial performance improvement, but are more complex to integrate into clinical detectors due mainly to their higher cost. Solid state photodetectors (APDs, SiPMs) have made new detector concepts possible and have led to improvements in different imaging modalities. Recent advances in detectors for medical imaging are revised.

IMPROVING TACONITE PROCESSING PLANT EFFICIENCY BY COMPUTER SIMULATION, Final Report

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

William M. Bond; Salih Ersayin

2007-03-30

This project involved industrial scale testing of a mineral processing simulator to improve the efficiency of a taconite processing plant, namely the Minorca mine. The Concentrator Modeling Center at the Coleraine Minerals Research Laboratory, University of Minnesota Duluth, enhanced the capabilities of available software, Usim Pac, by developing mathematical models needed for accurate simulation of taconite plants. This project provided funding for this technology to prove itself in the industrial environment. As the first step, data representing existing plant conditions were collected by sampling and sample analysis. Data were then balanced and provided a basis for assessing the efficiency ofmore » individual devices and the plant, and also for performing simulations aimed at improving plant efficiency. Performance evaluation served as a guide in developing alternative process strategies for more efficient production. A large number of computer simulations were then performed to quantify the benefits and effects of implementing these alternative schemes. Modification of makeup ball size was selected as the most feasible option for the target performance improvement. This was combined with replacement of existing hydrocyclones with more efficient ones. After plant implementation of these modifications, plant sampling surveys were carried out to validate findings of the simulation-based study. Plant data showed very good agreement with the simulated data, confirming results of simulation. After the implementation of modifications in the plant, several upstream bottlenecks became visible. Despite these bottlenecks limiting full capacity, concentrator energy improvement of 7% was obtained. Further improvements in energy efficiency are expected in the near future. The success of this project demonstrated the feasibility of a simulation-based approach. Currently, the Center provides simulation-based service to all the iron ore mining companies operating in northern Minnesota, and future proposals are pending with non-taconite mineral processing applications.« less

Working Memory Training Improves Dual-Task Performance on Motor Tasks.

PubMed

Kimura, Takehide; Kaneko, Fuminari; Nagahata, Keita; Shibata, Eriko; Aoki, Nobuhiro

2017-01-01

The authors investigated whether working memory training improves motor-motor dual-task performance consisted of upper and lower limb tasks. The upper limb task was a simple reaction task and the lower limb task was an isometric knee extension task. 45 participants (age = 21.8 ± 1.6 years) were classified into a working memory training group (WM-TRG), dual-task training group, or control group. The training duration was 2 weeks (15 min, 4 times/week). Our results indicated that working memory capacity increased significantly only in the WM-TRG. Dual-task performance improved in the WM-TRG and dual-task training group. Our study provides the novel insight that working memory training improves dual-task performance without specific training on the target motor task.

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

Kisner, R.; Melin, A.; Burress, T.

The objective of this project is to demonstrate improved reliability and increased performance made possible by deeply embedding instrumentation and controls (I&C) in nuclear power plant (NPP) components and systems. The project is employing a highly instrumented canned rotor, magnetic bearing, fluoride salt pump as its I&C technology demonstration platform. I&C is intimately part of the basic millisecond-by-millisecond functioning of the system; treating I&C as an integral part of the system design is innovative and will allow significant improvement in capabilities and performance. As systems become more complex and greater performance is required, traditional I&C design techniques become inadequate andmore » more advanced I&C needs to be applied. New I&C techniques enable optimal and reliable performance and tolerance of noise and uncertainties in the system rather than merely monitoring quasistable performance. Traditionally, I&C has been incorporated in NPP components after the design is nearly complete; adequate performance was obtained through over-design. By incorporating I&C at the beginning of the design phase, the control system can provide superior performance and reliability and enable designs that are otherwise impossible. This report describes the progress and status of the project and provides a conceptual design overview for the platform to demonstrate the performance and reliability improvements enabled by advanced embedded I&C.« less

Does Agency Competition Improve the Quality of Policy Analysis? Evidence from OMB and CBO Fiscal Projections

ERIC Educational Resources Information Center

Krause, George A.; Douglas, James W.

2006-01-01

Public management scholars often claim that agency competition provides an effective institutional check on monopoly authority, and hence, leads to improvement of administrative performance in public sector agencies. This logic was central for creating the Congressional Budget Office (CBO) in 1975 to challenge the policy information provided by…

Alkaline fuel cell performance investigation

NASA Technical Reports Server (NTRS)

Martin, R. E.; Manzo, M. A.

1988-01-01

An exploratory experimental fuel cell test program was conducted to investigate the performance characteristics of alkaline laboratory research electrodes. The objective of this work was to establish the effect of temperature, pressure, and concentration upon performance and evaluate candidate cathode configurations having the potential for improved performance. The performance characterization tests provided data to empirically establish the effect of temperature, pressure, and concentration upon performance for cell temperatures up to 300 F and reactant pressures up to 200 psia. Evaluation of five gold alloy cathode catalysts revealed that three doped gold alloys had more that two times the surface areas of reference cathodes and therefore offered the best potential for improved performance.

Alkaline fuel cell performance investigation

NASA Technical Reports Server (NTRS)

Martin, R. E.; Manzo, M. A.

1988-01-01

An exploratory experimental fuel cell test program was conducted to investigate the performance characteristics of alkaline laboratory research electrodes. The objective of this work was to establish the effect of temperature, pressure, and concentration upon performance and evaluate candidate cathode configurations having the potential for improved performance. The performance characterization tests provided data to empirically establish the effect of temperature, pressure, and concentration upon performance for cell temperatures up to 300 F and reactant pressures up to 200 psia. Evaluation of five gold alloy cathode catalysts revealed that three doped gold alloys had more than two times the surface areas of reference cathodes and therefore offered the best potential for improved performance.

Internet Delivered Support for Tobacco Control in Dental Practice: Randomized Controlled Trial

PubMed Central

Richman, Joshua S; Ray, Midge N; Allison, Jeroan J; Gilbert, Gregg H; Shewchuk, Richard M; Kohler, Connie L; Kiefe, Catarina I

2008-01-01

Background The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized. Objective To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings. Methods Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention. Results Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices’ mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK. Conclusion This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit. Trial Registration clinicaltrials.gov NCT00627185; http://clinicaltrials.gov/ct2/show/NCT00627185 (Archived by WebCite at http://www.webcitation.org/5c5Kugvzj) PMID:18984559

Improving motor performance without training: the effect of combining mirror visual feedback with transcranial direct current stimulation.

PubMed

von Rein, Erik; Hoff, Maike; Kaminski, Elisabeth; Sehm, Bernhard; Steele, Christopher J; Villringer, Arno; Ragert, Patrick

2015-04-01

Mirror visual feedback (MVF) during motor training has been shown to improve motor performance of the untrained hand. Here we thought to determine if MVF-induced performance improvements of the left hand can be augmented by upregulating plasticity in right primary motor cortex (M1) by means of anodal transcranial direct current stimulation (a-tDCS) while subjects trained with the right hand. Participants performed a ball-rotation task with either their left (untrained) or right (trained) hand on two consecutive days (days 1 and 2). During training with the right hand, MVF was provided concurrent with two tDCS conditions: group 1 received a-tDCS over right M1 (n = 10), whereas group 2 received sham tDCS (s-tDCS, n = 10). On day 2, performance was reevaluated under the same experimental conditions compared with day 1 but without tDCS. While baseline performance of the left hand (day 1) was not different between groups, a-tDCS exhibited stronger MVF-induced performance improvements compared with s-tDCS. Similar results were observed for day 2 (without tDCS application). A control experiment (n = 8) with a-tDCS over right M1 as outlined above but without MVF revealed that left hand improvement was significantly less pronounced than that induced by combined a-tDCS and MVF. Based on these results, we provide novel evidence that upregulating activity in the untrained M1 by means of a-tDCS is capable of augmenting MVF-induced performance improvements in young normal volunteers. Our findings suggest that concurrent MVF and tDCS might have synergistic and additive effects on motor performance of the untrained hand, a result of relevance for clinical approaches in neurorehabilitation and/or exercise science. Copyright © 2015 the American Physiological Society.

40 CFR 63.1035 - Quality improvement program for pumps.

Code of Federal Regulations, 2010 CFR

2010-07-01

... that have poorer than average emission performance and those that have better than average emission... with poorer than average emission performance. A superior performing pump or pump seal technology is... the areas identified as having poorer than average performance, except as provided in paragraph (d)(6...

Influence of pay-for-performance programs on information technology use among child health providers: the devil is in the details.

PubMed

Menachemi, Nir; Struchen-Shellhorn, Wendy; Brooks, Robert G; Simpson, Lisa

2009-01-01

Pay-for-performance programs are used to promote improved health care quality, often through increased use of health information technology. However, little is known about whether pay-for-performance programs influence the adoption of health information technology, especially among child health providers. This study explored how various pay-for-performance compensation methods are related to health information technology use. Survey data from 1014 child health providers practicing in Florida were analyzed by using univariate and multivariate techniques. Questions asked about the adoption of electronic health records and personal digital assistants, as well as types of activities that affected child health provider compensation or income. The most common reported method to affect respondents' compensation was traditional productivity or billing (78%). Of the pay-for-performance-related methods of compensation, child health providers indicated that measures of clinical care (41%), patient surveys and experience (34%), the use of health information technology (29%), and quality bonuses or incentives (27%) were a major or minor factor in their compensation. In multivariate logistic regression analyses, only pay-for-performance programs that compensated directly for health information technology use were associated with an increased likelihood of electronic health record system adoption. Pay-for-performance programs linking measures of clinical quality to compensation were positively associated with personal digital assistant use among child health providers. Pay-for-performance programs that do not directly emphasize health information technology use do not influence the adoption of electronic health records among Florida physicians treating children. Understanding how different pay-for-performance compensation methods incentivize health information technology adoption is important for improving quality.

Training children aged 5-10 years in manual compliance control to improve drawing and handwriting.

PubMed

Bingham, Geoffrey P; Snapp-Childs, Winona

2018-04-12

A large proportion of school-aged children exhibit poor drawing and handwriting. This prevalence limits the availability of therapy. We developed an automated method for training improved manual compliance control and relatedly, prospective control of a stylus. The approach included a difficult training task, while providing parametrically modifiable support that enables the children to perform successfully while developing good compliance control. The task was to use a stylus to push a bead along a 3D wire path. Support was provided by making the wire magnetically attractive to the stylus. Support was progressively reduced as 3D tracing performance improved. We report studies that (1) compared performance of Typically Developing (TD) children and children with Developmental Coordination Disorder (DCD), (2) tested training with active versus passive movement, (3) tested progressively reduced versus constant or no support during training, (4) tested children of different ages, (5) tested the transfer of training to a drawing task, (6) tested the specificity of training in respect to the size, shape and dimensionality of figures, and (7) investigated the relevance of the training task to the Beery VMI, an inventory used to diagnose DCD. The findings were as follows. (1) Pre-training performance of TD and DCD children was the same and good with high support but distinct and poor with low support. Support yielded good self-efficacy that motivated training. Post training performance with no support was improved and the same for TD and DCD children. (2) Actively controlled movements were required for improved performance. (3) Progressively reduced support was required for good performance during and after training. (4) Age differences in performance during pre-training were eliminated post-training. (5) Improvements transferred to drawing. (6) There was no evidence of specificity of training in transfer. (7) Disparate Beery scores were reflected in pre-training but not post-training performance. We conclude that the method improves manual compliance control, and more generally, prospective control of movements used in drawing performance. Copyright © 2018. Published by Elsevier B.V.

Performance of salmon fishery portfolios across western North America.

PubMed

Griffiths, Jennifer R; Schindler, Daniel E; Armstrong, Jonathan B; Scheuerell, Mark D; Whited, Diane C; Clark, Robert A; Hilborn, Ray; Holt, Carrie A; Lindley, Steven T; Stanford, Jack A; Volk, Eric C

2014-12-01

Quantifying the variability in the delivery of ecosystem services across the landscape can be used to set appropriate management targets, evaluate resilience and target conservation efforts. Ecosystem functions and services may exhibit portfolio-type dynamics, whereby diversity within lower levels promotes stability at more aggregated levels. Portfolio theory provides a framework to characterize the relative performance among ecosystems and the processes that drive differences in performance. We assessed Pacific salmon Oncorhynchus spp. portfolio performance across their native latitudinal range focusing on the reliability of salmon returns as a metric with which to assess the function of salmon ecosystems and their services to humans. We used the Sharpe ratio (e.g. the size of the total salmon return to the portfolio relative to its variability (risk)) to evaluate the performance of Chinook and sockeye salmon portfolios across the west coast of North America. We evaluated the effects on portfolio performance from the variance of and covariance among salmon returns within each portfolio, and the association between portfolio performance and watershed attributes. We found a positive latitudinal trend in the risk-adjusted performance of Chinook and sockeye salmon portfolios that also correlated negatively with anthropogenic impact on watersheds (e.g. dams and land-use change). High-latitude Chinook salmon portfolios were on average 2·5 times more reliable, and their portfolio risk was mainly due to low variance in the individual assets. Sockeye salmon portfolios were also more reliable at higher latitudes, but sources of risk varied among the highest performing portfolios. Synthesis and applications . Portfolio theory provides a straightforward method for characterizing the resilience of salmon ecosystems and their services. Natural variability in portfolio performance among undeveloped watersheds provides a benchmark for restoration efforts. Locally and regionally, assessing the sources of portfolio risk can guide actions to maintain existing resilience (protect habitat and disturbance regimes that maintain response diversity; employ harvest strategies sensitive to different portfolio components) or improve restoration activities. Improving our understanding of portfolio reliability may allow for management of natural resources that is robust to ongoing environmental change. Portfolio theory provides a straightforward method for characterizing the resilience of salmon ecosystems and their services. Natural variability in portfolio performance among undeveloped watersheds provides a benchmark for restoration efforts. Locally and regionally, assessing the sources of portfolio risk can guide actions to maintain existing resilience (protect habitat and disturbance regimes that maintain response diversity; employ harvest strategies sensitive to different portfolio components) or improve restoration activities. Improving our understanding of portfolio reliability may allow for management of natural resources that is robust to ongoing environmental change.

Performance of salmon fishery portfolios across western North America

PubMed Central

Griffiths, Jennifer R; Schindler, Daniel E; Armstrong, Jonathan B; Scheuerell, Mark D; Whited, Diane C; Clark, Robert A; Hilborn, Ray; Holt, Carrie A; Lindley, Steven T; Stanford, Jack A; Volk, Eric C

2014-01-01

Quantifying the variability in the delivery of ecosystem services across the landscape can be used to set appropriate management targets, evaluate resilience and target conservation efforts. Ecosystem functions and services may exhibit portfolio-type dynamics, whereby diversity within lower levels promotes stability at more aggregated levels. Portfolio theory provides a framework to characterize the relative performance among ecosystems and the processes that drive differences in performance. We assessed Pacific salmon Oncorhynchus spp. portfolio performance across their native latitudinal range focusing on the reliability of salmon returns as a metric with which to assess the function of salmon ecosystems and their services to humans. We used the Sharpe ratio (e.g. the size of the total salmon return to the portfolio relative to its variability (risk)) to evaluate the performance of Chinook and sockeye salmon portfolios across the west coast of North America. We evaluated the effects on portfolio performance from the variance of and covariance among salmon returns within each portfolio, and the association between portfolio performance and watershed attributes. We found a positive latitudinal trend in the risk-adjusted performance of Chinook and sockeye salmon portfolios that also correlated negatively with anthropogenic impact on watersheds (e.g. dams and land-use change). High-latitude Chinook salmon portfolios were on average 2·5 times more reliable, and their portfolio risk was mainly due to low variance in the individual assets. Sockeye salmon portfolios were also more reliable at higher latitudes, but sources of risk varied among the highest performing portfolios. Synthesis and applications. Portfolio theory provides a straightforward method for characterizing the resilience of salmon ecosystems and their services. Natural variability in portfolio performance among undeveloped watersheds provides a benchmark for restoration efforts. Locally and regionally, assessing the sources of portfolio risk can guide actions to maintain existing resilience (protect habitat and disturbance regimes that maintain response diversity; employ harvest strategies sensitive to different portfolio components) or improve restoration activities. Improving our understanding of portfolio reliability may allow for management of natural resources that is robust to ongoing environmental change. Portfolio theory provides a straightforward method for characterizing the resilience of salmon ecosystems and their services. Natural variability in portfolio performance among undeveloped watersheds provides a benchmark for restoration efforts. Locally and regionally, assessing the sources of portfolio risk can guide actions to maintain existing resilience (protect habitat and disturbance regimes that maintain response diversity; employ harvest strategies sensitive to different portfolio components) or improve restoration activities. Improving our understanding of portfolio reliability may allow for management of natural resources that is robust to ongoing environmental change. PMID:25552746

Improving Physical Task Performance with Counterfactual and Prefactual Thinking.

PubMed

Hammell, Cecilia; Chan, Amy Y C

2016-01-01

Counterfactual thinking (reflecting on "what might have been") has been shown to enhance future performance by translating information about past mistakes into plans for future action. Prefactual thinking (imagining "what might be if…") may serve a greater preparative function than counterfactual thinking as it is future-orientated and focuses on more controllable features, thus providing a practical script to prime future behaviour. However, whether or not this difference in hypothetical thought content may translate into a difference in actual task performance has been largely unexamined. In Experiment 1 (n = 42), participants performed trials of a computer-simulated physical task, in between which they engaged in either task-related hypothetical thinking (counterfactual or prefactual) or an unrelated filler task (control). As hypothesised, prefactuals contained more controllable features than counterfactuals. Moreover, participants who engaged in either form of hypothetical thinking improved significantly in task performance over trials compared to participants in the control group. The difference in thought content between counterfactuals and prefactuals, however, did not yield a significant difference in performance improvement. Experiment 2 (n = 42) replicated these findings in a dynamic balance task environment. Together, these findings provide further evidence for the preparatory function of counterfactuals, and demonstrate that prefactuals share this same functional characteristic.

Characterization Of Improved Binary Phase-Only Filters In A Real-Time Coherent Optical Correlation System

NASA Astrophysics Data System (ADS)

Flannery, D.; Keller, P.; Cartwright, S.; Loomis, J.

1987-06-01

Attractive correlation system performance potential is possible using magneto-optic spatial light modulators (SLM) to implement binary phase-only reference filters at high rates, provided the correlation performance of such reduced-information-content filters is adequate for the application. In the case studied here, the desired filter impulse response is a rectangular shape, which cannot be achieved with the usual binary phase-only filter formulation. The correlation application problem is described and techniques for synthesizing improved filter impulse response are considered. A compromise solution involves the cascading of a fixed amplitude-only weighting mask with the binary phase-only SLM. Based on simulations presented, this approach provides improved impulse responses and good correlation performance, while retaining the critical feature of real-time variations of the size, shape, and orientation of the rectangle by electronic programming of the phase pattern in the SLM. Simulations indicate that, for at least one very challenging input scene clutter situation, these filters provide higher correlation signal-to-noise than does "ideal" correlation, i.e. using a perfect rectangle filter response.

Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

PubMed

Mead, Holly; Grantham, Sarah; Siegel, Bruce

2014-01-01

Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

Using Brief Guided Imagery to Reduce Math Anxiety and Improve Math Performance: A Pilot Study

ERIC Educational Resources Information Center

Henslee, Amber M.; Klein, Brandi A.

2017-01-01

The objective of this study was to investigate whether brief guided imagery could provide a short-term reduction in math anxiety and improve math performance. Undergraduates (N = 581) were screened for math anxiety, and the highest and lowest quartiles were recruited to participate in a lab-based study. Participants were assigned to a brief guided…

A Comparison of Online and Face-to-Face Collaboration on the Performance of Middle School Math Students' Standardized Assessment

ERIC Educational Resources Information Center

Eliason, Norma Lynn

2014-01-01

The effects of incorporating an online social networking platform, hosted through Wikispace, as a method to potential improve the performance of middle school students on standardized math assessments was investigated in this study. A principal strategy for any educational setting may provide an instructional approach that improves the delivery of…

Constructive Feedback as a Learning Tool to Enhance Students' Self-Regulation and Performance in Higher Education

ERIC Educational Resources Information Center

du Toit, Erna

2012-01-01

If feedback is provided in a way that can develop students' self-regulatory skills, it could enhance learning and, consequently, lead to improved performance. To improve teaching and learning in higher education (HE), this study sought to determine whether the feedback to first-year students affords them an opportunity to learn from it. A…

A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

PubMed

Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

2018-02-21

Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311). An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

Learning to leverage existing information systems: Part 1. Principles.

PubMed

Neil, Nancy; Nerenz, David

2003-10-01

The success of performance improvement efforts depends on effective measurement and feedback regarding clinical processes and outcomes. Yet most health care organizations have fragmented rather than integrated data systems. Methods and practical guidance are provided for leveraging available information sources to obtain and create valid performance improvement-related information for use by clinicians and administrators. At Virginia Mason Health System (VMHS; Seattle), a vertically integrated hospital and multispecialty group practice, patient records are paper based and are supplemented with electronic reporting for laboratory and radiology services. Despite growth in the resources and interest devoted to organization-wide performance measurement, quality improvement, and evidence-based tools, VMHS's information systems consist of largely stand-alone, legacy systems organized around the ability to retrieve information on patients, one at a time. By 2002, without any investment in technology, VMHS had developed standardized, clinic-wide key indicators of performance updated and reported regularly at the patient, provider, site, and organizational levels. On the basis of VHMS's experience, principles can be suggested to guide other organizations to explore solutions using their own information systems: for example, start simply, but start; identify information needs; tap multiple data streams; and improve incrementally.

Improving Motor and Drive System Performance – A Sourcebook for Industry

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

None

This sourcebook outlines opportunities to improve motor and drive systems performance. The sourcebook is divided into four main sections: (1) Motor and Drive System Basics: Summarizes important terms, relationships, and system design considerations relating to motor and drive systems. (2) Performance Opportunity Road Map: Details the key components of well-functioning motor and drive systems and opportunities for energy performance opportunities. (3) Motor System Economics: Offers recommendations on how to propose improvement projects based on corporate priorities, efficiency gains, and financial payback periods. (4) Where to Find Help: Provides a directory of organizations associated with motors and drives, as well asmore » resources for additional information, tools, software, videos, and training opportunities.« less

Human perception testing methodology for evaluating EO/IR imaging systems

NASA Astrophysics Data System (ADS)

Graybeal, John J.; Monfort, Samuel S.; Du Bosq, Todd W.; Familoni, Babajide O.

2018-04-01

The U.S. Army's RDECOM CERDEC Night Vision and Electronic Sensors Directorate (NVESD) Perception Lab is tasked with supporting the development of sensor systems for the U.S. Army by evaluating human performance of emerging technologies. Typical research questions involve detection, recognition and identification as a function of range, blur, noise, spectral band, image processing techniques, image characteristics, and human factors. NVESD's Perception Lab provides an essential bridge between the physics of the imaging systems and the performance of the human operator. In addition to quantifying sensor performance, perception test results can also be used to generate models of human performance and to drive future sensor requirements. The Perception Lab seeks to develop and employ scientifically valid and efficient perception testing procedures within the practical constraints of Army research, including rapid development timelines for critical technologies, unique guidelines for ethical testing of Army personnel, and limited resources. The purpose of this paper is to describe NVESD Perception Lab capabilities, recent methodological improvements designed to align our methodology more closely with scientific best practice, and to discuss goals for future improvements and expanded capabilities. Specifically, we discuss modifying our methodology to improve training, to account for human fatigue, to improve assessments of human performance, and to increase experimental design consultation provided by research psychologists. Ultimately, this paper outlines a template for assessing human perception and overall system performance related to EO/IR imaging systems.

A Conceptual Framework for the Electronic Performance Support Systems within IBM Lotus Notes 6 (LN6) Example

ERIC Educational Resources Information Center

Bayram, Servet

2005-01-01

The concept of Electronic Performance Support Systems (EPSS) is containing multimedia or computer based instruction components that improves human performance by providing process simplification, performance information and decision support system. EPSS has become a hot topic for organizational development, human resources, performance technology,…

National Aeronautics and Space Administration FY 02 Revised Final Annual Performance Plan

NASA Technical Reports Server (NTRS)

2002-01-01

The Government Performance and Results Act (GPRA) was passed by Congress and signed by the President in 1993. GPRA was enacted to improve the efficiency of all Federal agencies, with the following specific goals: (1) Improve Federal program management, effectiveness, and public accountability; (2) Improve Congressional decision making on where to commit the Nation's financial and human resources; and (3) Improve citizen confidence in government performance. GPRA directs Executive Branch agencies to develop a customer-focused strategic plan that aligns activities with concrete missions and goals. The Act directs agencies to manage and measure results to justify Congressional appropriations and authorizations. The Report Consolidation Act of 2000 directs agencies to provide a report on the degree of success in achieving the goals and performance measures defined in the strategic and performance plans one hundred and fifty days after the completion of the fiscal year.

Autophagy Is a Promoter for Aerobic Exercise Performance during High Altitude Training

PubMed Central

Zhang, Ying

2018-01-01

High altitude training is one of the effective strategies for improving aerobic exercise performance at sea level via altitude acclimatization, thereby improving oxygen transport and/or utilization. But its underlying molecular mechanisms on physiological functions and exercise performance of athletes are still vague. More recent evidence suggests that the recycling of cellular components by autophagy is an important process of the body involved in the adaptive responses to exercise. Whether high altitude training can activate autophagy or whether high altitude training can improve exercise performance through exercise-induced autophagy is still unclear. In this narrative review article, we will summarize current research advances in the improvement of exercise performance through high altitude training and its reasonable molecular mechanisms associated with autophagy, which will provide a new field to explore the molecular mechanisms of adaptive response to high altitude training. PMID:29849885

Module 3--School-Family-Community Connections. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

The Job Is the Learning Environment: Performance-Centered Learning To Support Knowledge Worker Performance.

ERIC Educational Resources Information Center

Dickover, Noel T.

2002-01-01

Explains performance-centered learning (PCL), an approach to optimize support for performance on the job by making corporate assets available to knowledge workers so they can solve actual problems. Illustrates PCL with a Web site that provides just-in-time learning, collaboration, and performance support tools to improve performance at the…

Fine tuning GPS clock estimation in the MCS

NASA Technical Reports Server (NTRS)

Hutsell, Steven T.

1995-01-01

With the completion of a 24 operational satellite constellation, GPS is fast approaching the critical milestone, Full Operational Capability (FOC). Although GPS is well capable of providing the timing accuracy and stability figures required by system specifications, the GPS community will continue to strive for further improvements in performance. The GPS Master Control Station (MCS) recently demonstrated that timing improvements are always composite Clock, and hence, Kalman Filter state estimation, providing a small improvement to user accuracy.

Are university rankings useful to improve research? A systematic review.

PubMed

Vernon, Marlo M; Balas, E Andrew; Momani, Shaher

2018-01-01

Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and "luxury" indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance.

Using organizational and clinical performance data to increase the value of mental health care.

PubMed

Schmidt, Eric M; Krahn, Dean D; McGuire, Marsden H; Tavakoli, Sara; Wright, David M; Solares, Hugo E; Lemke, Sonne; Trafton, Jodie

2017-02-01

U.S. health systems, policy makers, and patients increasingly demand high-value care that improves health outcomes at lower cost. This study describes the initial design and analysis of the Mental Health Management System (MHMS), a performance data and quality improvement tool used by the Veterans Health Administration (VHA) to increase the value of its mental health care. The MHMS evaluates access to and quality of mental health care, organizational structure and efficiency, implementation of innovative treatment options, and, in collaboration with management, resource needs for delivering care. Performance on 31 measures was calculated for all U.S. VHA facilities (N = 139). Pearson correlations revealed that better access to care was significantly associated with fewer mental health provider staffing vacancies (r = -.24) and higher staff-to-patient ratios for psychiatrists (r = .19) and other outpatient mental health providers (r = .27). Higher staff-to-patient ratios were significantly associated with higher performance on a number of patient and provider satisfaction measures (range of r = .18-.51) and continuity of care measures (range of r = .26-.43). Relationships observed between organizational and clinical performance measures suggest that the MHMS is a robust informatics and quality improvement tool that can serve as a model for health systems planning to adopt a value perspective. Future research should expand the MHMS framework to measure patient and health systems costs and psychosocial outcomes, as well as evaluate whether quality improvement solutions implemented as a result of using organizational information leads to higher-value mental health care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Methods for operating parallel computing systems employing sequenced communications

DOEpatents

Benner, R.E.; Gustafson, J.L.; Montry, G.R.

1999-08-10

A parallel computing system and method are disclosed having improved performance where a program is concurrently run on a plurality of nodes for reducing total processing time, each node having a processor, a memory, and a predetermined number of communication channels connected to the node and independently connected directly to other nodes. The present invention improves performance of the parallel computing system by providing a system which can provide efficient communication between the processors and between the system and input and output devices. A method is also disclosed which can locate defective nodes with the computing system. 15 figs.

Autonomous Integrated Receive System (AIRS) requirements definition. Volume 2: Design and development

NASA Technical Reports Server (NTRS)

Chie, C. M.; White, M. A.; Lindsey, W. C.; Davarian, F.; Dixon, R. C.

1984-01-01

Functional requirements and specifications are defined for an autonomous integrated receive system (AIRS) to be used as an improvement in the current tracking and data relay satellite system (TDRSS), and as a receiving system in the future tracking and data acquisition system (TDAS). The AIRS provides improved acquisition, tracking, bit error rate (BER), RFI mitigation techniques, and data operations performance compared to the current TDRSS ground segment receive system. A computer model of the AIRS is used to provide simulation results predicting the performance of AIRS. Cost and technology assessments are included.

ChIP and ChIP-Related Techniques: Expanding the Fields of Application and Improving ChIP Performance.

PubMed

Visa, Neus; Jordán-Pla, Antonio

2018-01-01

Protein-DNA interactions in vivo can be detected and quantified by chromatin immunoprecipitation (ChIP). ChIP has been instrumental for the advancement of epigenetics and has set the groundwork for the development of a number of ChIP-related techniques that have provided valuable information about the organization and function of genomes. Here, we provide an introduction to ChIP and discuss the applications of ChIP in different research areas. We also review some of the strategies that have been devised to improve ChIP performance.

Review of Proposed Automotive Carburetor Concepts for Improved Fuel Economy

DOT National Transportation Integrated Search

1975-03-01

This report summarizes available information pertaining to proposed concepts for improved automotive carburetors. In particular, information is provided which depicts the development and performance characteristics of a selected number of advanced, n...

How to Sustain Change and Support Continuous Quality Improvement

PubMed Central

McQuillan, Rory; Harel, Ziv; Weizman, Adam V.; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M.; Chan, Christopher T.; Chertow, Glenn M.

2016-01-01

To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). PMID:27016498

Protocol for the evaluation of a quality-based pay for performance scheme in Liberia.

PubMed

Bawo, Luke; Leonard, Kenneth L; Mohammed, Rianna

2015-01-13

Improving the quality of care at hospitals is a key next step in rebuilding Liberia's health system. In order to improve the efficiency, effectiveness, and quality of care at the secondary hospital level, the country is developing a system to upgrade health worker skills and competencies, and shifting towards improved provider accountability for results, including a Graduate Medical Residency Program (GMRP) and provider accountability for improvements in quality through performance-based financing (PBF) at the hospital level. This document outlines the protocol for the impact evaluation of the hospital improvement program. The evaluation will provide an estimate of the impact of the project and investigate the mechanism for success in a way that can provide general lessons about the quality of health care in low-income countries. The evaluation aims 1) to provide the best possible estimate of program impact and 2) to quantitatively describe the changes that took place within facilities as a result of the program. In particular, the impact evaluation focuses on the changes in human resources within the hospitals. As such, we use a three-period intensive evaluation of treated and matched comparison hospitals to see how services change in treated hospitals as well as a continuous data collection effort to track the activities of individual health workers within treated hospitals. We are particularly interested in understanding how facilities met quality targets. Did they bring in new health workers with higher qualifications? Did they improve the knowledge or competence of their existing staff? Did they improve the availability of medicines and equipment so that the capacities of existing health workers were improved? Did they address the motivation of health workers so that individuals with the same competence and capacity were able to provide higher quality? And, if they did improve quality, did patients notice?

Performance Assessment as a Diagnostic Tool for Science Teachers

NASA Astrophysics Data System (ADS)

Kruit, Patricia; Oostdam, Ron; van den Berg, Ed; Schuitema, Jaap

2018-04-01

Information on students' development of science skills is essential for teachers to evaluate and improve their own education, as well as to provide adequate support and feedback to the learning process of individual students. The present study explores and discusses the use of performance assessments as a diagnostic tool for formative assessment to inform teachers and guide instruction of science skills in primary education. Three performance assessments were administered to more than 400 students in grades 5 and 6 of primary education. Students performed small experiments using real materials while following the different steps of the empirical cycle. The mutual relationship between the three performance assessments is examined to provide evidence for the value of performance assessments as useful tools for formative evaluation. Differences in response patterns are discussed, and the diagnostic value of performance assessments is illustrated with examples of individual student performances. Findings show that the performance assessments were difficult for grades 5 and 6 students but that much individual variation exists regarding the different steps of the empirical cycle. Evaluation of scores as well as a more substantive analysis of students' responses provided insight into typical errors that students make. It is concluded that performance assessments can be used as a diagnostic tool for monitoring students' skill performance as well as to support teachers in evaluating and improving their science lessons.

Reimplantation with a conventional length electrode following residual hearing loss in four hybrid implant recipients

PubMed Central

Carlson, Matthew L; Archibald, David J; Gifford, Rene H; Driscoll, Colin LW; Beatty, Charles W

2014-01-01

Hypothesis Revision surgery using a newer-generation conventional length cochlear implant electrode will provide improved speech perception in patients that initially underwent hybrid electrode implantation and experienced post-operative loss of residual hearing and performance deterioration. Clinical presentation We present four patients who experienced delayed post-operative hearing loss following implantation with the Nucleus Hybrid S8 device and underwent reimplantation with the Nucleus Freedom or Nucleus 5 device using the Contour Advance array. Pure-tone thresholds and speech perception data were retrospectively reviewed. Intervention Four subjects underwent reimplantation with the Nucleus Freedom or Nucleus 5 device after experiencing deteriorating performance related to delayed acoustic hearing loss. Comparison of pre-revision performance to the most recent post-revision performance demonstrated improved speech perception performance in all subjects following reimplantation. Conclusions A small percent of patients will experience a significant loss of residual low-frequency hearing following hybrid implantation thereby becoming completely reliant on a shorter electrode for electrical stimulation. In the current series, reimplantation with a conventional length electrode provided improved speech perception performance in such patients. Revision surgery with a conventional length electrode should be considered in ‘short electrode’ recipients who experience performance deterioration following loss of residual hearing. PMID:22333755

Exercise Performance Measurement with Smartphone Embedded Sensor for Well-Being Management

PubMed Central

Liu, Chung-Tse; Chan, Chia-Tai

2016-01-01

Regular physical activity reduces the risk of many diseases and improves physical and mental health. However, physical inactivity is widespread globally. Improving physical activity levels is a global concern in well-being management. Exercise performance measurement systems have the potential to improve physical activity by providing feedback and motivation to users. We propose an exercise performance measurement system for well-being management that is based on the accumulated activity effective index (AAEI) and incorporates a smartphone-embedded sensor. The proposed system generates a numeric index that is based on users’ exercise performance: their level of physical activity and number of days spent exercising. The AAEI presents a clear number that can serve as a useful feedback and goal-setting tool. We implemented the exercise performance measurement system by using a smartphone and conducted experiments to assess the feasibility of the system and investigated the user experience. We recruited 17 participants for validating the feasibility of the measurement system and a total of 35 participants for investigating the user experience. The exercise performance measurement system showed an overall precision of 88% in activity level estimation. Users provided positive feedback about their experience with the exercise performance measurement system. The proposed system is feasible and has a positive effective on well-being management. PMID:27727188

Exercise Performance Measurement with Smartphone Embedded Sensor for Well-Being Management.

PubMed

Liu, Chung-Tse; Chan, Chia-Tai

2016-10-11

Regular physical activity reduces the risk of many diseases and improves physical and mental health. However, physical inactivity is widespread globally. Improving physical activity levels is a global concern in well-being management. Exercise performance measurement systems have the potential to improve physical activity by providing feedback and motivation to users. We propose an exercise performance measurement system for well-being management that is based on the accumulated activity effective index (AAEI) and incorporates a smartphone-embedded sensor. The proposed system generates a numeric index that is based on users' exercise performance: their level of physical activity and number of days spent exercising. The AAEI presents a clear number that can serve as a useful feedback and goal-setting tool. We implemented the exercise performance measurement system by using a smartphone and conducted experiments to assess the feasibility of the system and investigated the user experience. We recruited 17 participants for validating the feasibility of the measurement system and a total of 35 participants for investigating the user experience. The exercise performance measurement system showed an overall precision of 88% in activity level estimation. Users provided positive feedback about their experience with the exercise performance measurement system. The proposed system is feasible and has a positive effective on well-being management.

Improving Climate Projections Using "Intelligent" Ensembles

NASA Technical Reports Server (NTRS)

Baker, Noel C.; Taylor, Patrick C.

2015-01-01

Recent changes in the climate system have led to growing concern, especially in communities which are highly vulnerable to resource shortages and weather extremes. There is an urgent need for better climate information to develop solutions and strategies for adapting to a changing climate. Climate models provide excellent tools for studying the current state of climate and making future projections. However, these models are subject to biases created by structural uncertainties. Performance metrics-or the systematic determination of model biases-succinctly quantify aspects of climate model behavior. Efforts to standardize climate model experiments and collect simulation data-such as the Coupled Model Intercomparison Project (CMIP)-provide the means to directly compare and assess model performance. Performance metrics have been used to show that some models reproduce present-day climate better than others. Simulation data from multiple models are often used to add value to projections by creating a consensus projection from the model ensemble, in which each model is given an equal weight. It has been shown that the ensemble mean generally outperforms any single model. It is possible to use unequal weights to produce ensemble means, in which models are weighted based on performance (called "intelligent" ensembles). Can performance metrics be used to improve climate projections? Previous work introduced a framework for comparing the utility of model performance metrics, showing that the best metrics are related to the variance of top-of-atmosphere outgoing longwave radiation. These metrics improve present-day climate simulations of Earth's energy budget using the "intelligent" ensemble method. The current project identifies several approaches for testing whether performance metrics can be applied to future simulations to create "intelligent" ensemble-mean climate projections. It is shown that certain performance metrics test key climate processes in the models, and that these metrics can be used to evaluate model quality in both current and future climate states. This information will be used to produce new consensus projections and provide communities with improved climate projections for urgent decision-making.

Measure Guideline. Wood Window Repair, Rehabilitation, and Replacement

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

Baker, P.; Eng, P.

2012-12-01

This measure guideline provides information and guidance on rehabilitating, retrofitting, and replacing existing window assemblies in residential construction. The intent is to provide information regarding means and methods to improve the energy and comfort performance of existing wood window assemblies in a way that takes into consideration component durability, in-service operation, and long term performance of the strategies.

Measure Guideline: Window Repair, Rehabilitation, and Replacement

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

Baker, P.

2012-12-01

This measure guideline provides information and guidance on rehabilitating, retrofitting, and replacing existing window assemblies in residential construction. The intent is to provide information regarding means and methods to improve the energy and comfort performance of existing wood window assemblies in a way that takes into consideration component durability, in-service operation, and long term performance of the strategies.

Using the Malcolm Baldrige "are we making progress" survey for organizational self-assessment and performance improvement.

PubMed

Shields, Judith A; Jennings, Jerry L

2013-01-01

A national healthcare company applied the Malcolm Baldrige Criteria for Performance Excellence and its "Are We Making Progress?" survey as an annual organizational self-assessment to identify areas for improvement. For 6 years, Liberty Healthcare Corporation reviewed the survey results on an annual basis to analyze positive and negative trends, monitor company progress toward targeted goals and develop new initiatives to address emerging areas for improvement. As such, the survey provided a simple and inexpensive methodology to gain useful information from employees at all levels and from multiple service sites and business sectors. In particular, it provided a valuable framework for assessing and improving the employees' commitment to the company's mission and values, high standards and ethics, quality of work, and customer satisfaction. The methodology also helped the company to incorporate the philosophy and principles of continuous quality improvement in a unified fashion. Corporate and local leadership used the same measure to evaluate the performance of individual programs relative to each other, to the company as a whole, and to the "best practices" standard of highly successful companies that received the Malcolm Baldrige National Quality Award. © 2012 National Association for Healthcare Quality.

Improving Early Adaptation Following Long Duration Spaceflight by Enhancing Vestibular Information

NASA Technical Reports Server (NTRS)

Mulavara, Ajitkumar; Kofman, Igor; DeDios, Yiri E.; Galvan, Raquel; Miller, Chris; Peters, Brian; Cohen, Helen; Jeevarajan, Jerome; Reschke, Millard; Wood, Scott;

Performing Well on Nursing Home Report Cards: Does It Pay Off?

PubMed Central

Park, Jeongyoung; Konetzka, R Tamara; Werner, Rachel M

2011-01-01

Objective To examine whether high performance or improvement on quality measures leads to economic rewards for nursing homes in the presence of public reporting. Data Sources Data from 6,286 freestanding Medicare-certified nursing homes between 1999 and 2005 were identified in Medicare Cost Reports, Minimum Data Set, and Online Survey and Certification Reporting System. Study Design Using a facility-level fixed-effects model, the effect of public reporting on financial performance was measured by comparing each of four financial outcomes (revenues, expenses, operating, and total profit margins) before (1999–2002) to after (2003–2005) public reporting was initiated. The effects were estimated separately by level of performance and improvement over time. Principal Findings Facilities that improved on publicly reported performance had increased revenues and higher profit margins after public reporting, mainly through increased Medicare admissions. High-scoring facilities showed similar patterns, though differences were not statistically significant. Conclusions Providers that improve their performance under public reporting may receive a return on their investment in quality improvement. This supports the business case for public reporting. PMID:21029093

Using benchmarking to assist the improvement of service quality in home support services for older people-IN TOUCH (Integrated Networks Towards Optimising Understanding of Community Health).

PubMed

Jacobs, Stephen P; Parsons, Matthew; Rouse, Paul; Parsons, John; Gunderson-Reid, Michelle

2018-04-01

Service providers and funders need ways to work together to improve services. Identifying critical performance variables provides a mechanism by which funders can understand what they are purchasing without getting caught up in restrictive service specifications that restrict the ability of service providers to meet the needs of the clients. An implementation pathway and benchmarking programme called IN TOUCH provided contracted providers of home support and funders with a consistent methodology to follow when developing and implementing new restorative approaches for service delivery. Data from performance measurement was used to triangulate the personal and social worlds of the stakeholders enabling them to develop a shared understanding of what is working and what is not. The initial implementation of IN TOUCH involved five District Health Boards. The recursive dialogue encouraged by the IN TOUCH programme supports better and more sustainable service development because performance management is anchored to agreed data that has meaning to all stakeholders. Copyright © 2017 Elsevier Ltd. All rights reserved.

Drivers of Dashboard Development (3-D): A Curricular Continuous Quality Improvement Approach.

PubMed

Shroyer, A Laurie; Lu, Wei-Hsin; Chandran, Latha

2016-04-01

Undergraduate medical education (UME) programs are seeking systematic ways to monitor and manage their educational performance metrics and document their achievement of external goals (e.g., Liaison Committee on Medical Education [LCME] accreditation requirements) and internal objectives (institution-specific metrics). In other continuous quality improvement (CQI) settings, summary dashboard reports have been used to evaluate and improve performance. The Stony Brook University School of Medicine UME leadership team developed and implemented summary dashboard performance reports in 2009 to document LCME standards/criteria compliance, evaluate medical student performance, and identify progress in attaining institutional curricular goals and objectives. Key performance indicators (KPIs) and benchmarks were established and have been routinely monitored as part of the novel Drivers of Dashboard Development (3-D) approach to curricular CQI. The systematic 3-D approach has had positive CQI impacts. Substantial improvements over time have been documented in KPIs including timeliness of clerkship grades, midclerkship feedback, student mistreatment policy awareness, and student satisfaction. Stakeholder feedback indicates that the dashboards have provided useful information guiding data-driven curricular changes, such as integrating clinician-scientists as lecturers in basic science courses to clarify the clinical relevance of specific topics. Gaining stakeholder acceptance of the 3-D approach required clear communication of preestablished targets and annual meetings with department leaders and course/clerkship directors. The 3-D approach may be considered by UME programs as a template for providing faculty and leadership with a CQI framework to establish shared goals, document compliance, report accomplishments, enrich communications, facilitate decisions, and improve performance.

Incompetent Teachers or Dysfunctional Systems?

ERIC Educational Resources Information Center

Futernick, Ken

2010-01-01

Calls to fire the lowest-performing teachers are widespread, but such actions are not likely to improve teacher quality. Instead, educators should focus on improving the education system that can prevent even good teachers from providing high-quality teaching. To improve the teaching environment, educators and policy makers need to better…

STDAC: Solar thermal design assistance center annual report fiscal year 1994

NASA Astrophysics Data System (ADS)

The Solar Thermal Design Assistance Center (STDAC) at Sandia is a resource provided by the DOE Solar Thermal Program. The STDAC's major objective is to accelerate the use of solar thermal systems by providing direct technical assistance to users in industry, government, and foreign countries; cooperating with industry to test, evaluate, and develop renewable energy systems and components; and educating public and private professionals, administrators, and decision makers. This FY94 report highlights the activities and accomplishments of the STDAC. In 1994, the STDAC continued to provide significant direct technical assistance to domestic and international organizations in industry, government, and education, Applying solar thermal technology to solve energy problems is a vital element of direct technical assistance. The STDAC provides information on the status of new, existing, and developing solar technologies; helps users screen applications; predicts the performance of components and systems; and incorporates the experience of Sandia's solar energy personnel and facilities to provide expert guidance. The STDAC directly enhances the US solar industry's ability to successfully bring improved systems to the marketplace. By collaborating with Sandia's Photovoltaic Design Assistance Center and the National Renewable Energy Laboratory the STDAC is able to offer each customer complete service in applying solar thermal technology. At the National Solar Thermal Test Facility the STDAC tests and evaluates new and innovative solar thermal technologies. Evaluations are conducted in dose cooperation with manufacturers, and the results are used to improve the product and/or quantify its performance characteristics. Manufacturers, in turn, benefit from the improved design, economic performance, and operation of their solar thermal technology. The STDAC provides cost sharing and in-kind service to manufacturers in the development and improvement of solar technology.

Effect of outboard vertical-fin position and orientation on the low-speed aerodynamic performance of highly swept wings. [supersonic cruise aircraft research

NASA Technical Reports Server (NTRS)

Johnson, V. S.; Coe, P. L., Jr.

1979-01-01

A theoretical study was conducted to determine the potential low-speed performance improvements which can be achieved by altering the position and orientation of the outboard vertical fins of low-aspect-ratio highly swept wings. Results show that the magnitude of the performance improvements is solely a function of the span-load distribution. Both the vertical-fin-chordwise position and toe angle provided effective means for adjusting the overall span-load distribution.

Performance of defect-tolerant set-associative cache memories

NASA Technical Reports Server (NTRS)

Frenzel, J. F.

1991-01-01

The increased use of on-chip cache memories has led researchers to investigate their performance in the presence of manufacturing defects. Several techniques for yield improvement are discussed and results are presented which indicate that set-associativity may be used to provide defect tolerance as well as improve the cache performance. Tradeoffs between several cache organizations and replacement strategies are investigated and it is shown that token-based replacement may be a suitable alternative to the widely-used LRU strategy.

Models for the Effects of G-seat Cuing on Roll-axis Tracking Performance

NASA Technical Reports Server (NTRS)

Levison, W. H.; Mcmillan, G. R.; Martin, E. A.

1984-01-01

Including whole-body motion in a flight simulator improves performance for a variety of tasks requiring a pilot to compensate for the effects of unexpected disturbances. A possible mechanism for this improvement is that whole-body motion provides high derivative vehicle state information whic allows the pilot to generate more lead in responding to the external disturbances. During development of motion simulating algorithms for an advanced g-cuing system it was discovered that an algorithm based on aircraft roll acceleration producted little or no performance improvement. On the other hand, algorithms based on roll position or roll velocity produced performance equivalent to whole-body motion. The analysis and modeling conducted at both the sensory system and manual control performance levels to explain the above results are described.

Internal performance characteristics of thrust-vectored axisymmetric ejector nozzles

NASA Technical Reports Server (NTRS)

Lamb, Milton

1995-01-01

A series of thrust-vectored axisymmetric ejector nozzles were designed and experimentally tested for internal performance and pumping characteristics at the Langley research center. This study indicated that discontinuities in the performance occurred at low primary nozzle pressure ratios and that these discontinuities were mitigated by decreasing expansion area ratio. The addition of secondary flow increased the performance of the nozzles. The mid-to-high range of secondary flow provided the most overall improvements, and the greatest improvements were seen for the largest ejector area ratio. Thrust vectoring the ejector nozzles caused a reduction in performance and discharge coefficient. With or without secondary flow, the vectored ejector nozzles produced thrust vector angles that were equivalent to or greater than the geometric turning angle. With or without secondary flow, spacing ratio (ejector passage symmetry) had little effect on performance (gross thrust ratio), discharge coefficient, or thrust vector angle. For the unvectored ejectors, a small amount of secondary flow was sufficient to reduce the pressure levels on the shroud to provide cooling, but for the vectored ejector nozzles, a larger amount of secondary air was required to reduce the pressure levels to provide cooling.

Investigation of the mediating effects of IT governance-value delivery on service quality and ERP performance

NASA Astrophysics Data System (ADS)

Tsai, Wen-Hsien; Chou, Yu-Wei; Leu, Jun-Der; Chao Chen, Der; Tsaur, Tsen-Shu

2015-02-01

This study aimed to explore the mediating effects of IT governance (ITG)-value delivery in the relationships among the quality of vendor service, the quality of consultant services, ITG-value delivery and enterprise resource planning (ERP) performance. The sampling of this research was acquired from a questionnaire survey concerning ERP implementations in Taiwan. In this survey, 4366 questionnaires were sent to manufacturing and service companies listed in the TOP 5000: The Largest Corporations in Taiwan 2009. The results showed that an ERP system will exhibit a decreased error rate and improved performance if ERP system vendors and consultants provide good service quality. The results also demonstrated that significant relationships exist among the quality of vendor service, the quality of consultant services and value delivery. The contribution of this article is twofold. First, it found that value delivery provides an effective measure of ERP performance under an ITG framework. Second, it provides evidence of the partial mediating effects of value delivery between service quality and ERP performance. In other words, if enterprises want to improve ERP performance, they need to consider factors such as value delivery and the quality of a vendor/consultant's service.

The Relationship between Health Plan Performance Measures and Physician Network Overlap: Implications for Measuring Plan Quality

PubMed Central

Maeng, Daniel D; Scanlon, Dennis P; Chernew, Michael E; Gronniger, Tim; Wodchis, Walter P; McLaughlin, Catherine G

2010-01-01

Objective To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. Data Source We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas. Study Design We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures. Principal Findings The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality. Conclusions Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance. PMID:20403064

An augmented-reality edge enhancement application for Google Glass.

PubMed

Hwang, Alex D; Peli, Eli

2014-08-01

Google Glass provides a platform that can be easily extended to include a vision enhancement tool. We have implemented an augmented vision system on Glass, which overlays enhanced edge information over the wearer's real-world view, to provide contrast-improved central vision to the Glass wearers. The enhanced central vision can be naturally integrated with scanning. Google Glass' camera lens distortions were corrected by using an image warping. Because the camera and virtual display are horizontally separated by 16 mm, and the camera aiming and virtual display projection angle are off by 10°, the warped camera image had to go through a series of three-dimensional transformations to minimize parallax errors before the final projection to the Glass' see-through virtual display. All image processes were implemented to achieve near real-time performance. The impacts of the contrast enhancements were measured for three normal-vision subjects, with and without a diffuser film to simulate vision loss. For all three subjects, significantly improved contrast sensitivity was achieved when the subjects used the edge enhancements with a diffuser film. The performance boost is limited by the Glass camera's performance. The authors assume that this accounts for why performance improvements were observed only with the diffuser filter condition (simulating low vision). Improvements were measured with simulated visual impairments. With the benefit of see-through augmented reality edge enhancement, natural visual scanning process is possible and suggests that the device may provide better visual function in a cosmetically and ergonomically attractive format for patients with macular degeneration.

Helping Female Juveniles Improve their On-Task Behavior and Academic Performance Using a Self-Management Procedure in a Correctional Facility

ERIC Educational Resources Information Center

Caldwell, Stacy; Joseph, Laurice M.

2012-01-01

The purpose of this study was to teach female juvenile offenders with disabilities a self-management procedure to help improve on-task behavior and academic performance during independent practice of math calculation facts. Students were taught to set goals and were provided with incentives for goal attainment. A reversal single-case design…

Investigating the Variables in a Mock Exam Study Session Designed to Improve Student Exam Performance in an Undergraduate Behavior Modification and Therapy Course

ERIC Educational Resources Information Center

Dotson, Wesley H.

2010-01-01

The purpose of the present study was to identify components of an optional mock exam review session (e.g. requiring students to write answers, providing students grading keys for questions) responsible for improvements in student performance on application-based short-essay exams in an undergraduate behavior modification course. Both…

Implement balanced scorecard to translate strategic plan into actionable objectives.

PubMed

2004-09-01

Faced with challenges ranging from declining reimbursement to staff shortages, health care organizations--integrated delivery systems, physician group practices, disease management providers, and others--increasingly are turning to general business models to map out step-by-step action plans for performance measurement and process improvement. Creating a "balanced scorecard" is an obvious starting point for assessing and improving clinical and financial performance.

Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

PubMed

Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E

Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.

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

Collins, Benjamin S.; Hamilton, Steven P.; Jarrett, Michael G.

This report describes the performance improvements made to the VERA Core Simulator (VERA-CS) during FY2016. The development of the VERA Core Simulator has focused on the capability needed to deplete physical reactors and help solve various problems; this capability required the accurate simulation of many operating cycles of a nuclear power plant. The first section of this report introduces two test problems used to assess the run-time performance of VERA-CS using a source dated February 2016. The next section provides a brief overview of the major modifications made to decrease the computational cost. Following the descriptions of the major improvements,more » the run-time for each improvement is shown. Conclusions on the work are presented, and further follow-on performance improvements are suggested.« less

Bingo! Externally-Supported Performance Intervention for Deficient Visual Search in Normal Aging, Parkinson’s Disease and Alzheimer’s Disease

PubMed Central

Laudate, Thomas M.; Neargarder, Sandy; Dunne, Tracy E.; Sullivan, Karen D.; Joshi, Pallavi; Gilmore, Grover C.; Riedel, Tatiana M.; Cronin-Golomb, Alice

2011-01-01

External support may improve task performance regardless of an individual’s ability to compensate for cognitive deficits through internally-generated mechanisms. We investigated if performance of a complex, familiar visual search task (the game of bingo) could be enhanced in groups with suboptimal vision by providing external support through manipulation of task stimuli. Participants were 19 younger adults, 14 individuals with probable Alzheimer’s disease (AD), 13 AD-matched healthy adults, 17 non-demented individuals with Parkinson’s disease (PD), and 20 PD-matched healthy adults. We varied stimulus contrast, size, and visual complexity during game play. The externally-supported performance interventions of increased stimulus size and decreased complexity resulted in improvements in performance by all groups. Performance improvement through increased stimulus size and decreased complexity was demonstrated by all groups. AD also obtained benefit from increasing contrast, presumably by compensating for their contrast sensitivity deficit. The general finding of improved performance across healthy and afflicted groups suggests the value of visual support as an easy-to-apply intervention to enhance cognitive performance. PMID:22066941

Breaking through barriers: using technology to address executive function weaknesses and improve student achievement.

PubMed

Schwartz, David M

2014-01-01

Assistive technologies provide significant capabilities for improving student achievement. Improved accessibility, cost, and diversity of applications make integration of technology a powerful tool to compensate for executive function weaknesses and deficits and their impact on student performance, learning, and achievement. These tools can be used to compensate for decreased working memory, poor time management, poor planning and organization, poor initiation, and decreased memory. Assistive technology provides mechanisms to assist students with diverse strengths and weaknesses in mastering core curricular concepts.

Performance Contracting as a Performance Management Tool in the Public Sector in Kenya: Lessons of learning

ERIC Educational Resources Information Center

Hope, Kempe Ronald, Sr.

2013-01-01

The purpose of this article is to provide an assessment and analysis of public sector performance contracting as a performance management tool in Kenya. It aims to demonstrate that performance contracting remains a viable and important tool for improving public sector performance as a key element of the on-going public sector transformation…

Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

PubMed

Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

2016-01-01

Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

[Financial incentives for quality improvement].

PubMed

Belicza, Eva; Evetovits, Tamás

2010-05-01

Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

Computer-Tailored Student Support in Introductory Physics.

PubMed

Huberth, Madeline; Chen, Patricia; Tritz, Jared; McKay, Timothy A

2015-01-01

Large introductory courses are at a disadvantage in providing personalized guidance and advice for students during the semester. We introduce E2Coach (an Expert Electronic Coaching system), which allows instructors to personalize their communication with thousands of students. We describe the E2Coach system, the nature of the personalized support it provides, and the features of the students who did (and did not) opt-in to using it during the first three terms of its use in four introductory physics courses at the University of Michigan. Defining a 'better-than-expected' measure of performance, we compare outcomes for students who used E2Coach to those who did not. We found that moderate and high E2Coach usage was associated with improved performance. This performance boost was prominent among high users, who improved by 0.18 letter grades on average when compared to nonusers with similar incoming GPAs. This improvement in performance was comparable across both genders. E2Coach represents one way to use technology to personalize education at scale, contributing to the move towards individualized learning that is becoming more attainable in the 21st century.

21st Century Human Performance.

ERIC Educational Resources Information Center

Clark, Ruth Colvin

1995-01-01

Technology can extend human memory and improve performance, but bypassing human intelligence has its dangers. Cognitive apprenticeships that compress learning experiences, provide coaching, and allow trial and error can build complex problem-solving skills and develop expertise. (SK)

Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%--a randomised controlled trial.

PubMed

Martin, Philip; Theobald, Peter; Kemp, Alison; Maguire, Sabine; Maconochie, Ian; Jones, Michael

2013-08-01

European and Advanced Paediatric Life Support training courses. Sixty-nine certified CPR providers. CPR providers were randomly allocated to a 'no-feedback' or 'feedback' group, performing two-thumb and two-finger chest compressions on a "physiological", instrumented resuscitation manikin. Baseline data was recorded without feedback, before chest compressions were repeated with one group receiving feedback. Indices were calculated that defined chest compression quality, based upon comparison of the chest wall displacement to the targets of four, internationally recommended parameters: chest compression depth, release force, chest compression rate and compression duty cycle. Baseline data were consistent with other studies, with <1% of chest compressions performed by providers simultaneously achieving the target of the four internationally recommended parameters. During the 'experimental' phase, 34 CPR providers benefitted from the provision of 'real-time' feedback which, on analysis, coincided with a statistical improvement in compression rate, depth and duty cycle quality across both compression techniques (all measures: p<0.001). Feedback enabled providers to simultaneously achieve the four targets in 75% (two-finger) and 80% (two-thumb) of chest compressions. Real-time feedback produced a dramatic increase in the quality of chest compression (i.e. from <1% to 75-80%). If these results transfer to a clinical scenario this technology could, for the first time, support providers in consistently performing accurate chest compressions during infant CPR and thus potentially improving clinical outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Building Electronic Performance Support Systems for First-Year University Students

ERIC Educational Resources Information Center

Barker, Philip; van Schaik, Paul; Famakinwa, Oladeji

2007-01-01

This paper outlines the principles and theory of performance support (in general) and of electronic performance support (in particular). It explains why the design and creation of electronic performance support systems are so important as a mechanism for providing scaffolding environments for use in improving the learning experience for new (and…

Stereopsis cueing effects on hover-in-turbulence performance in a simulated rotorcraft

NASA Technical Reports Server (NTRS)

Parrish, Russell V.; Williams, Steven P.

1990-01-01

The efficacy of stereopsis cueing in pictorial displays was assessed in a real-time piloted simulation experiment of a rotorcraft precision hover-in-turbulence task. Seven pilots endeavored to maintain a hover by visually aligning a set of inner and outer wickets (major elements of a real-world pictorial display, thus attaining the desired hover position, in a full factorial experimental design. The display conditions examined included the presence or absence of a velocity display element (a velocity head-up display) as well as the stereopsis cueing conditions, which included non-stereo (binoptic or monoscopic - no depth cues other than those provided by a perspective, real-world display), stereo 3-D, and hyper stereo (telestereoscopic). Subjective and objective results indicated that the depth cues provided by the stereo displays enhanced the situational awareness of the pilot and enabled improved hover performance to be achieved. The velocity display element also improved the hover performance, with the best hover performance being achieved with the combined use of stereo and the velocity display element. Pilot control input data revealed that less control action was required to attain the improved hover performance with the stereo displays.

Increasing performance of health care services within economic constraints: working towards improved incentive structures.

PubMed

Custers, Thomas; Klazinga, Niek S; Brown, Adalsteinn D

2007-01-01

There is increasing evidence that health care systems can create better value for money by improving performance and setting the right incentives. Worldwide this has led to an emergence of financial and non-financial incentive structures as a strategy to improve performance. The role of incentives is not only to motivate high performance through the alignment of results and rewards (financial/non-financial as well as direct/indirect) but also to enable health care providers to perform better by mitigating financial barriers that typically result from funding schemes. Various incentive structures in health care, identified in the scientific literature, are described in this article and available evidence on effectiveness and side effects is summarized. Literature shows that there is no single best approach to create an incentive yet and that the ability of financial and non-financial incentives to achieve desired results depends on a number of circumstantial elements. Several incentive schemes that can be used by health care insurers or local health authorities are discussed and concrete examples are provided. Decision-making on incentive schemes requires a careful design with the involvement of those targeted by incentives.

Audible Beaconing with Accessible Pedestrian Signals

PubMed Central

Barlow, Janet M.; Scott, Alan C.; Bentzen, Billie Louise

2010-01-01

Purpose Although Accessible Pedestrian Signals (APS) are often assumed to provide wayfinding information, the type of APS that has been typically installed in the U.S has not had positive effects on finding crosswalks, locating pushbuttons, or providing directional guidance. This paper reports the results of research on crossings by blind pedestrians at complex signalized intersections, before and after the installation of APS with innovative audible beaconing features, designed to improve wayfinding. Methods Objective data on measures of street crossing performance by 56 participants was obtained at four intersections, two each in Charlotte, NC, and Portland, OR. Results In the first round of testing, APS with beaconing features resulted in only slightly improved wayfinding. Revisions to the audible beaconing features resulted in improved performance on four measures of wayfinding as compared to the pre-installation condition: beginning crossings within the crosswalk, ending crossings within the crosswalk, independence in finding the starting location, and independence in aligning to cross. Implications for Practice Use of APS that provide beaconing from the far-end of the crosswalk show promise of improving wayfinding at street crossings. PMID:20622978

Patient and family involvement in contemporary health care.

PubMed

Angood, Peter; Dingman, Jennifer; Foley, Mary E; Ford, Dan; Martins, Becky; O'Regan, Patti; Salamendra, Arlene; Sheridan, Sue; Denham, Charles R

2010-03-01

The objective of this article was to provide a guide to health care providers on patient and family involvement in health care. This article evaluated the latest published studies for patient and family involvement and reexamined the objectives, the requirements for achieving these objectives, and the evidence of how to involve patients and families. Critical components for patient safety include changing the organizational culture; including patients and families on teams; listening to patients and families; incorporating their input into leadership structures and systems; providing full detail about treatment, procedures, and medication adverse effects; involving them on patient safety and performance improvement committees; and disclosing medical errors. The conclusion of this article is that, for the future, patient and family involvement starts with educating patients and families and ends with listening to them and taking them seriously. If patient and family input is emphatically built into systems of performance improvement, and if patients and families are taken seriously and are respected for their valuable perspectives about how care can be improved, then organizations can improve at improving. Resources in health care are in short supply, yet the resources of patient and family help and time are almost limitless, are ready to be tapped, and can have a huge impact on improving the reliability and overall success for any health care organization.

Composite Measures of Health Care Provider Performance: A Description of Approaches

PubMed Central

Shwartz, Michael; Restuccia, Joseph D; Rosen, Amy K

2015-01-01

Context Since the Institute of Medicine’s 2001 report Crossing the Quality Chasm, there has been a rapid proliferation of quality measures used in quality-monitoring, provider-profiling, and pay-for-performance (P4P) programs. Although individual performance measures are useful for identifying specific processes and outcomes for improvement and tracking progress, they do not easily provide an accessible overview of performance. Composite measures aggregate individual performance measures into a summary score. By reducing the amount of data that must be processed, they facilitate (1) benchmarking of an organization’s performance, encouraging quality improvement initiatives to match performance against high-performing organizations, and (2) profiling and P4P programs based on an organization’s overall performance. Methods We describe different approaches to creating composite measures, discuss their advantages and disadvantages, and provide examples of their use. Findings The major issues in creating composite measures are (1) whether to aggregate measures at the patient level through all-or-none approaches or the facility level, using one of the several possible weighting schemes; (2) when combining measures on different scales, how to rescale measures (using z scores, range percentages, ranks, or 5-star categorizations); and (3) whether to use shrinkage estimators, which increase precision by smoothing rates from smaller facilities but also decrease transparency. Conclusions Because provider rankings and rewards under P4P programs may be sensitive to both context and the data, careful analysis is warranted before deciding to implement a particular method. A better understanding of both when and where to use composite measures and the incentives created by composite measures are likely to be important areas of research as the use of composite measures grows. PMID:26626986

Acute effects of verbal feedback on upper-body performance in elite athletes.

PubMed

Argus, Christos K; Gill, Nicholas D; Keogh, Justin Wl; Hopkins, Will G

2011-12-01

Argus, CK, Gill, ND, Keogh, JWL, and Hopkins, WG. Acute effects of verbal feedback on upper-body performance in elite athletes. J Strength Cond Res 25(12): 3282-3287, 2011-Improved training quality has the potential to enhance training adaptations. Previous research suggests that receiving feedback improves single-effort maximal strength and power tasks, but whether quality of a training session with repeated efforts can be improved remains unclear. The purpose of this investigation was to determine the effects of verbal feedback on upper-body performance in a resistance training session consisting of multiple sets and repetitions in well-trained athletes. Nine elite rugby union athletes were assessed using the bench throw exercise on 4 separate occasions each separated by 7 days. Each athlete completed 2 sessions consisting of 3 sets of 4 repetitions of the bench throw with feedback provided after each repetition and 2 identical sessions where no feedback was provided after each repetition. When feedback was received, there was a small increase of 1.8% (90% confidence limits, ±2.7%) and 1.3% (±0.7%) in mean peak power and velocity when averaged over the 3 sets. When individual sets were compared, there was a tendency toward the improvements in mean peak power being greater in the second and third sets. These results indicate that providing verbal feedback produced acute improvements in upper-body power output of well-trained athletes. The benefits of feedback may be greatest in the latter sets of training and could improve training quality and result in greater long-term adaptation.

Performance of new alternative providers of primary care services in England: an observational study

PubMed Central

Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem

2015-01-01

Summary Objectives Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants – including private companies – have been allowed into the primary care market under ‘alternative provider of medical services’ contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Design Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. Setting The English National Health Service. Participants All general practices open from 2008/2009 to 2012/2013. Main outcome measures Seventeen established quality indicators – covering clinical effectiveness, efficiency, access and patient experience. Results In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance. Conclusions The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. PMID:25908312

Performance of new alternative providers of primary care services in England: an observational study.

PubMed

Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem; Millett, Christopher

2015-05-01

Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants--including private companies--have been allowed into the primary care market under 'alternative provider of medical services' contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. The English National Health Service. All general practices open from 2008/2009 to 2012/2013. Seventeen established quality indicators--covering clinical effectiveness, efficiency, access and patient experience. In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance. The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. © The Royal Society of Medicine.

Methodology of quality improvement projects for the Texas Medicare population.

PubMed

Pendergrass, P W; Abel, R L; Bing, M; Vaughn, R; McCauley, C

1998-07-01

The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.

Making health markets work better for poor people: the case of informal providers.

PubMed

Bloom, Gerald; Standing, Hilary; Lucas, Henry; Bhuiya, Abbas; Oladepo, Oladimeji; Peters, David H

2011-07-01

There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.

The Effects of Rhythm and Robotic Interventions on the Imitation/Praxis, Interpersonal Synchrony, and Motor Performance of Children with Autism Spectrum Disorder (ASD): A Pilot Randomized Controlled Trial

PubMed Central

Srinivasan, Sudha M.; Kaur, Maninderjit; Park, Isabel K.; Gifford, Timothy D.; Marsh, Kerry L.; Bhat, Anjana N.

2015-01-01

We assessed the effects of three interventions, rhythm, robotic, and standard-of-care, on the imitation/praxis, interpersonal synchrony, and overall motor performance of 36 children with Autism Spectrum Disorder (ASD) between 5 and 12 years of age. Children were matched on age, level of functioning, and services received, prior to random assignment to one of the three groups. Training was provided for 8 weeks with 4 sessions provided each week. We assessed generalized changes in motor skills from the pretest to the posttest using a standardized test of motor performance, the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2). We also assessed training-specific changes in imitation/praxis and interpersonal synchrony during an early and a late session. Consistent with the training activities practiced, the rhythm and robot groups improved on the body coordination composite of the BOT-2, whereas the comparison group improved on the fine manual control composite of the BOT-2. All three groups demonstrated improvements in imitation/praxis. The rhythm and robot groups also showed improved interpersonal synchrony performance from the early to the late session. Overall, socially embedded movement-based contexts are valuable in promoting imitation/praxis, interpersonal synchrony, and motor performance and should be included within the standard-of-care treatment for children with ASD. PMID:26793394

Performance statistics of the FORTRAN 4 /H/ library for the IBM system/360

NASA Technical Reports Server (NTRS)

Clark, N. A.; Cody, W. J., Jr.; Hillstrom, K. E.; Thieleker, E. A.

1969-01-01

Test procedures and results for accuracy and timing tests of the basic IBM 360/50 FORTRAN 4 /H/ subroutine library are reported. The testing was undertaken to verify performance capability and as a prelude to providing some replacement routines of improved performance.

Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.

PubMed

Meaney, Peter A; Bobrow, Bentley J; Mancini, Mary E; Christenson, Jim; de Caen, Allan R; Bhanji, Farhan; Abella, Benjamin S; Kleinman, Monica E; Edelson, Dana P; Berg, Robert A; Aufderheide, Tom P; Menon, Venu; Leary, Marion

2013-07-23

The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient's response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.

Chandler Public Library, Final Performance Report for Library Services and Construction Act (LSCA) Title VI, Library Literacy Program.

ERIC Educational Resources Information Center

Drake, Karen; Rodriguez, Leonard

This final performance report for the Chandler Public Library literacy project for fiscal year 1992 begins with a section that provides quantitative data. The next section compares actual accomplishments to the project goal--to improve the quality of life for illiterate, semiliterate, and non-English-speaking citizens by providing a comprehensive…

The architecture of the High Performance Storage System (HPSS)

NASA Technical Reports Server (NTRS)

Teaff, Danny; Watson, Dick; Coyne, Bob

1994-01-01

The rapid growth in the size of datasets has caused a serious imbalance in I/O and storage system performance and functionality relative to application requirements and the capabilities of other system components. The High Performance Storage System (HPSS) is a scalable, next-generation storage system that will meet the functionality and performance requirements or large-scale scientific and commercial computing environments. Our goal is to improve the performance and capacity of storage by two orders of magnitude or more over what is available in the general or mass marketplace today. We are also providing corresponding improvements in architecture and functionality. This paper describes the architecture and functionality of HPSS.

Microvascular Anastomosis: Proposition of a Learning Curve.

PubMed

Mokhtari, Pooneh; Tayebi Meybodi, Ali; Benet, Arnau; Lawton, Michael T

2018-04-14

Learning to perform a microvascular anastomosis is one of the most difficult tasks in cerebrovascular surgery. Previous studies offer little regarding the optimal protocols to maximize learning efficiency. This failure stems mainly from lack of knowledge about the learning curve of this task. To delineate this learning curve and provide information about its various features including acquisition, improvement, consistency, stability, and recall. Five neurosurgeons with an average surgical experience history of 5 yr and without any experience in bypass surgery performed microscopic anastomosis on progressively smaller-caliber silastic tubes (Biomet, Palm Beach Gardens, Florida) during 24 consecutive sessions. After a 1-, 2-, and 8-wk retention interval, they performed recall test on 0.7-mm silastic tubes. The anastomoses were rated based on anastomosis patency and presence of any leaks. Improvement rate was faster during initial sessions compared to the final practice sessions. Performance decline was observed in the first session of working on a smaller-caliber tube. However, this rapidly improved during the following sessions of practice. Temporary plateaus were seen in certain segments of the curve. The retention interval between the acquisition and recall phase did not cause a regression to the prepractice performance level. Learning the fine motor task of microvascular anastomosis adapts to the basic rules of learning such as the "power law of practice." Our results also support the improvement of performance during consecutive sessions of practice. The objective evidence provided may help in developing optimized learning protocols for microvascular anastomosis.

A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD.

PubMed

Zorn, Lucile; Nageotte, Florent; Zanne, Philippe; Legner, Andras; Dallemagne, Bernard; Marescaux, Jacques; de Mathelin, Michel

2018-04-01

Minimally invasive surgical interventions in the gastrointestinal tract, such as endoscopic submucosal dissection (ESD), are very difficult for surgeons when performed with standard flexible endoscopes. Robotic flexible systems have been identified as a solution to improve manipulation. However, only a few such systems have been brought to preclinical trials as of now. As a result, novel robotic tools are required. We developed a telemanipulated robotic device, called STRAS, which aims to assist surgeons during intraluminal surgical endoscopy. This is a modular system, based on a flexible endoscope and flexible instruments, which provides 10 degrees of freedom (DoFs). The modularity allows the user to easily set up the robot and to navigate toward the operating area. The robot can then be teleoperated using master interfaces specifically designed to intuitively control all available DoFs. STRAS capabilities have been tested in laboratory conditions and during preclinical experiments. We report 12 colorectal ESDs performed in pigs, in which large lesions were successfully removed. Dissection speeds are compared with those obtained in similar conditions with the manual Anubiscope platform from Karl Storz. We show significant improvements ( ). These experiments show that STRAS (v2) provides sufficient DoFs, workspace, and force to perform ESD, that it allows a single surgeon to perform all the surgical tasks and those performances are improved with respect to manual systems. The concepts developed for STRAS are validated and could bring new tools for surgeons to improve comfort, ease, and performances for intraluminal surgical endoscopy.

Improving Seismic Data Accessibility and Performance Using HDF Containers

NASA Astrophysics Data System (ADS)

Evans, B. J. K.; Wang, J.; Yang, R.

2017-12-01

The performance of computational geophysical data processing and forward modelling relies on both computational and data. Significant efforts on developing new data formats and libraries have been made the community, such as IRIS/PASSCAL and ASDF in data, and programs and utilities such as ObsPy and SPECFEM. The National Computational Infrastructure hosts a national significant geophysical data collection that is co-located with a high performance computing facility and provides an opportunity to investigate how to improve the data formats from both a data management and a performance point of view. This paper investigates how to enhance the data usability in several perspectives: 1) propose a convention for the seismic (both active and passive) community to improve the data accessibility and interoperability; 2) recommend the convention used in the HDF container when data is made available in PH5 or ASDF formats; 3) provide tools to convert between various seismic data formats; 4) provide performance benchmark cases using ObsPy library and SPECFEM3D to demonstrate how different data organization in terms of chunking size and compression impact on the performance by comparing new data formats, such as PH5 and ASDF to traditional formats such as SEGY, SEED, SAC, etc. In this work we apply our knowledge and experience on data standards and conventions, such as CF and ACDD from the climate community to the seismology community. The generic global attributes widely used in climate community are combined with the existing convention in the seismology community, such as CMT and QuakeML, StationXML, SEGY header convention. We also extend such convention by including the provenance and benchmarking records so that the r user can learn the footprint of the data together with its baseline performance. In practise we convert the example wide angle reflection seismic data from SEGY to PH5 or ASDF by using ObsPy and pyasdf libraries. It quantitatively demonstrates how the accessibility can be improved if the seismic data are stored in the HDF container.

Indexing Volumetric Shapes with Matching and Packing

PubMed Central

Koes, David Ryan; Camacho, Carlos J.

2014-01-01

We describe a novel algorithm for bulk-loading an index with high-dimensional data and apply it to the problem of volumetric shape matching. Our matching and packing algorithm is a general approach for packing data according to a similarity metric. First an approximate k-nearest neighbor graph is constructed using vantage-point initialization, an improvement to previous work that decreases construction time while improving the quality of approximation. Then graph matching is iteratively performed to pack related items closely together. The end result is a dense index with good performance. We define a new query specification for shape matching that uses minimum and maximum shape constraints to explicitly specify the spatial requirements of the desired shape. This specification provides a natural language for performing volumetric shape matching and is readily supported by the geometry-based similarity search (GSS) tree, an indexing structure that maintains explicit representations of volumetric shape. We describe our implementation of a GSS tree for volumetric shape matching and provide a comprehensive evaluation of parameter sensitivity, performance, and scalability. Compared to previous bulk-loading algorithms, we find that matching and packing can construct a GSS-tree index in the same amount of time that is denser, flatter, and better performing, with an observed average performance improvement of 2X. PMID:26085707

Improving Physical Task Performance with Counterfactual and Prefactual Thinking

PubMed Central

Hammell, Cecilia; Chan, Amy Y. C.

2016-01-01

Counterfactual thinking (reflecting on “what might have been”) has been shown to enhance future performance by translating information about past mistakes into plans for future action. Prefactual thinking (imagining “what might be if…”) may serve a greater preparative function than counterfactual thinking as it is future-orientated and focuses on more controllable features, thus providing a practical script to prime future behaviour. However, whether or not this difference in hypothetical thought content may translate into a difference in actual task performance has been largely unexamined. In Experiment 1 (n = 42), participants performed trials of a computer-simulated physical task, in between which they engaged in either task-related hypothetical thinking (counterfactual or prefactual) or an unrelated filler task (control). As hypothesised, prefactuals contained more controllable features than counterfactuals. Moreover, participants who engaged in either form of hypothetical thinking improved significantly in task performance over trials compared to participants in the control group. The difference in thought content between counterfactuals and prefactuals, however, did not yield a significant difference in performance improvement. Experiment 2 (n = 42) replicated these findings in a dynamic balance task environment. Together, these findings provide further evidence for the preparatory function of counterfactuals, and demonstrate that prefactuals share this same functional characteristic. PMID:27942041

Mindfulness Meditation and Interprofessional Cardiopulmonary Resuscitation: A Mixed-Methods Pilot Study.

PubMed

Kelm, Diana J; Ridgeway, Jennifer L; Gas, Becca L; Mohan, Monali; Cook, David A; Nelson, Darlene R; Benzo, Roberto P

2018-05-18

Mindfulness training includes mindfulness meditation, which has been shown to improve both attention and self-awareness. Medical providers in the intensive care unit often deal with difficult situations with strong emotions, life-and-death decisions, and both interpersonal and interprofessional conflicts. The effect of mindfulness meditation training on healthcare providers during acute care tasks such as cardiopulmonary resuscitation remains unknown. Mindfulness meditation has the potential to improve provider well-being and reduce stress in individuals involved in resuscitation teams, which could then translate into better team communication and delivery of care under stress. A better understanding of this process could lead to more effective training approaches, improved team performance, and better patient outcomes. All participants were instructed to use a mindfulness meditation device (Muse™ headband) at home for 7 min twice a day or 14 min daily over the 4-week training period. This device uses brainwave sensors to monitor active versus relaxing brain activity and provides real-time feedback. We conducted a single-group pretest-posttest convergent mixed-methods study. We enrolled 24 healthcare providers, comprising 4 interprofessional code teams, including physicians, nurses, respiratory therapists, and pharmacists. Each team participated in a simulation session immediately before and after the mindfulness training period. Each session consisted of two simulated cardiopulmonary arrest scenarios. Both quantitative and qualitative outcomes were assessed. The median proportion of participants who used the device as prescribed was 85%. Emotional balance, as measured by the critical positivity ratio, improved significantly from pretraining to posttraining (p = .02). Qualitative findings showed that mindfulness meditation changed how participants responded to work-related stress, including stress in real-code situations. Participants described the value of time for self-guided practice with feedback from the device, which then helped them develop individual approaches to meditation not reliant on the technology. Time measures during the simulated scenarios improved, specifically, time to epinephrine in Scenario 1 (p = .03) and time to defibrillation in Scenario 2 (p = .02), improved. In addition, team performance, such as teamwork (p = .04), task management (p = .01), and overall performance (p = .04), improved significantly after mindfulness meditation training. Physiologic stress (skin conductance) improved but did not reach statistical significance (p = .11). Mindfulness meditation practice may improve individual well-being and team function in high-stress clinical environments. Our results may represent a foundation to design larger confirmatory studies.

Additional Development and Systems Analyses of Pneumatic Technology for High Speed Civil Transport Aircraft

NASA Technical Reports Server (NTRS)

Englar, Robert J.; Willie, F. Scott; Lee, Warren J.

1999-01-01

In the Task I portion of this NASA research grant, configuration development and experimental investigations have been conducted on a series of pneumatic high-lift and control surface devices applied to a generic High Speed Civil Transport (HSCT) model configuration to determine their potential for improved aerodynamic performance, plus stability and control of higher performance aircraft. These investigations were intended to optimize pneumatic lift and drag performance; provide adequate control and longitudinal stability; reduce separation flowfields at high angle of attack; increase takeoff/climbout lift-to-drag ratios; and reduce system complexity and weight. Experimental aerodynamic evaluations were performed on a semi-span HSCT generic model with improved fuselage fineness ratio and with interchangeable plain flaps, blown flaps, pneumatic Circulation Control Wing (CCW) high-lift configurations, plain and blown canards, a novel Circulation Control (CC) cylinder blown canard, and a clean cruise wing for reference. Conventional tail power was also investigated for longitudinal trim capability. Also evaluated was unsteady pulsed blowing of the wing high-lift system to determine if reduced pulsed mass flow rates and blowing requirements could be made to yield the same lift as that resulting from steady-state blowing. Depending on the pulsing frequency applied, reduced mass flow rates were indeed found able to provide lift augmentation at lesser blowing values than for the steady conditions. Significant improvements in the aerodynamic characteristics leading to improved performance and stability/control were identified, and the various components were compared to evaluate the pneumatic potential of each. Aerodynamic results were provided to the Georgia Tech Aerospace System Design Lab. to conduct the companion system analyses and feasibility study (Task 2) of theses concepts applied to an operational advanced HSCT aircraft. Results and conclusions from these experimental evaluations are presented herein, as are recommendations for further development and follow-on investigations. Also provided as an Appendix for reference are the basic results from the previous pneumatic HSCT investigations.

Improved motor and cognitive performance with sodium nitrite supplementation is related to small metabolite signatures: a pilot trial in middle-aged and older adults

PubMed Central

DeVan, Allison E.; Cruickshank-Quinn, Charmion; Reisdorph, Nichole; Bassett, Candace J.; Evans, Trent D.; Brooks, Forrest A.; Bryan, Nathan S.; Chonchol, Michel B.; Giordano, Tony; McQueen, Matthew B.; Seals, Douglas R.

2015-01-01

Advancing age is associated with reductions in nitric oxide bioavailability and changes in metabolic activity, which are implicated in declines in motor and cognitive function. In preclinical models, sodium nitrite supplementation (SN) increases plasma nitrite and improves motor function, whereas other nitric oxide-boosting agents improve cognitive function. This pilot study was designed to translate these findings to middle-aged and older (MA/O) humans to provide proof-of-concept support for larger trials. SN (10 weeks, 80 or 160 mg/day capsules, TheraVasc, Inc.) acutely and chronically increased plasma nitrite and improved performance on measures of motor and cognitive outcomes (all p<0.05 or better) in healthy MA/O adults (62 ± 7 years). Untargeted metabolomics analysis revealed that SN significantly altered 33 (160 mg/day) to 45 (80 mg/day) different metabolites, 13 of which were related to changes in functional outcomes; baseline concentrations of 99 different metabolites predicted functional improvements with SN. This pilot study provides the first evidence that SN improves aspects of motor and cognitive function in healthy MA/O adults, and that these improvements are associated with, and predicted by, the plasma metabolome. Our findings provide the necessary support for larger clinical trials on this promising pharmacological strategy for preserving physiological function with aging. PMID:26626856

Yoga for Your Students

ERIC Educational Resources Information Center

Tummers, Nanette

2004-01-01

Improved focus and involvement in one's physical education class are just a few of the many benefits that yoga can provide to students. Yoga, the art of bringing together the body and mind for improved strength, flexibility, and self-esteem, can also help decrease stress levels, improve academic performance, and self-confidence in school children.…

Use of Unlabeled Samples for Mitigating the Hughes Phenomenon

NASA Technical Reports Server (NTRS)

Landgrebe, David A.; Shahshahani, Behzad M.

1993-01-01

The use of unlabeled samples in improving the performance of classifiers is studied. When the number of training samples is fixed and small, additional feature measurements may reduce the performance of a statistical classifier. It is shown that by using unlabeled samples, estimates of the parameters can be improved and therefore this phenomenon may be mitigated. Various methods for using unlabeled samples are reviewed and experimental results are provided.

Concept analysis of safety climate in healthcare providers.

PubMed

Lin, Ying-Siou; Lin, Yen-Chun; Lou, Meei-Fang

2017-06-01

To report an analysis of the concept of safety climate in healthcare providers. Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care. Concept analysis. The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'. The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers. Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate. More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures. The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients. © 2016 John Wiley & Sons Ltd.

Effects of the performance management information system in improving performance: an empirical study in Shanghai Ninth People's Hospital.

PubMed

Cui, Yinghui; Wu, Zhengyi; Lu, Yao; Jin, Wenzhong; Dai, Xing; Bai, Jinxi

2016-01-01

Improving the performance of clinical departments is not only the significant content of the healthcare system reform in China, but also the essential approach to better satisfying the Chinese growing demand for medical services. Performance management is vital and meaningful to public hospitals in China. Several studies are conducted in hospital internal performance management, but almost none of them consider the effects of informational tools. Therefore, we carried out an empirical study on effects of using performance management information system in Shanghai Ninth People's Hospital. The main feature of the system is that it provides a real-time query platform for users to analyze and dynamically monitor the key performance indexes, timely detect problems and make adjustments. We collected pivotal medical data on 35 clinical departments of this hospital from January 2013 until December 2014, 1 year before and after applying the performance management information system. Comparative analysis was conducted by statistical methods. The results show that the system is beneficial to improve performance scores of clinical departments and lower the proportion of drug expenses, meanwhile, shorten the average hospitalized days and increase the bed turnover rate. That is to say, with the increasing medical services, the quality and efficiency is greatly improved. In a word, application of the performance management information system has a positive effect on improving performance of clinical departments.

New ORNL Method Could Unleash Solar Power Potential

ScienceCinema

Simpson, Mary Jane

2018-01-16

Measurement and data analysis techniques developed at the Department of Energy’s Oak Ridge National Laboratory could provide new insight into performance-robbing flaws in crystalline structures, ultimately improving the performance of solar cells.

Nanotechnology-Based Performance Improvements For Portland Cement Concrete - Phase I

DOT National Transportation Integrated Search

2012-08-16

A fundamental understanding of the nano-structure of Portland cement concrete (PCC) is the key to realizing significant breakthroughs regarding high performance and susta : (MBTC 2095/3004) using molecular dynamics (MD) provided new understanding of ...

Improvement of electrochemical performance of nickel rich LiNi0.6Co0.2Mn0.2O2 cathode active material by ultrathin TiO2 coating.

PubMed

Qin, CanCan; Cao, JiaLi; Chen, Jun; Dai, GaoLe; Wu, TongFu; Chen, Yanbin; Tang, YueFeng; Li, AiDong; Chen, Yanfeng

2016-06-21

LiNi0.6Co0.2Mn0.2O2 cathode material has been surface-modified by coating with ultrathin TiO2via atomic layer deposition (ALD) technology to improve the electrochemical performance of LiNi0.6Co0.2Mn0.2O2 cathodes for lithium ion batteries. Within the cut-off voltage of 2.5-4.3 V, the coated sample delivers an initial discharge capacity of 187.7 mA h g(-1) at 0.1 C and with a capacity retention about 85.9% after 100 cycles at 1 C, which provides a significant improvement in terms of discharge capacity and cyclability, as compared with those of the bare one. Such enhanced electrochemical performance of the coated sample is ascribed to its high-quality ultrathin coating of amorphous TiO2, which can protect the active material from HF attack, withstand the dissolution of metal ions in the electrode and favor the lithium diffusion of oxide as proved by electrochemical impedance spectroscopy (EIS) tests. TiO2 coating via the ALD process provides a potential approach for battery factories to surface-modify Ni-rich electrode materials so as to realize improvements in electrochemical performance.

Constrained independent component analysis approach to nonobtrusive pulse rate measurements

NASA Astrophysics Data System (ADS)

Tsouri, Gill R.; Kyal, Survi; Dianat, Sohail; Mestha, Lalit K.

2012-07-01

Nonobtrusive pulse rate measurement using a webcam is considered. We demonstrate how state-of-the-art algorithms based on independent component analysis suffer from a sorting problem which hinders their performance, and propose a novel algorithm based on constrained independent component analysis to improve performance. We present how the proposed algorithm extracts a photoplethysmography signal and resolves the sorting problem. In addition, we perform a comparative study between the proposed algorithm and state-of-the-art algorithms over 45 video streams using a finger probe oxymeter for reference measurements. The proposed algorithm provides improved accuracy: the root mean square error is decreased from 20.6 and 9.5 beats per minute (bpm) for existing algorithms to 3.5 bpm for the proposed algorithm. An error of 3.5 bpm is within the inaccuracy expected from the reference measurements. This implies that the proposed algorithm provided performance of equal accuracy to the finger probe oximeter.

Current target acquisition methodology in force on force simulations

NASA Astrophysics Data System (ADS)

Hixson, Jonathan G.; Miller, Brian; Mazz, John P.

2017-05-01

The U.S. Army RDECOM CERDEC NVESD MSD's target acquisition models have been used for many years by the military community in force on force simulations for training, testing, and analysis. There have been significant improvements to these models over the past few years. The significant improvements are the transition of ACQUIRE TTP-TAS (ACQUIRE Targeting Task Performance Target Angular Size) methodology for all imaging sensors and the development of new discrimination criteria for urban environments and humans. This paper is intended to provide an overview of the current target acquisition modeling approach and provide data for the new discrimination tasks. This paper will discuss advances and changes to the models and methodologies used to: (1) design and compare sensors' performance, (2) predict expected target acquisition performance in the field, (3) predict target acquisition performance for combat simulations, and (4) how to conduct model data validation for combat simulations.

A framework for evaluating the formation, implementation, and performance of accountable care organizations.

PubMed

Fisher, Elliott S; Shortell, Stephen M; Kreindler, Sara A; Van Citters, Aricca D; Larson, Bridget K

2012-11-01

The implementation of accountable care organizations (ACOs), a new health care payment and delivery model designed to improve care and lower costs, is proceeding rapidly. We build on our experience tracking early ACOs to identify the major factors-such as contract characteristics; structure, capabilities, and activities; and local context-that would be likely to influence ACO formation, implementation, and performance. We then propose how an ACO evaluation program could be structured to guide policy makers and payers in improving the design of ACO contracts, while providing insights for providers on approaches to care transformation that are most likely to be successful in different contexts. We also propose key activities to support evaluation of ACOs in the near term, including tracking their formation, developing a set of performance measures across all ACOs and payers, aggregating those performance data, conducting qualitative and quantitative research, and coordinating different evaluation activities.

Constrained independent component analysis approach to nonobtrusive pulse rate measurements.

PubMed

Tsouri, Gill R; Kyal, Survi; Dianat, Sohail; Mestha, Lalit K

2012-07-01

Nonobtrusive pulse rate measurement using a webcam is considered. We demonstrate how state-of-the-art algorithms based on independent component analysis suffer from a sorting problem which hinders their performance, and propose a novel algorithm based on constrained independent component analysis to improve performance. We present how the proposed algorithm extracts a photoplethysmography signal and resolves the sorting problem. In addition, we perform a comparative study between the proposed algorithm and state-of-the-art algorithms over 45 video streams using a finger probe oxymeter for reference measurements. The proposed algorithm provides improved accuracy: the root mean square error is decreased from 20.6 and 9.5 beats per minute (bpm) for existing algorithms to 3.5 bpm for the proposed algorithm. An error of 3.5 bpm is within the inaccuracy expected from the reference measurements. This implies that the proposed algorithm provided performance of equal accuracy to the finger probe oximeter.

Applying a rateless code in content delivery networks

NASA Astrophysics Data System (ADS)

Suherman; Zarlis, Muhammad; Parulian Sitorus, Sahat; Al-Akaidi, Marwan

2017-09-01

Content delivery network (CDN) allows internet providers to locate their services, to map their coverage into networks without necessarily to own them. CDN is part of the current internet infrastructures, supporting multi server applications especially social media. Various works have been proposed to improve CDN performances. Since accesses on social media servers tend to be short but frequent, providing redundant to the transmitted packets to ensure lost packets not degrade the information integrity may improve service performances. This paper examines the implementation of rateless code in the CDN infrastructure. The NS-2 evaluations show that rateless code is able to reduce packet loss up to 50%.

Critical validation studies of neurofeedback.

PubMed

Gruzelier, John; Egner, Tobias

2005-01-01

The field of neurofeedback training has proceeded largely without validation. In this article the authors review studies directed at validating sensory motor rhythm, beta and alpha-theta protocols for improving attention, memory, and music performance in healthy participants. Importantly, benefits were demonstrable with cognitive and neurophysiologic measures that were predicted on the basis of regression models of learning to enhance sensory motor rhythm and beta activity. The first evidence of operant control over the alpha-theta ratio is provided, together with remarkable improvements in artistic aspects of music performance equivalent to two class grades in conservatory students. These are initial steps in providing a much needed scientific basis to neurofeedback.

Performance characteristics of LOX-H2, tangential-entry, swirl-coaxial, rocket injectors

NASA Technical Reports Server (NTRS)

Howell, Doug; Petersen, Eric; Clark, Jim

1993-01-01

Development of a high performing swirl-coaxial injector requires an understanding of fundamental performance characteristics. This paper addresses the findings of studies on cold flow atomic characterizations which provided information on the influence of fluid properties and element operating conditions on the produced droplet sprays. These findings are applied to actual rocket conditions. The performance characteristics of swirl-coaxial injection elements under multi-element hot-fire conditions were obtained by analysis of combustion performance data from three separate test series. The injection elements are described and test results are analyzed using multi-variable linear regression. A direct comparison of test results indicated that reduced fuel injection velocity improved injection element performance through improved propellant mixing.

Assessing students' performance in software requirements engineering education using scoring rubrics

NASA Astrophysics Data System (ADS)

Mkpojiogu, Emmanuel O. C.; Hussain, Azham

2017-10-01

The study investigates how helpful the use of scoring rubrics is, in the performance assessment of software requirements engineering students and whether its use can lead to students' performance improvement in the development of software requirements artifacts and models. Scoring rubrics were used by two instructors to assess the cognitive performance of a student in the design and development of software requirements artifacts. The study results indicate that the use of scoring rubrics is very helpful in objectively assessing the performance of software requirements or software engineering students. Furthermore, the results revealed that the use of scoring rubrics can also produce a good achievement assessments direction showing whether a student is either improving or not in a repeated or iterative assessment. In a nutshell, its use leads to the performance improvement of students. The results provided some insights for further investigation and will be beneficial to researchers, requirements engineers, system designers, developers and project managers.

Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality.

PubMed

Backman, Chantal; Vanderloo, Saskia; Forster, Alan John

2016-09-01

Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today's health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture

PubMed Central

Johnson, Eric J.; Hassin, Ran; Baker, Tom; Bajger, Allison T.; Treuer, Galen

2013-01-01

Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a “smart” default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year. PMID:24367484

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance

PubMed Central

Lamb, Geoffrey C.; Smith, Maureen; Weeks, William B.; Queram, Christopher

2014-01-01

Public reporting of performance on quality measures is increasingly common but little is known about the impact, especially among physician groups. The Wisconsin Collaborative for Healthcare Quality (Collaborative) is a voluntary consortium of physician groups which has publicly reported quality measures since 2004, providing an opportunity to study the effect of this effort on participating groups. Analyses included member performance on 14 ambulatory measures from 2004–2009, a survey regarding reporting and its relationship to improvement efforts, and use of Medicare billing data to independently compare Collaborative members to the rest of Wisconsin, neighboring states and the rest of the United States. Faced with limited resources, groups prioritized their efforts based on the nature of the measure and their performance compared to others. The outcomes demonstrated that public reporting was associated with improvement in health quality and that large physician group practices will engage in improvement efforts in response. PMID:23459733

Improving health worker performance of abortion services: an assessment of post-training support to providers in India, Nepal and Nigeria.

PubMed

Benson, Janie; Healy, Joan; Dijkerman, Sally; Andersen, Kathryn

2017-11-21

Health worker performance has been the focus of numerous interventions and evaluation studies in low- and middle-income countries. Few have examined changes in individual provider performance with an intervention encompassing post-training support contacts to improve their clinical practice and resolve programmatic problems. This paper reports the results of an intervention with 3471 abortion providers in India, Nepal and Nigeria. Following abortion care training, providers received in-person visits and virtual contacts by a clinical and programmatic support team for a 12-month period, designed to address their individual practice issues. The intervention also included technical assistance to and upgrades in facilities where the providers worked. Quantitative measures to assess provider performance were established, including: 1) Increase in service provision; 2) Consistent service provision; 3) Provision of high quality of care through use of World Health Organization-recommended uterine evacuation technologies, management of pain and provision of post-abortion contraception; and 4) Post-abortion contraception method mix. Descriptive univariate analysis was conducted, followed by examination of the bivariate relationships between all independent variables and the four dependent performance outcome variables by calculating unadjusted odds ratios, by country and overall. Finally, multivariate logistic regression was performed for each outcome. Providers received an average of 5.7 contacts. Sixty-two percent and 46% of providers met measures for consistent service provision and quality of care, respectively. Fewer providers achieved an increased number of services (24%). Forty-six percent provided an appropriate postabortion contraceptive mix to clients. Most providers met the quality components for use of WHO-recommended abortion methods and provision of pain management. Factors significantly associated with achievement of all measures were providers working in sites offering community outreach and those trained in intervention year two. The number of in-person contacts was significantly associated with achievement of three of four measures. Post-training support holds promise for strengthening health worker performance. Further research is needed to compare this intervention with other approaches and assess how post-training contacts could be incorporated into current health system supervision.

40 CFR 65.116 - Quality improvement program for pumps.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., and pump or pump seal designs or technologies that have poorer than average emission performance and...), operating conditions, or pump or pump seal designs associated with poorer than average emission performance... poorer than average performance except as provided in paragraph (d)(6)(v) of this section. The trial...

Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

ERIC Educational Resources Information Center

Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

2010-01-01

Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

Clackamas County Public Health: Employee Engagement in Quality Improvement and Performance Management Activities.

PubMed

Mason, Philip

This case report provides an example of a local health department's use of performance management tools across its agency. An emphasis is on engaging staff across all levels of the organization so that employees can understand how their work affects overall performance management.

Component Repair Experiment-1: An Experiment Evaluating Electronic Component-Level Repair During Spaceflight

NASA Technical Reports Server (NTRS)

Easton, John W.; Struk, Peter M.

2012-01-01

The Component Repair Experiment-1 (CRE-1) examines the capability for astronauts to perform electronics repair tasks in space. The goal is to determine the current capabilities and limits for the crew, and to make recommendations to improve and expand the range of work that astronauts may perform. CRE-1 provided two-layer, functional circuit boards and replacement components, a small tool kit, written and video training materials, and 1 hr of hands on training for the crew slated to perform the experiment approximately 7 months prior to the mission. Astronauts Michael Fincke and Sandra Magnus performed the work aboard the International Space Station (ISS) in February and March 2009. The astronauts were able to remove and replace components successfully, demonstrating the feasibility of performing component-level electronics repairs within a spacecraft. Several unsuccessful tasks demonstrated areas in need of improvement. These include improved and longer training prior to a mission, an improved soldering iron with a higher operating temperature and steady power source, video training and practice boards for refresher work or practice before a repair, and improved and varied hand tools and containment system.

Physician performance assessment using a composite quality index.

PubMed

Liu, Kaibo; Jain, Shabnam; Shi, Jianjun

2013-07-10

Assessing physician performance is important for the purposes of measuring and improving quality of service and reducing healthcare delivery costs. In recent years, physician performance scorecards have been used to provide feedback on individual measures; however, one key challenge is how to develop a composite quality index that combines multiple measures for overall physician performance evaluation. A controversy arises over establishing appropriate weights to combine indicators in multiple dimensions, and cannot be easily resolved. In this study, we proposed a generic unsupervised learning approach to develop a single composite index for physician performance assessment by using non-negative principal component analysis. We developed a new algorithm named iterative quadratic programming to solve the numerical issue in the non-negative principal component analysis approach. We conducted real case studies to demonstrate the performance of the proposed method. We provided interpretations from both statistical and clinical perspectives to evaluate the developed composite ranking score in practice. In addition, we implemented the root cause assessment techniques to explain physician performance for improvement purposes. Copyright © 2012 John Wiley & Sons, Ltd.

Computer-Supported Feedback Message Tailoring for Healthcare Providers in Malawi: Proof-of-Concept.

PubMed

Landis-Lewis, Zach; Douglas, Gerald P; Hochheiser, Harry; Kam, Matthew; Gadabu, Oliver; Bwanali, Mwatha; Jacobson, Rebecca S

2015-01-01

Although performance feedback has the potential to help clinicians improve the quality and safety of care, healthcare organizations generally lack knowledge about how this guidance is best provided. In low-resource settings, tools for theory-informed feedback tailoring may enhance limited clinical supervision resources. Our objectives were to establish proof-of-concept for computer-supported feedback message tailoring in Malawi, Africa. We conducted this research in five stages: clinical performance measurement, modeling the influence of feedback on antiretroviral therapy (ART) performance, creating a rule-based message tailoring process, generating tailored messages for recipients, and finally analysis of performance and message tailoring data. We retrospectively generated tailored messages for 7,448 monthly performance reports from 11 ART clinics. We found that tailored feedback could be routinely generated for four guideline-based performance indicators, with 35% of reports having messages prioritized to optimize the effect of feedback. This research establishes proof-of-concept for a novel approach to improving the use of clinical performance feedback in low-resource settings and suggests possible directions for prospective evaluations comparing alternative designs of feedback messages.

Case Studies of Fatigue Life Improvement Using Low Plasticity Burnishing in Gas Turbine Engine Applications

NASA Technical Reports Server (NTRS)

Prevey, Paul S.; Shepard, Michael; Ravindranath, Ravi A.; Gabb, Timothy

2003-01-01

Surface enhancement technologies such as shot peening, laser shock peening (LSP), and low plasticity burnishing (LPB) can provide substantial fatigue life improvement. However, to be effective, the compressive residual stresses that increase fatigue strength must be retained in service. For successful integration into turbine design, the process must be affordable and compatible with the manufacturing environment. LPB provides thermally stable compression of comparable magnitude and even greater depth than other methods, and can be performed in conventional machine shop environments on CNC machine tools. LPB provides a means to extend the fatigue lives of both new and legacy aircraft engines and ground-based turbines. Improving fatigue performance by introducing deep stable layers of compressive residual stress avoids the generally cost prohibitive alternative of modifying either material or design. The X-ray diffraction based background studies of thermal and mechanical stability of surface enhancement techniques are briefly reviewed, demonstrating the importance of minimizing cold work. The LPB process, tooling, and control systems are described. An overview of current research programs conducted for engine OEMs and the military to apply LPB to a variety of engine and aging aircraft components are presented. Fatigue performance and residual stress data developed to date for several case studies are presented including: * The effect of LPB on the fatigue performance of the nickel based super alloy IN718, showing fatigue benefit of thermal stability at engine temperatures. * An order of magnitude improvement in damage tolerance of LPB processed Ti-6-4 fan blade leading edges. * Elimination of the fretting fatigue debit for Ti-6-4 with prior LPB. * Corrosion fatigue mitigation with LPB in Carpenter 450 steel. *Damage tolerance improvement in 17-4PH steel. Where appropriate, the performance of LPB is compared to conventional shot peening after exposure to engine operating temperatures.

Importance of Indigenous Breeds of Chicken for Rural Economy and Their Improvements for Higher Production Performance

PubMed Central

Padhi, Mahendra Kumar

2016-01-01

Indigenous/native breeds of chickens are playing an important role in rural economies in most of the developing and underdeveloped countries. They play a major role for the rural poor and marginalised section of the people with respect to their subsidiary income and also provide them with nutritious chicken egg and meat for their own consumption. Performance of native fowl can be improved by change in husbandry, feeding, and better health cover. However, genetic improvement may be made either through selection and crossbreeding or by utilisation of both selection and crossbreeding. Improvement through selection may be time consuming but the improvement will be permanent. Through crossbreeding improvement may be faster but research has to aim for the production of native-type birds with higher production potential. In the present review efforts have been made to present the importance of native fowl to rural economy and their improvement for higher production performance. PMID:27144053

Quality of Midwife-provided Intrapartum Care in Amhara Regional State, Ethiopia.

PubMed

Yigzaw, Tegbar; Abebe, Fantu; Belay, Lalem; Assaye, Yewulsew; Misganaw, Equlinet; Kidane, Ashebir; Ademie, Desalegn; van Roosmalen, Jos; Stekelenburg, Jelle; Kim, Young-Mi

2017-08-16

Despite much progress recently, Ethiopia remains one of the largest contributors to the global burden of maternal and newborn deaths and stillbirths. Ethiopia's plan to meet the sustainable development goals for maternal and child health includes unprecedented emphasis on improving quality of care. The purpose of this study was to assess the quality of midwifery care during labor, delivery and immediate postpartum period. A cross-sectional study using multiple data collection methods and a 2-stage cluster sampling technique was conducted from January 25 to February 14, 2015 in government health facilities of the Amhara National Regional State of Ethiopia. Direct observation of performance was used to determine competence of midwives in providing care during labor, delivery, and the first 6 h after childbirth. Inventory of drugs, medical equipment, supplies, and infrastructure was conducted to identify availability of resources in health facilities. Structured interview was done to assess availability of resources and performance improvement opportunities. Data analysis involved calculating percentages, means and chi-square tests. A total of 150 midwives and 56 health facilities were included in the study. The performance assessment showed 16.5% of midwives were incompetent, 72.4% were competent, and 11.1% were outstanding in providing routine intrapartum care. Forty five midwives were observed while managing 54 obstetric and newborn complications and 41 (91%) of them were rated competent. Inventory of resources found that the proportion of facilities with more than 75% of the items in each category was 32.6% for drugs, 73.1% for equipment, 65.4% for supplies, 47.9% for infection prevention materials, and 43.6% for records and forms. Opportunities for performance improvement were inadequate, with 31.3% reporting emergency obstetric and newborn care training, and 44.7% quarterly or more frequent supportive supervision. Health centers fared worse in provider competence, physical resources, and quality improvement practices except for supportive supervision visits and in-service training. Although our findings indicate most midwives are competent in giving routine and emergency intrapartum care, the major gaps in the enabling environment and the significant proportion of midwives with unsatisfactory performance suggest that the conditions for providing quality intrapartum care are not optimal.

An integrated evaluation for the performance of clinical engineering department.

PubMed

Yousry, Ahmed M; Ouda, Bassem K; Eldeib, Ayman M

2014-01-01

Performance benchmarking have become a very important component in all successful organizations nowadays that must be used by Clinical Engineering Department (CED) in hospitals. Many researchers identified essential mainstream performance indicators needed to improve the CED's performance. These studies revealed mainstream performance indicators that use the database of a CED to evaluate its performance. In this work, we believe that those indicators are insufficient for hospitals. Additional important indicators should be included to improve the evaluation accuracy. Therefore, we added new indicators: technical/maintenance indicators, economic indicators, intrinsic criticality indicators, basic hospital indicators, equipment acquisition, and safety indicators. Data is collected from 10 hospitals that cover different types of healthcare organizations. We developed a software tool that analyses collected data to provide a score for each CED under evaluation. Our results indicate that there is an average gap of 67% between the CEDs' performance and the ideal target. The reasons for the noncompliance are discussed in order to improve performance of CEDs under evaluation.

The Impact of Performance Measurement on Library and Information Services: A Decade of Experience.

ERIC Educational Resources Information Center

Willemse, John

Performance measurement at the University of South Africa (Unisa) library is integrated in its planning and review procedures and is continuously adapted and improved. This paper traces the development of performance measurement at Unisa over more than a decade. Performance measurement provides an indication of how good or bad the library is doing…

Health service delivery in China: a literature review.

PubMed

Eggleston, Karen; Ling, Li; Qingyue, Meng; Lindelow, Magnus; Wagstaff, Adam

2008-02-01

We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that current health service delivery in China leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector or by simply encouraging providers -- public and private -- to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid -- shifting away from fee-for-service and the distorted price schedule. Other elements of 'active purchasing' by insurers could further improve outcomes. Rigorous evaluations, based on richer micro-level data, could considerably strengthen the evidence base for service delivery policy in China.

A Framework and Improvements of the Korea Cloud Services Certification System.

PubMed

Jeon, Hangoo; Seo, Kwang-Kyu

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed.

Magnetostrictive materials and method for improving AC characteristics in same

DOEpatents

Pulvirenti, Patricia P.; Jiles, David C.

2001-08-14

The present invention provides Terfenol-D alloys ("doped" Terfenol) having optimized performances under the condition of time-dependent magnetic fields. In one embodiment, performance is optimized by lowering the conductivity of Terfenol, thereby improving the frequency response. This can be achieved through addition of Group III or IV elements, such as Si and Al. Addition of these types of elements provides scattering sites for conduction electrons, thereby increasing resistivity by 125% which leads to an average increase in penetration depth of 80% at 1 kHz and an increase in energy conversion efficiency of 55%. The permeability of doped Terfenol remains constant over a wider frequency range as compared with undoped Terfenol. These results demonstrate that adding impurities, such as Si and Al, are effective in improving the ac characteristics of Terfenol. A magnetoelastic Gruneisen parameter, .gamma..sub.me, has also been derived from the thermodynamic equations of state, and provides another means by which to characterize the coupling efficiency in magnetostrictive materials on a more fundamental basis.

A Framework and Improvements of the Korea Cloud Services Certification System

PubMed Central

Jeon, Hangoo

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed. PMID:26125049

The Chemistry Development Kit (CDK) v2.0: atom typing, depiction, molecular formulas, and substructure searching.

PubMed

Willighagen, Egon L; Mayfield, John W; Alvarsson, Jonathan; Berg, Arvid; Carlsson, Lars; Jeliazkova, Nina; Kuhn, Stefan; Pluskal, Tomáš; Rojas-Chertó, Miquel; Spjuth, Ola; Torrance, Gilleain; Evelo, Chris T; Guha, Rajarshi; Steinbeck, Christoph

2017-06-06

The Chemistry Development Kit (CDK) is a widely used open source cheminformatics toolkit, providing data structures to represent chemical concepts along with methods to manipulate such structures and perform computations on them. The library implements a wide variety of cheminformatics algorithms ranging from chemical structure canonicalization to molecular descriptor calculations and pharmacophore perception. It is used in drug discovery, metabolomics, and toxicology. Over the last 10 years, the code base has grown significantly, however, resulting in many complex interdependencies among components and poor performance of many algorithms. We report improvements to the CDK v2.0 since the v1.2 release series, specifically addressing the increased functional complexity and poor performance. We first summarize the addition of new functionality, such atom typing and molecular formula handling, and improvement to existing functionality that has led to significantly better performance for substructure searching, molecular fingerprints, and rendering of molecules. Second, we outline how the CDK has evolved with respect to quality control and the approaches we have adopted to ensure stability, including a code review mechanism. This paper highlights our continued efforts to provide a community driven, open source cheminformatics library, and shows that such collaborative projects can thrive over extended periods of time, resulting in a high-quality and performant library. By taking advantage of community support and contributions, we show that an open source cheminformatics project can act as a peer reviewed publishing platform for scientific computing software. Graphical abstract CDK 2.0 provides new features and improved performance.

Web-based mammography audit feedback.

PubMed

Geller, Berta M; Ichikawa, Laura; Miglioretti, Diana L; Eastman, David

2012-06-01

Interpreting screening mammography accurately is challenging and requires ongoing education to maintain and improve interpretative skills. Recognizing this, many countries with organized breast screening programs have developed audit and feedback systems using national performance data to help radiologists assess and improve their skills. We developed and tested an interactive Website to provide screening and diagnostic mammography audit feedback with comparisons to national and regional benchmarks. Radiologists who participate in three Breast Cancer Surveillance Consortium registries in the United States were invited during 2009 and 2010 to use a Website that provides tabular and graphical displays of mammography audit reports with comparisons to national and regional performance measures. We collected data about the use and perceptions of the Website. Thirty-five of 111 invited radiologists used the Website from one to five times in a year. The most popular measure was sensitivity for both screening and diagnostic mammography, whereas a table with all measures was the most visited page. Of the 13 radiologists who completed the postuse survey, all found the Website easy to use and navigate, 11 found the benchmarks useful, and nine reported that they intended to improve a specific outcome measure that year. An interactive Website to provide customized mammography audit feedback reports to radiologists has the potential to be a powerful tool in improving interpretive performance. The conceptual framework of customized audit feedback reports can also be generalized to other imaging tests.

Design and development of high performance solar photovoltaic inverter with advanced modulation techniques to improve power quality

NASA Astrophysics Data System (ADS)

Alexander Stonier, Albert

2017-02-01

In addition to the focus towards growing demand on electrical energy due to the increase in population, industries, consumer loads, etc., the need for improving the quality of electrical power also needs to be considered. The design and development of solar photovoltaic (PV) inverter with reduced harmonic distortions is proposed. Unlike the conventional solar PV inverters, the proposed inverter provides the advantages of reduced harmonic distortions thereby intend towards the improvement in power quality. This inverter comprises of multiple stages which provides the required 230VRMS, 50 Hz in spite of variations in solar PV due to temperature and irradiance. The reduction of harmonics is governed by applying proper switching sequences required for the inverter switches. The detailed analysis is carried out by employing different switching techniques and observing its performance. With a separate mathematical model for a solar PV, simulations are performed in MATLAB software. To show the advantage of the system proposed, a 3 kWp photovoltaic plant coupled with multilevel inverter is demonstrated in hardware. The novelty resides in the design of a single chip controller which can provide the switching sequence based on the requirement and application. As per the results obtained, the solar-fed multistage inverter improves the quality of power which makes this inverter suitable for both stand-alone and grid-connected systems.

Assessing the value of diagnostic imaging: the role of perception

NASA Astrophysics Data System (ADS)

Potchen, E. J.; Cooper, Thomas G.

2000-04-01

The value of diagnostic radiology rests in its ability to provide information. Information is defined as a reduction in randomness. Quality improvement in any system requires diminution in the variation in its performance. The major variation in performance of the system of diagnostic radiology occurs in observer performance and in the communication of information from the observer to someone who will apply that information to the benefit of the patient. The ability to provide information can be determined by observer performance studies using a receiver-operating characteristic (ROC) curve analysis. The amount of information provided by each observer can be measured in terms of the uncertainty they reduce. Using a set of standardized radiographs, some normal and some abnormal, sorting them randomly, and then asking an observer to redistribute them according to their probability of normality can measure the difference in the value added by different observers. By applying this observer performance measure, we have been able to characterize individual radiologists, groups of radiologists, and regions of the United States in their ability to add value in chest radiology. The use of these technologies in health care may improve upon the contribution of diagnostic imaging.

The influence of stress responses on surgical performance and outcomes: Literature review and the development of the surgical stress effects (SSE) framework.

PubMed

Chrouser, Kristin L; Xu, Jie; Hallbeck, Susan; Weinger, Matthew B; Partin, Melissa R

2018-02-22

Surgical adverse events persist despite several decades of system-based quality improvement efforts, suggesting the need for alternative strategies. Qualitative studies suggest stress-induced negative intraoperative interpersonal dynamics might contribute to performance errors and undesirable patient outcomes. Understanding the impact of intraoperative stressors may be critical to reducing adverse events and improving outcomes. We searched MEDLINE, psycINFO, EMBASE, Business Source Premier, and CINAHL databases (1996-2016) to assess the relationship between negative (emotional and behavioral) responses to acute intraoperative stressors and provider performance or patient surgical outcomes. Drawing on theory and evidence from reviewed studies, we present the Surgical Stress Effects (SSE) framework. This illustrates how emotional and behavioral responses to stressors can influence individual surgical provider (e.g. surgeon, nurse) performance, team performance, and patient outcomes. It also demonstrates how uncompensated intraoperative threats and errors can lead to adverse events, highlighting evidence gaps for future research efforts. Published by Elsevier Inc.

Hypersonic flight performance improvements by overfueled ramjet combustion

NASA Astrophysics Data System (ADS)

Sachs, G.; Bayer, R.; Lederer, R.; Schaber, R.

1991-12-01

The performance characteristics of hypersonic airbreathing engines are examined with emphasis on the effect of overfueled combustion on thrust and specific fuel-consumption, as well as on the combustion temperature, real gas effects, and pollution due to exhaust gas. It is shown that overfueled ramjet combustion can provide a means for improving flight performance at hypersonic speed and, consequently, reduce the mission fuel burn and the propulsion system weight. It is also shown that, in the separation flight maneuver, the separation condition for the upper stage can be improved by overfueled ramjet combustion of the first stage, making it possible to increase the payload which the upper stage can deliver into orbit. The flight mechanics modeling considerations are presented.

Mobile Multicast in Hierarchical Proxy Mobile IPV6

NASA Astrophysics Data System (ADS)

Hafizah Mohd Aman, Azana; Hashim, Aisha Hassan A.; Mustafa, Amin; Abdullah, Khaizuran

2013-12-01

Mobile Internet Protocol Version 6 (MIPv6) environments have been developing very rapidly. Many challenges arise with the fast progress of MIPv6 technologies and its environment. Therefore the importance of improving the existing architecture and operations increases. One of the many challenges which need to be addressed is the need for performance improvement to support mobile multicast. Numerous approaches have been proposed to improve mobile multicast performance. This includes Context Transfer Protocol (CXTP), Hierarchical Mobile IPv6 (HMIPv6), Fast Mobile IPv6 (FMIPv6) and Proxy Mobile IPv6 (PMIPv6). This document describes multicast context transfer in hierarchical proxy mobile IPv6 (H-PMIPv6) to provide better multicasting performance in PMIPv6 domain.

Polymeric Materials for Aerospace Power and Propulsion: Overview of Polymer Research at NASA Glenn

NASA Technical Reports Server (NTRS)

Meador, Michael A.

2007-01-01

Weight, durability and performance are all major concerns for any NASA mission. Use of lightweight materials, such as fiber reinforced polymer matrix composites can lead to significant reductions in vehicle weight and improvements in vehicle performance. Research in the Polymeric Materials Branch at NASA Glenn is focused on improving the durability, properties, processability and performance of polymeric materials by utilizing both conventional polymer science and engineering as well as nanotechnology and bioinspired approaches. This presentation will provide an overview of these efforts and highlight recent progress.

Development of a cloud-based application for the Fracture Liaison Service model of care.

PubMed

Holzmueller, C G; Karp, S; Zeldow, D; Lee, D B; Thompson, D A

2016-02-01

The aims of this study are to develop a cloud-based application of the Fracture Liaison Service for practitioners to coordinate the care of osteoporotic patients after suffering primary fractures and provide a performance feedback portal for practitioners to determine quality of care. The application provides continuity of care, improved patient outcomes, and reduced medical costs. The purpose of this study is to describe the content development and functionality of a cloud-based application to broadly deploy the Fracture Liaison Service (FLS) to coordinate post-fracture care for osteoporotic patients. The Bone Health Collaborative developed the FLS application in 2013 to support practitioners' access to information and management of patients and provide a feedback portal for practitioners to track their performance in providing quality care. A five-step protocol (identify, inform, initiate, investigate, and iterate) organized osteoporotic post-fracture care-related tasks and timelines for the application. A range of descriptive data about the patient, their medical condition, therapies and care, and current providers can be collected. Seven quality of care measures from the National Quality Forum, The Joint Commission, and the Centers for Medicare and Medicaid Services can be tracked through the application. There are five functional areas including home, tasks, measures, improvement, and data. The home, tasks, and data pages are used to enter patient information and coordinate care using the five-step protocol. Measures and improvement pages are used to enter quality measures and provide practitioners with continuous performance feedback. The application resides within a portal, running on a multitenant, private cloud-based Avedis enterprise registry platform. All data are encrypted in transit and users access the application using a password from any common web browser. The application could spread the FLS model of care across the US health care system, provide continuity of care, effectively manage osteoporotic patients, improve outcomes, and reduce medical costs.

Leaders with heart.

PubMed

Heck, Susan

2005-02-01

Although cardiovascular care is typically a lucrative service line, competition from other providers is often fierce. To gain market advantage, providers should follow best practices of top-performing organizations and use benchmarking data to identify areas in need of process improvement.

Landsat 4 and 5 status and results from Thematic Mapper data analyses

NASA Technical Reports Server (NTRS)

Salomonson, V. V.

1984-01-01

Landsat-1, 2, and 3 have functioned successfully well beyond their design lifetimes of one year and provided a very sizable collection of data. On July 16, 1982 with the successful launch of Landsat-4, a second generation of Landsat satellites was introduced. Landsat-4 continues to make available the observational services which had been provided by the Multispectral Scanner (MSS) on Landsats 1-3. In addition, the new satellite is provided with an improved observational capability which is based on a utilization of the Thematic Mapper (TM). The system status (March 1984) of Landsat-4 is considered along with an evaluation of the MSS, and a description of the design and performance of the TM. Attention is also given to the satellite Landsat-5, which was launched successfully on March 1, 1984, taking into account design modifications leading to improved performance and some scenes provided by the new spacecraft.

Healthcare managers' roles, competencies, and outputs in organizational performance improvement.

PubMed

Wallick, William G

2002-01-01

Healthcare CEOs recognize that managers are under increasing pressure to work smarter and more efficiently with fewer available resources. Jobs in the healthcare industry are in a constant state of change, requiring a workforce that is not only prepared to adjust quickly to the changing environment but to simultaneously maintain or improve overall organizational performance. Traditionally, trainers were viewed as the people with the primary responsibility for improving organizational performance. Today some CEOs believe healthcare managers should own that responsibility, and other CEOs believe the responsibility should be shared among healthcare managers and trainers. This shift in how accountability is viewed poses at least two important questions. Are managers aware of the various roles they need to enact to achieve successful organizational performance improvement? Do managers possess the competencies associated with those roles? The seven most contemporary trainer roles, now referred to as workplace learning and performance roles, are examined in this article to help managers increase their knowledge of the roles, competencies, and outputs expected of them. Based on findings of a study conducted to examine CEO's perceptions of managers' roles in the performance improvement process, this article provides theoretical backgrounds, includes verbatim study comments, and offers practical recommendations or tips for managers.

Are university rankings useful to improve research? A systematic review

PubMed Central

Momani, Shaher

2018-01-01

Introduction Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. Methods A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. Results A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. Discussion No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and “luxury” indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance. PMID:29513762

Direct synthesis of vertically aligned ZnO nanowires on FTO substrates using a CVD method and the improvement of photovoltaic performance

PubMed Central

2012-01-01

In this work, we report a direct synthesis of vertically aligned ZnO nanowires on fluorine-doped tin oxide-coated substrates using the chemical vapor deposition (CVD) method. ZnO nanowires with a length of more than 30 μm were synthesized, and dye-sensitized solar cells (DSSCs) based on the as-grown nanowires were fabricated, which showed improvement of the device performance compared to those fabricated using transferred ZnO nanowires. Dependence of the cell performance on nanowire length and annealing temperature was also examined. This synthesis method provided a straightforward, one-step CVD process to grow relatively long ZnO nanowires and avoided subsequent nanowire transfer process, which simplified DSSC fabrication and improved cell performance. PMID:22673046

An Augmented-Reality Edge Enhancement Application for Google Glass

PubMed Central

Hwang, Alex D.; Peli, Eli

2014-01-01

Purpose Google Glass provides a platform that can be easily extended to include a vision enhancement tool. We have implemented an augmented vision system on Glass, which overlays enhanced edge information over the wearer’s real world view, to provide contrast-improved central vision to the Glass wearers. The enhanced central vision can be naturally integrated with scanning. Methods Goggle Glass’s camera lens distortions were corrected by using an image warping. Since the camera and virtual display are horizontally separated by 16mm, and the camera aiming and virtual display projection angle are off by 10°, the warped camera image had to go through a series of 3D transformations to minimize parallax errors before the final projection to the Glass’ see-through virtual display. All image processes were implemented to achieve near real-time performance. The impacts of the contrast enhancements were measured for three normal vision subjects, with and without a diffuser film to simulate vision loss. Results For all three subjects, significantly improved contrast sensitivity was achieved when the subjects used the edge enhancements with a diffuser film. The performance boost is limited by the Glass camera’s performance. The authors assume this accounts for why performance improvements were observed only with the diffuser filter condition (simulating low vision). Conclusions Improvements were measured with simulated visual impairments. With the benefit of see-through augmented reality edge enhancement, natural visual scanning process is possible, and suggests that the device may provide better visual function in a cosmetically and ergonomically attractive format for patients with macular degeneration. PMID:24978871

Fire Safety Aspects of Polymeric Materials. Volume 6. Aircraft. Civil and Military

DTIC Science & Technology

1977-01-01

resistance of the existing Polyurethane foam- based seating sys- tems be improved through design, construction, and selection of covering materials. 12. A...aircraft interiors under real fire conditions. To provide the data base for developing improved fire safety standards for aircraft, four types of...the determination of immobilizing effect was based on performance in the swimming test, a simple exercise method also favored by Kimmerle to provide

How can routine health information systems improve health systems functioning in low- and middle-income countries? Assessing the evidence base.

PubMed

Hotchkiss, David R; Diana, Mark L; Foreit, Karen G Fleischman

2012-01-01

Health system performance depends on production and use of quality health data and information. Routine health information systems (RHIS) are defined as systems that provide information at regular intervals of a year or less to meet predictable information needs. These include paper-based or electronic health records and facility- and district-level management information systems. RHIS are receiving increasing attention as an essential component of efficient, country-owned, integrated national systems. To guide investment decisions on RHIS, evidence is needed on which types of RHIS interventions work and which do not. This chapter is a systematic review of the literature on the evaluation of RHIS interventions in low- and middle-income countries, starting from the premise that investments in RHIS could be better understood and so produce greater benefits than they currently do. We describe the conceptual literature on the determinants of RHIS performance and its role in improving health systems functioning, discuss the evidence base on the effectiveness of strategies to improve RHIS performance, provide an overview of RHIS evaluation challenges, and make suggestions to improve the evidence base. The goal is to help ensure that (a) RHIS interventions are appropriately designed and implemented to improve health systems functioning and (b) resulting RHIS information is used more effectively.

Final Report of Technical Assistance Provided to Guarantee Agencies with Recommendations for Further Improving Program Performance.

ERIC Educational Resources Information Center

Touche Ross and Co., Washington, DC.

Technical assistance provided to loan guarantee agencies by Touche Ross and Co. under contract to the U.S. Office of Education (OE) is described. Objectives of the report are: to summarize the work performed and the results of each of the projects that were conducted; to describe certain prototype systems that were developed for the guarantee…

A Program Manager's Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs.

PubMed

Ryan, Gery W; Farmer, Carrie M; Adamson, David M; Weinick, Robin M

2014-01-01

Between 2001 and 2011, the U.S. Department of Defense has implemented numerous programs to support service members and their families in coping with the stressors from a decade of the longstanding conflicts in Iraq and Afghanistan. These programs, which address both psychological health and traumatic brain injury (TBI), number in the hundreds and vary in their size, scope, and target population. To ensure that resources are wisely invested and maximize the benefits of such programs, RAND developed a tool to help assess program performance, consider options for improvement, implement solutions, then assess whether the changes worked, with the intention of helping those responsible for managing or implementing programs to conduct assessments of how well the program is performing and to implement solutions for improving performance. Specifically, the tool is intended to provide practical guidance in program improvement and continuous quality improvement for all programs.

IT investments can add business value.

PubMed

Williams, Terry G

2002-05-01

Investment in information technology (IT) is costly, but necessary to enable healthcare organizations to improve their infrastructure and achieve other improvement initiatives. Such an investment is even more costly, however, if the technology does not appropriately enable organizations to perform business processes that help them accomplish their mission of providing safe, high-quality care cost-effectively. Before committing to a costly IT investment, healthcare organizations should implement a decision-making process that can help them choose, implement, and use technology that will provide sustained business value. A seven-step decision-making process that can help healthcare organizations achieve this result involves performing a gap analysis, assessing and aligning organizational goals, establishing distributed accountability, identifying linked organizational-change initiatives, determining measurement methods, establishing appropriate teams to ensure systems are integrated with multidisciplinary improvement methods, and developing a plan to accelerate adoption of the IT product.

Facilitation Standards: A Mixed Methods Study

ERIC Educational Resources Information Center

Hunter, Jennifer

2017-01-01

Online education is increasing as a solution to manage ever increasing enrollment numbers at higher education institutions. Intentionally and thoughtfully constructed courses allow students to improve performance through practice and self-assessment and instructors benefit from improving consistency in providing content and assessing process,…

Improving Rural Emergency Medical Services (EMS) through transportation system enhancements Phase II.

DOT National Transportation Integrated Search

2015-12-01

Providing acute medical care outside of the hospital, Emergency Medical Services (EMS) is crucial in rural environments where hospitals are not close by and are difficult to access. Establishing EMS performance measures is critical in improving a rur...

Optical links in the angle-data assembly of the 70-meter antennas

NASA Technical Reports Server (NTRS)

Nelson, M. D.; Schroeder, J. R.; Tubbs, E. F.

1988-01-01

In the precision-pointing mode the 70 meter antennas utilize an optical link provided by an autocollimator. In an effort to improve reliability and performance, commercial instruments were evaluated as replacement candidates, and upgraded versions of the existing instruments were designed and tested. The latter were selected for the Neptune encounter, but commercial instruments with digital output show promise of significant performance improvement for the post-encounter period.

School Improvement Plans and Student Learning in Jamaica

ERIC Educational Resources Information Center

Lockheed, Marlaine; Harris, Abigail; Jayasundera, Tamara

2010-01-01

A school improvement program that provided support to poor-performing schools on the basis of needs identified in a school improvement plan was implemented in 72 government schools in Jamaica, from 1998 to 2005. In this independent evaluation of the program, we use propensity score matching to create, post hoc, a control group of schools that were…

The chief nurse executive role in large healthcare systems.

PubMed

Englebright, Jane; Perlin, Jonathan

2008-01-01

Community hospitals are most frequently led by nonclinicians. Although some may have employed physician leaders, most often clinical leadership is provided by a chief nurse executive (CNE) or chief nursing officer. Clinical leadership of community hospital and health systems may similarly be provided by a system-level nursing executive or, often, by a council of facility CNEs. The increasingly competitive healthcare environment in which value-based purchasing of healthcare and pay-for-performance programs demand improved clinical performance for financial success has led to reconsideration of whether a council model can provide either the leadership or adequate attention to clinical (and operational) improvement. In turn, community hospitals and health systems look to CNE or chief nursing officer roles at the highest level of the organization as resources that are able to segue between the clinical and operational domains, translating clinical performance demands into operating strategies and tactics. This article explores CNE characteristics required for success in these increasingly responsible and visible roles.

Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

PubMed

Penney, Christine; Henry, Effie

2008-01-01

The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also raised by the finding in Australia that the current case-mix system is inadequate to describe these patients. Further, given the inadequacy of our understanding of health system capacity and output, consideration of a more comprehensive national reporting system along the care continuum may be warranted. This project is an example of effective collaboration between the provincial government, a national organization and HAs, and suggests that provincial governments can participate in a meaningful way to accomplish research-informed health services policy.

Improving the photovoltaic performance of perovskite solar cells with acetate

PubMed Central

Zhao, Qian; Li, G. R.; Song, Jian; Zhao, Yulong; Qiang, Yinghuai; Gao, X. P.

2016-01-01

In an all-solid-state perovskite solar cell, methylammonium lead halide film is in charge of generating photo-excited electrons, thus its quality can directly influence the final photovoltaic performance of the solar cell. This paper accentuates a very simple chemical approach to improving the quality of a perovskite film with a suitable amount of acetic acid. With introduction of acetate ions, a homogeneous, continual and hole-free perovskite film comprised of high-crystallinity grains is obtained. UV-visible spectra, steady-state and time-resolved photoluminescence (PL) spectra reveal that the obtained perovskite film under the optimized conditions shows a higher light absorption, more efficient electron transport, and faster electron extraction to the adjoining electron transport layer. The features result in the optimized perovskite film can provide an improved short-circuit current. The corresponding solar cells with a planar configuration achieves an improved power conversion efficiency of 13.80%, and the highest power conversion efficiency in the photovoltaic measurements is up to 14.71%. The results not only provide a simple approach to optimizing perovskite films but also present a novel angle of view on fabricating high-performance perovskite solar cells. PMID:27934924

Improving the photovoltaic performance of perovskite solar cells with acetate.

PubMed

Zhao, Qian; Li, G R; Song, Jian; Zhao, Yulong; Qiang, Yinghuai; Gao, X P

2016-12-09

In an all-solid-state perovskite solar cell, methylammonium lead halide film is in charge of generating photo-excited electrons, thus its quality can directly influence the final photovoltaic performance of the solar cell. This paper accentuates a very simple chemical approach to improving the quality of a perovskite film with a suitable amount of acetic acid. With introduction of acetate ions, a homogeneous, continual and hole-free perovskite film comprised of high-crystallinity grains is obtained. UV-visible spectra, steady-state and time-resolved photoluminescence (PL) spectra reveal that the obtained perovskite film under the optimized conditions shows a higher light absorption, more efficient electron transport, and faster electron extraction to the adjoining electron transport layer. The features result in the optimized perovskite film can provide an improved short-circuit current. The corresponding solar cells with a planar configuration achieves an improved power conversion efficiency of 13.80%, and the highest power conversion efficiency in the photovoltaic measurements is up to 14.71%. The results not only provide a simple approach to optimizing perovskite films but also present a novel angle of view on fabricating high-performance perovskite solar cells.

How social information can improve estimation accuracy in human groups.

PubMed

Jayles, Bertrand; Kim, Hye-Rin; Escobedo, Ramón; Cezera, Stéphane; Blanchet, Adrien; Kameda, Tatsuya; Sire, Clément; Theraulaz, Guy

2017-11-21

In our digital and connected societies, the development of social networks, online shopping, and reputation systems raises the questions of how individuals use social information and how it affects their decisions. We report experiments performed in France and Japan, in which subjects could update their estimates after having received information from other subjects. We measure and model the impact of this social information at individual and collective scales. We observe and justify that, when individuals have little prior knowledge about a quantity, the distribution of the logarithm of their estimates is close to a Cauchy distribution. We find that social influence helps the group improve its properly defined collective accuracy. We quantify the improvement of the group estimation when additional controlled and reliable information is provided, unbeknownst to the subjects. We show that subjects' sensitivity to social influence permits us to define five robust behavioral traits and increases with the difference between personal and group estimates. We then use our data to build and calibrate a model of collective estimation to analyze the impact on the group performance of the quantity and quality of information received by individuals. The model quantitatively reproduces the distributions of estimates and the improvement of collective performance and accuracy observed in our experiments. Finally, our model predicts that providing a moderate amount of incorrect information to individuals can counterbalance the human cognitive bias to systematically underestimate quantities and thereby improve collective performance. Copyright © 2017 the Author(s). Published by PNAS.

How social information can improve estimation accuracy in human groups

PubMed Central

Jayles, Bertrand; Kim, Hye-rin; Cezera, Stéphane; Blanchet, Adrien; Kameda, Tatsuya; Sire, Clément; Theraulaz, Guy

2017-01-01

In our digital and connected societies, the development of social networks, online shopping, and reputation systems raises the questions of how individuals use social information and how it affects their decisions. We report experiments performed in France and Japan, in which subjects could update their estimates after having received information from other subjects. We measure and model the impact of this social information at individual and collective scales. We observe and justify that, when individuals have little prior knowledge about a quantity, the distribution of the logarithm of their estimates is close to a Cauchy distribution. We find that social influence helps the group improve its properly defined collective accuracy. We quantify the improvement of the group estimation when additional controlled and reliable information is provided, unbeknownst to the subjects. We show that subjects’ sensitivity to social influence permits us to define five robust behavioral traits and increases with the difference between personal and group estimates. We then use our data to build and calibrate a model of collective estimation to analyze the impact on the group performance of the quantity and quality of information received by individuals. The model quantitatively reproduces the distributions of estimates and the improvement of collective performance and accuracy observed in our experiments. Finally, our model predicts that providing a moderate amount of incorrect information to individuals can counterbalance the human cognitive bias to systematically underestimate quantities and thereby improve collective performance. PMID:29118142

A Pilot Program: Using Text Messaging to Improve Timely Communication to Tonsillectomy Patients.

PubMed

Newton, Laurie; Sulman, Cecille

2016-01-01

Approximately 1,500 tonsillectomies are performed annually at a large pediatric academic medical center each year. Families need to be educated on how to care for their child after this surgery. Most tonsillectomy patients are discharged home either the same day as surgery or after one night of observation, resulting in post-operative tonsillectomy recovery and care falling upon the patient's family. Multiple quality improvement efforts to improve family education post tonsillectomy surgery have been performed over the last several years at a large pediatric academic medical center. None of these efforts, however, have focused on the use of technology to provide innovative patient education. The purpose of this project is to provide information to parents via text messages and videos to improve patient experience and outcomes following tonsillectomy. Families provided positive feedback, including that the texts were helpful, easy to understand, and reduced pre-operative and recovery anxiety. Also, none of these families needed to call the ENT clinic for any other questions or concerns. The recovery from tonsillectomy is not easy and this pediatric otolaryngology practice is always searching for new ways to improve care and education. Use of technology is an innovative approach and likely one that will be used more often in the future.

Improving HIV outcomes in resource-limited countries: the importance of quality indicators.

PubMed

Ahonkhai, Aima A; Bassett, Ingrid V; Ferris, Timothy G; Freedberg, Kenneth A

2012-11-24

Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped. Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment. This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level. An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.

Investigation of goal change to optimize upper-extremity motor performance in a robotic environment.

PubMed

Brewer, Bambi R; Klatzky, Roberta; Markham, Heather; Matsuoka, Yoky

2009-10-01

Robotic devices for therapy have the potential to enable intensive, fully customized home rehabilitation over extended periods for individuals with stroke and traumatic brain injury, thus empowering them to maximize their functional recovery. For robotic rehabilitation to be most effective, systems must have the capacity to assign performance goals to the user and to increment those goals to encourage performance improvement. Otherwise, individuals may plateau at an artificially low level of function. Frequent goal change is needed to motivate improvements in performance by individuals with brain injury; but because of entrenched habits, these individuals may avoid striving for goals that they perceive as becoming ever more difficult. For this reason, implicit, undetectable goal change (distortion) may be more effective than explicit goal change at optimizing the motor performance of some individuals with brain injury. This paper reviews a body of work that provides a basis for incorporating implicit goal change into a robotic rehabilitation paradigm. This work was conducted with individuals without disability to provide foundational knowledge for using goal change in a robotic environment. In addition, we compare motor performance with goal change to performance with no goal or with a static goal for individuals without brain injury. Our results show that goal change can improve motor performance when participants attend to visual feedback. Building on these preliminary results can lead to more effective robotic paradigms for the rehabilitation of individuals with brain injury, including individuals with cerebral palsy.

A Prototype Tool to Enable Farmers to Measure and Improve the Welfare Performance of the Farm Animal Enterprise: The Unified Field Index

PubMed Central

Colditz, Ian G.; Ferguson, Drewe M.; Collins, Teresa; Matthews, Lindsay; Hemsworth, Paul H.

2014-01-01

Simple Summary Benchmarking is a tool widely used in agricultural industries that harnesses the experience of farmers to generate knowledge of practices that lead to better on-farm productivity and performance. We propose, by analogy with production performance, a method for measuring the animal welfare performance of an enterprise and describe a tool for farmers to monitor and improve the animal welfare performance of their business. A general framework is outlined for assessing and monitoring risks to animal welfare based on measures of animals, the environment they are kept in and how they are managed. The tool would enable farmers to continually improve animal welfare. Abstract Schemes for the assessment of farm animal welfare and assurance of welfare standards have proliferated in recent years. An acknowledged short-coming has been the lack of impact of these schemes on the welfare standards achieved on farm due in part to sociological factors concerning their implementation. Here we propose the concept of welfare performance based on a broad set of performance attributes of an enterprise and describe a tool based on risk assessment and benchmarking methods for measuring and managing welfare performance. The tool termed the Unified Field Index is presented in a general form comprising three modules addressing animal, resource, and management factors. Domains within these modules accommodate the principle conceptual perspectives for welfare assessment: biological functioning; emotional states; and naturalness. Pan-enterprise analysis in any livestock sector could be used to benchmark welfare performance of individual enterprises and also provide statistics of welfare performance for the livestock sector. An advantage of this concept of welfare performance is its use of continuous scales of measurement rather than traditional pass/fail measures. Through the feedback provided via benchmarking, the tool should help farmers better engage in on-going improvement of farm practices that affect animal welfare. PMID:26480317

In the Mind's Eye: Enhancing Human Performance.

ERIC Educational Resources Information Center

Druckman, Daniel, Ed.; Bjork, Robert A., Ed.

This book presents a look at methods of performance enhancement, examining basic issues of performance through a series of papers which evaluate several popular self-improvement approaches by weighing the evidence to determine what works. The first of the book's four parts provides an overview of the volume with two chapters describing the history…

Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services. Monograph

ERIC Educational Resources Information Center

Stecher, Brian M.; Camm, Frank; Damberg, Cheryl L.; Hamilton, Laura S.; Mullen, Kathleen J.; Nelson, Christopher; Sorensen, Paul; Wachs, Martin; Yoh, Allison; Zellman, Gail L.

2010-01-01

Performance-based accountability systems (PBASs), which link incentives to measured performance as a means of improving services to the public, have gained popularity. While PBASs can vary widely across sectors, they share three main components: goals, incentives, and measures. Research suggests that PBASs influence provider behaviors, but little…

Self-Reflection and Math Performance in an Online Learning Environment

ERIC Educational Resources Information Center

Choi, Jinnie; Walters, Alyssa; Hoge, Pat

2017-01-01

According to recent reports, K-12 full-time virtual school students have shown lower performance in math than their counterparts in brick-and-mortar schools. However, research is lacking in what kind of programmatic interventions virtual schools might be particularly well-suited to provide to improve math performance. Engaging students in…

Performance Templates and the Regulation of Learning

ERIC Educational Resources Information Center

Lyons, Paul

2009-01-01

Purpose: The purpose of this paper is to provide a detailed, theoretical underpinning for the training and performance improvement method: performance template (P-T). The efficacy of P-T, with limitations, has been demonstrated in this journal and in others. However, the theoretical bases of the P-T approach had not been well-developed. The other…

Performance Management in Education: Improving Practice. British Educational Management Series.

ERIC Educational Resources Information Center

Reeves, Jenny; Forde, Christine; O'Brien, Jim; Smith, Pauline; Tomlinson, Harry

This book explores managing the performance of education staff in England and Wales and in Scotland. It compares the different policies of performance management as practiced in England and Wales and in Scotland. (The Scottish system of education is independent of that of England and Wales.) Chapter 1 provides an introduction to performance…

Promoting Accountability and Continual Improvement: A Review of the Respective Roles of Performance Measurement, Auditing, Evaluation, and Reporting.

ERIC Educational Resources Information Center

Reid, William

1999-01-01

Provides a synthesis of the literature pertaining to the principles and practices of performance measurement, auditing, evaluation, and reporting. Discusses how bringing these elements together in a performance management system can be achieved through refinement of strategic direction, reporting on key measures, and periodic, systematic…

Physician performance feedback in a Canadian academic center.

PubMed

Garvin, Dennis; Worthington, James; McGuire, Shaun; Burgetz, Stephanie; Forster, Alan J; Patey, Andrea; Gerin-Lajoie, Caroline; Turnbull, Jeffrey; Roth, Virginia

2017-10-02

Purpose This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization. Design/methodology/approach A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions. Findings This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met. Originality/value This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement.

The effects of magnetic field in plume region on the performance of multi-cusped field thruster

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

Hu, Peng, E-mail: hupengemail@126.com; Liu, Hui, E-mail: thruster@126.com; Yu, Daren

2015-10-15

The performance characteristics of a Multi-cusped Field Thruster depending on the magnetic field in the plume region were investigated. Five magnetic field shielding rings were separately mounted near the exit of discharge channel to decrease the strength of magnetic field in the plume region in different levels, while the magnetic field in the upstream was well maintained. The test results show that the electron current increases with the decrease of magnetic field strength in the plume region, which gives rise to higher propellant utilization and lower current utilization. On the other hand, the stronger magnetic field in the plume regionmore » improves the performance at low voltages (high current mode) while lower magnetic field improves the performance at high voltages (low current mode). This work can provide some optimal design ideas of the magnetic strength in the plume region to improve the performance of thruster.« less

Dependence of LTX plasma performance on surface conditions as determined by in situ analysis of plasma facing components

NASA Astrophysics Data System (ADS)

Lucia, M.; Kaita, R.; Majeski, R.; Bedoya, F.; Allain, J. P.; Abrams, T.; Bell, R. E.; Boyle, D. P.; Jaworski, M. A.; Schmitt, J. C.

2015-08-01

The Materials Analysis and Particle Probe (MAPP) diagnostic has been implemented on the Lithium Tokamak Experiment (LTX) at PPPL, providing the first in situ X-ray photoelectron spectroscopy (XPS) surface characterization of tokamak plasma facing components (PFCs). MAPP samples were exposed to argon glow discharge conditioning (GDC), lithium evaporations, and hydrogen tokamak discharges inside LTX. Samples were analyzed with XPS, and alterations to surface conditions were correlated against observed LTX plasma performance changes. Argon GDC caused the accumulation of nm-scale metal oxide layers on the PFC surface, which appeared to bury surface carbon and oxygen contamination and thus improve plasma performance. Lithium evaporation led to the rapid formation of a lithium oxide (Li2O) surface; plasma performance was strongly improved for sufficiently thick evaporative coatings. Results indicate that a 5 h argon GDC or a 50 nm evaporative lithium coating will both significantly improve LTX plasma performance.

Flash memory management system and method utilizing multiple block list windows

NASA Technical Reports Server (NTRS)

Chow, James (Inventor); Gender, Thomas K. (Inventor)

2005-01-01

The present invention provides a flash memory management system and method with increased performance. The flash memory management system provides the ability to efficiently manage and allocate flash memory use in a way that improves reliability and longevity, while maintaining good performance levels. The flash memory management system includes a free block mechanism, a disk maintenance mechanism, and a bad block detection mechanism. The free block mechanism provides efficient sorting of free blocks to facilitate selecting low use blocks for writing. The disk maintenance mechanism provides for the ability to efficiently clean flash memory blocks during processor idle times. The bad block detection mechanism provides the ability to better detect when a block of flash memory is likely to go bad. The flash status mechanism stores information in fast access memory that describes the content and status of the data in the flash disk. The new bank detection mechanism provides the ability to automatically detect when new banks of flash memory are added to the system. Together, these mechanisms provide a flash memory management system that can improve the operational efficiency of systems that utilize flash memory.

Strength training for athletes: does it really help sports performance?

PubMed

McGuigan, Michael R; Wright, Glenn A; Fleck, Steven J

2012-03-01

The use of strength training designed to increase underlying strength and power qualities in elite athletes in an attempt to improve athletic performance is commonplace. Although the extent to which strength and power are important to sports performance may vary depending on the activity, the associations between these qualities and performance have been well documented in the literature. The purpose of this review is to provide a brief overview of strength training research to determine if it really helps improve athletic performance. While there is a need for more research with elite athletes to investigate the relationship between strength training and athletic performance, there is sufficient evidence for strength training programs to continue to be an integral part of athletic preparation in team sports.

Computer-Tailored Student Support in Introductory Physics

PubMed Central

Huberth, Madeline; Chen, Patricia; Tritz, Jared; McKay, Timothy A.

2015-01-01

Large introductory courses are at a disadvantage in providing personalized guidance and advice for students during the semester. We introduce E2Coach (an Expert Electronic Coaching system), which allows instructors to personalize their communication with thousands of students. We describe the E2Coach system, the nature of the personalized support it provides, and the features of the students who did (and did not) opt-in to using it during the first three terms of its use in four introductory physics courses at the University of Michigan. Defining a ‘better-than-expected’ measure of performance, we compare outcomes for students who used E2Coach to those who did not. We found that moderate and high E2Coach usage was associated with improved performance. This performance boost was prominent among high users, who improved by 0.18 letter grades on average when compared to nonusers with similar incoming GPAs. This improvement in performance was comparable across both genders. E2Coach represents one way to use technology to personalize education at scale, contributing to the move towards individualized learning that is becoming more attainable in the 21st century. PMID:26352403

Flight Test Comparison of Different Adaptive Augmentations for Fault Tolerant Control Laws for a Modified F-15 Aircraft

NASA Technical Reports Server (NTRS)

Burken, John J.; Hanson, Curtis E.; Lee, James A.; Kaneshige, John T.

2009-01-01

This report describes the improvements and enhancements to a neural network based approach for directly adapting to aerodynamic changes resulting from damage or failures. This research is a follow-on effort to flight tests performed on the NASA F-15 aircraft as part of the Intelligent Flight Control System research effort. Previous flight test results demonstrated the potential for performance improvement under destabilizing damage conditions. Little or no improvement was provided under simulated control surface failures, however, and the adaptive system was prone to pilot-induced oscillations. An improved controller was designed to reduce the occurrence of pilot-induced oscillations and increase robustness to failures in general. This report presents an analysis of the neural networks used in the previous flight test, the improved adaptive controller, and the baseline case with no adaptation. Flight test results demonstrate significant improvement in performance by using the new adaptive controller compared with the previous adaptive system and the baseline system for control surface failures.

The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

PubMed

Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P

2012-01-01

The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project.

Are well functioning civil registration and vital statistics systems associated with better health outcomes?

PubMed

Phillips, David E; AbouZahr, Carla; Lopez, Alan D; Mikkelsen, Lene; de Savigny, Don; Lozano, Rafael; Wilmoth, John; Setel, Philip W

2015-10-03

In this Series paper, we examine whether well functioning civil registration and vital statistics (CRVS) systems are associated with improved population health outcomes. We present a conceptual model connecting CRVS to wellbeing, and describe an ecological association between CRVS and health outcomes. The conceptual model posits that the legal identity that civil registration provides to individuals is key to access entitlements and services. Vital statistics produced by CRVS systems provide essential information for public health policy and prevention. These outcomes benefit individuals and societies, including improved health. We use marginal linear models and lag-lead analysis to measure ecological associations between a composite metric of CRVS performance and three health outcomes. Results are consistent with the conceptual model: improved CRVS performance coincides with improved health outcomes worldwide in a temporally consistent manner. Investment to strengthen CRVS systems is not only an important goal for individuals and societies, but also a development imperative that is good for health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Safety culture and care: a program to prevent surgical errors.

PubMed

Hemingway, Maureen White; O'Malley, Catherine; Silvestri, Sandra

2015-04-01

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Implementation Pearls from a New Guidebook on Improving Medication Use and Outcomes with Clinical Decision Support

PubMed Central

Sirajuddin, Anwar M; Osheroff, Jerome A.; Sittig, Dean F.; Chuo, John; Velasco, Ferdinand; Collins, David A.

2012-01-01

Effective clinical decision support (CDS) is essential for addressing healthcare performance improvement imperatives, but care delivery organizations (CDO) typically struggle with CDS deployment. Ensuring safe and effective medication delivery to patients is a central focus of CDO performance improvement efforts, and this article provides an overview of best-practice strategies for applying CDS to these goals. The strategies discussed are drawn from a new guidebook, co-published and co-sponsored by more than a dozen leading organizations. Developed by scores of CDS implementers and experts, the guidebook outlines key steps and success factors for applying CDS to medication management. A central thesis is that improving outcomes with CDS interventions requires that the CDS five rights be addressed successfully. That is, the interventions must deliver the right information, to the right person, in the right format, through the right channel, at the right point in workflow. This paper provides further details about these CDS five rights, and highlights other important strategies for successful CDS programs. PMID:19894486

Evaluation and Improved Use of Fecal Occult Blood Test in the Constipated Child.

PubMed

Kilway, Denise M

2016-01-01

This quality improvement project examined the use of fecal occult blood test in the constipated child in a pediatric gastroenterology outpatient clinic. A retrospective chart review was completed on 100 children seen for an initial visit with the gastroenterology provider. The number of fecal occult blood tests performed and the child's coinciding symptoms were tallied and compared with the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition recommendations. An educational intervention was held with the pediatric gastroenterology providers consisting of a PowerPoint presentation summarizing aims of the quality improvement project and reviewing recommendations for use of fecal occult blood test in the constipated child. Pre- and post-intervention chart review data sets were compared. Results showed a 19.6% decrease in the use of fecal occult blood tests performed during the post-intervention timeframe. However, when used in conjunction with North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition recommendations, the appropriateness of fecal occult blood test use increased by 71.4% in the post-intervention patients. Reviewing the recommendations with gastroenterology providers assisted in optimizing the meaningful use of fecal occult blood test, improving quality and safety of care for children seen in the pediatric gastroenterology outpatient clinic.

Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

PubMed

Lopez-Campos, Jose Luis; Asensio-Cruz, M Isabel; Castro-Acosta, Ady; Calero, Carmen; Pozo-Rodriguez, Francisco

2014-01-01

Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy. The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November-December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival. A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality. The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in-hospital mortality.

Pay-for-performance in disease management: a systematic review of the literature.

PubMed

de Bruin, Simone R; Baan, Caroline A; Struijs, Jeroen N

2011-10-14

Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. © 2011 de Bruin et al; licensee BioMed Central Ltd.

Pay-for-performance in disease management: a systematic review of the literature

PubMed Central

2011-01-01

Background Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. Methods A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Results Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. Conclusion The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. PMID:21999234

Improving the performance of a filling line based on simulation

NASA Astrophysics Data System (ADS)

Jasiulewicz-Kaczmarek, M.; Bartkowiak, T.

2016-08-01

The paper describes the method of improving performance of a filling line based on simulation. This study concerns a production line that is located in a manufacturing centre of a FMCG company. A discrete event simulation model was built using data provided by maintenance data acquisition system. Two types of failures were identified in the system and were approximated using continuous statistical distributions. The model was validated taking into consideration line performance measures. A brief Pareto analysis of line failures was conducted to identify potential areas of improvement. Two improvements scenarios were proposed and tested via simulation. The outcome of the simulations were the bases of financial analysis. NPV and ROI values were calculated taking into account depreciation, profits, losses, current CIT rate and inflation. A validated simulation model can be a useful tool in maintenance decision-making process.

Neutron reflecting supermirror structure

DOEpatents

Wood, J.L.

1992-12-01

An improved neutron reflecting supermirror structure comprising a plurality of stacked sets of bilayers of neutron reflecting materials. The improved neutron reflecting supermirror structure is adapted to provide extremely good performance at high incidence angles, i.e. up to four time the critical angle of standard neutron mirror structures. The reflection of neutrons striking the supermirror structure at a high critical angle provides enhanced neutron throughput, and hence more efficient and economical use of neutron sources. 2 figs.

Neutron reflecting supermirror structure

DOEpatents

Wood, James L.

1992-01-01

An improved neutron reflecting supermirror structure comprising a plurality of stacked sets of bilayers of neutron reflecting materials. The improved neutron reflecting supermirror structure is adapted to provide extremely good performance at high incidence angles, i.e. up to four time the critical angle of standard neutron mirror structures. The reflection of neutrons striking the supermirror structure at a high critical angle provides enhanced neutron throughput, and hence more efficient and economical use of neutron sources.

Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services.

PubMed

Woods, Cindy; Carlisle, Karen; Larkins, Sarah; Thompson, Sandra Claire; Tsey, Komla; Matthews, Veronica; Bailie, Ross

2017-01-01

Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care. High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems' component. High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance, and subsequent SAT data provided evidence of changes made to address concerns. Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas.

Coupled Solid Rocket Motor Ballistics and Trajectory Modeling for Higher Fidelity Launch Vehicle Design

NASA Technical Reports Server (NTRS)

Ables, Brett

2014-01-01

Multi-stage launch vehicles with solid rocket motors (SRMs) face design optimization challenges, especially when the mission scope changes frequently. Significant performance benefits can be realized if the solid rocket motors are optimized to the changing requirements. While SRMs represent a fixed performance at launch, rapid design iterations enable flexibility at design time, yielding significant performance gains. The streamlining and integration of SRM design and analysis can be achieved with improved analysis tools. While powerful and versatile, the Solid Performance Program (SPP) is not conducive to rapid design iteration. Performing a design iteration with SPP and a trajectory solver is a labor intensive process. To enable a better workflow, SPP, the Program to Optimize Simulated Trajectories (POST), and the interfaces between them have been improved and automated, and a graphical user interface (GUI) has been developed. The GUI enables real-time visual feedback of grain and nozzle design inputs, enforces parameter dependencies, removes redundancies, and simplifies manipulation of SPP and POST's numerous options. Automating the analysis also simplifies batch analyses and trade studies. Finally, the GUI provides post-processing, visualization, and comparison of results. Wrapping legacy high-fidelity analysis codes with modern software provides the improved interface necessary to enable rapid coupled SRM ballistics and vehicle trajectory analysis. Low cost trade studies demonstrate the sensitivities of flight performance metrics to propulsion characteristics. Incorporating high fidelity analysis from SPP into vehicle design reduces performance margins and improves reliability. By flying an SRM designed with the same assumptions as the rest of the vehicle, accurate comparisons can be made between competing architectures. In summary, this flexible workflow is a critical component to designing a versatile launch vehicle model that can accommodate a volatile mission scope.

Managing hospital quality performance in two related areas: patient care and customer service.

PubMed

Dwore, R B

1993-01-01

The Joint Commission on Accreditation of Healthcare Organization's new emphasis on continuous quality improvement provides hospitals with an opportunity to enhance both customer service as well as patient care. Both are expected by patients and delivered by providers. Patient care is the core product; customer service augments it by adding value and providing the opportunity for a competitive advantage. This article discusses issues for administrators to consider before including customer service as a component of continuous quality improvement and then presents methods for bringing about change.

Thermal evaluation of advanced solar dynamic heat receiver performance

NASA Technical Reports Server (NTRS)

Crane, Roger A.

1989-01-01

The thermal performance of a variety of concepts for thermal energy storage as applied to solar dynamic applications is discussed. It is recognized that designs providing large thermal gradients or large temperature swings during orbit are susceptible to early mechanical failure. Concepts incorporating heat pipe technology may encounter operational limitations over sufficiently large ranges. By reviewing the thermal performance of basic designs, the relative merits of the basic concepts are compared. In addition the effect of thermal enhancement and metal utilization as applied to each design provides a partial characterization of the performance improvements to be achieved by developing these technologies.

Report to Lincoln Labs on TWPAs

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

Dubois, J.; Carosi, G.; Woollett, N.

2017-09-26

This past spring LLNL’s Quantum Sensor’s team received two TWPA amplifiers from Lincoln Labs along with a data-sheet explaining handling, operations and expected performance. Here we will outline some of the initial tests performed on this amplifiers as part of LLNL’s Quantum Sensors Strategic Initiative (QSSI). Initial testing confirmed that both amplifiers worked and provided gain and SNR improvement similar to that called out in the data-sheets provided.

Algorithm improvement program nuclide identification algorithm scoring criteria and scoring application.

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

Enghauser, Michael

2016-02-01

The goal of the Domestic Nuclear Detection Office (DNDO) Algorithm Improvement Program (AIP) is to facilitate gamma-radiation detector nuclide identification algorithm development, improvement, and validation. Accordingly, scoring criteria have been developed to objectively assess the performance of nuclide identification algorithms. In addition, a Microsoft Excel spreadsheet application for automated nuclide identification scoring has been developed. This report provides an overview of the equations, nuclide weighting factors, nuclide equivalencies, and configuration weighting factors used by the application for scoring nuclide identification algorithm performance. Furthermore, this report presents a general overview of the nuclide identification algorithm scoring application including illustrative examples.

Improving The Performance of Customer Loyalty of Online Ticketing in Indonesia's Showbiz Industry

NASA Astrophysics Data System (ADS)

Dachyar, M.; Athory, E. S.

2015-06-01

Currently the entertainment industry is adopting online ticketing for supporting business from main products to profitability improvement. E-loyalty needs to be examined because are deals with less loyal customer characteristic. The sample are 249 customers whom have purchased for tickets online at least once. Data was gathered by questionnaires and analyzed by Path Analysis and Importance - Performance Analysis. The findings of the research indicate that satisfaction has the strongest relationship to e-loyalty. This study provides four improvement alternatives as a form of new business development strategy for showbiz industry in Indonesia.

Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

PubMed

Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

2012-01-01

In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

A study to determine methods of improving the subsonic performance of a proposed Personnel Launch System (PLS) concept

NASA Technical Reports Server (NTRS)

Spencer, Bernard, Jr.; Fox, Charles H.; Huffman, Jarrett K.

1995-01-01

An investigation has been conducted in the Langley 7- by 10-Foot High Speed Wind Tunnel to determine the longitudinal and lateral directional aerodynamic characteristics of a series of personnel launch system concepts. This series of configurations evolved during an effort to improve the subsonic characteristics of a proposed lifting entry vehicle (designated the HL-20). The primary purpose of the overall investigation was to provide a vehicle concept which was inherently stable and trimable from entry to landing while examining methods of improving subsonic aerodynamic performance.

Baselining the New GSFC Information Systems Center: The Foundation for Verifiable Software Process Improvement

NASA Technical Reports Server (NTRS)

Parra, A.; Schultz, D.; Boger, J.; Condon, S.; Webby, R.; Morisio, M.; Yakimovich, D.; Carver, J.; Stark, M.; Basili, V.;

STOCKPILED PRAIRIEGRASS PROVIDES HIGH-QUALITY FALL GRAZING FOR LAMBS

USDA-ARS?s Scientific Manuscript database

New varieties of prairiegrass (Bromus catharticus Vahl. = B. willdenowii Kunth.) exhibit improved persistence over ‘Matua’ under USA growing conditions, but animal performance data is lacking. We evaluated performance of lambs grazing stockpiled ‘Dixon’ prairiegrass on West Virginia hill pasture in...

Evaluation of Soil Media for Stormwater Infiltration Best Management Practices (BMPs)

EPA Science Inventory

This project will improve the performance of structural management practices, and provide guidance that will allow designers to balance infiltration rates with sorption capacity. This project will also perform a standard column test procedure for evaluating candidate soil media.

Lithium metal doped electrodes for lithium-ion rechargeable chemistry

DOEpatents

Liu, Gao; Battaglia, Vince; Wang, Lei

2016-09-13

An embodiment of the invention combines the superior performance of a polyvinylidene difluoride (PVDF) or polyethyleneoxide (POE) binder, the strong binding force of a styrene-butadiene (SBR) binder, and a source of lithium ions in the form of solid lithium metal powder (SLMP) to form an electrode system that has improved performance as compared to PVDF/SBR binder based electrodes. This invention will provide a new way to achieve improved results at a much reduced cost.

Cooling improves the writing performance of patients with writer's cramp.

PubMed

Pohl, Christoph; Happe, Jörg; Klockgether, Thomas

2002-11-01

Cooling of hand and forearm muscles by immersion in 15 degrees C cold water for 5 minutes improved the writing performance of patients with writer's cramp. Since abnormal processing of muscle spindle afferent discharges contributes to the pathology of writer's cramp, this effect might result from a reduction in muscle spindle activity by lowering muscle temperature. Cooling is a simple, cheap, and safe procedure, providing temporary relief for patients with writer's cramp. Copyright 2002 Movement Disorder Society

Leveraging Health Care Simulation Technology for Human Factors Research: Closing the Gap Between Lab and Bedside.

PubMed

Deutsch, Ellen S; Dong, Yue; Halamek, Louis P; Rosen, Michael A; Taekman, Jeffrey M; Rice, John

2016-11-01

We describe health care simulation, designed primarily for training, and provide examples of how human factors experts can collaborate with health care professionals and simulationists-experts in the design and implementation of simulation-to use contemporary simulation to improve health care delivery. The need-and the opportunity-to apply human factors expertise in efforts to achieve improved health outcomes has never been greater. Health care is a complex adaptive system, and simulation is an effective and flexible tool that can be used by human factors experts to better understand and improve individual, team, and system performance within health care. Expert opinion is presented, based on a panel delivered during the 2014 Human Factors and Ergonomics Society Health Care Symposium. Diverse simulators, physically or virtually representing humans or human organs, and simulation applications in education, research, and systems analysis that may be of use to human factors experts are presented. Examples of simulation designed to improve individual, team, and system performance are provided, as are applications in computational modeling, research, and lifelong learning. The adoption or adaptation of current and future training and assessment simulation technologies and facilities provides opportunities for human factors research and engineering, with benefits for health care safety, quality, resilience, and efficiency. Human factors experts, health care providers, and simulationists can use contemporary simulation equipment and techniques to study and improve health care delivery. © 2016, Human Factors and Ergonomics Society.

Open source acceleration of wave optics simulations on energy efficient high-performance computing platforms

NASA Astrophysics Data System (ADS)

Beck, Jeffrey; Bos, Jeremy P.

2017-05-01

We compare several modifications to the open-source wave optics package, WavePy, intended to improve execution time. Specifically, we compare the relative performance of the Intel MKL, a CPU based OpenCV distribution, and GPU-based version. Performance is compared between distributions both on the same compute platform and between a fully-featured computing workstation and the NVIDIA Jetson TX1 platform. Comparisons are drawn in terms of both execution time and power consumption. We have found that substituting the Fast Fourier Transform operation from OpenCV provides a marked improvement on all platforms. In addition, we show that embedded platforms offer some possibility for extensive improvement in terms of efficiency compared to a fully featured workstation.

Employee empowerment through team building and use of process control methods.

PubMed

Willems, S

1998-02-01

The article examines the use of statistical process control and performance improvement techniques in employee empowerment. The focus is how these techniques provide employees with information to improve their productivity and become involved in the decision-making process. Findings suggest that at one Mississippi hospital employee improvement has had a positive effect on employee productivity, morale, and quality of work.

77 FR 49653 - Applications for New Awards; Race to the Top-District

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-16

... evaluation data, and student and parent surveys); (4) evaluates principals on a regular basis; (5) provides... on rigorous teacher performance standards, teacher portfolios, and student and parent surveys); (4..., locally directed improvements in learning and teaching that will directly improve student achievement and...

Fast and unbiased estimator of the time-dependent Hurst exponent.

PubMed

Pianese, Augusto; Bianchi, Sergio; Palazzo, Anna Maria

2018-03-01

We combine two existing estimators of the local Hurst exponent to improve both the goodness of fit and the computational speed of the algorithm. An application with simulated time series is implemented, and a Monte Carlo simulation is performed to provide evidence of the improvement.

Fast and unbiased estimator of the time-dependent Hurst exponent

NASA Astrophysics Data System (ADS)

Pianese, Augusto; Bianchi, Sergio; Palazzo, Anna Maria

2018-03-01

We combine two existing estimators of the local Hurst exponent to improve both the goodness of fit and the computational speed of the algorithm. An application with simulated time series is implemented, and a Monte Carlo simulation is performed to provide evidence of the improvement.

Sustainability in the AAP Bronchiolitis Quality Improvement Project.

PubMed

Shadman, Kristin A; Ralston, Shawn L; Garber, Matthew D; Eickhoff, Jens; Mussman, Grant M; Walley, Susan C; Rice-Conboy, Elizabeth; Coller, Ryan J

2017-11-01

Adherence to American Academy of Pediatrics (AAP) bronchiolitis clinical practice guideline recommendations improved significantly through the AAP's multiinstitutional collaborative, the Bronchiolitis Quality Improvement Project (BQIP). We assessed sustainability of improvements at participating institutions for 1 year following completion of the collaborative. Twenty-one multidisciplinary hospital-based teams provided monthly data for key inpatient bronchiolitis measures during baseline and intervention bronchiolitis seasons. Nine sites provided data in the season following completion of the collaborative. Encounters included children younger than 24 months who were hospitalized for bronchiolitis without comorbid chronic illness, prematurity, or intensive care. Changes between baseline-, intervention-, and sustainability-season data were assessed using generalized linear mixed-effects models with site-specific random effects. Differences between hospital characteristics, baseline performance, and initial improvement between sites that did and did not participate in the sustainability season were compared. A total of 2275 discharges were reviewed, comprising 995 baseline, 877 intervention, and 403 sustainability- season encounters. Improvements in all key bronchiolitis quality measures achieved during the intervention season were maintained during the sustainability season, and orders for intermittent pulse oximetry increased from 40.6% (95% confidence interval [CI], 22.8-61.1) to 79.2% (95% CI, 58.0- 91.3). Sites that did and did not participate in the sustainability season had similar characteristics. BQIP participating sites maintained improvements in key bronchiolitis quality measures for 1 year following the project's completion. This approach, which provided an evidence-based best-practice toolkit while building the quality-improvement capacity of local interdisciplinary teams, may support performance gains that persist beyond the active phase of the collaborative. © 2017 Society of Hospital Medicine

The development of an imaging informatics-based multi-institutional platform to support sports performance and injury prevention in track and field

NASA Astrophysics Data System (ADS)

Liu, Joseph; Wang, Ximing; Verma, Sneha; McNitt-Gray, Jill; Liu, Brent

2018-03-01

The main goal of sports science and performance enhancement is to collect video and image data, process them, and quantify the results, giving insight to help athletes improve technique. For long jump in track and field, the processed output of video with force vector overlays and force calculations allow coaches to view specific stages of the hop, step, and jump, and identify how each stage can be improved to increase jump distance. Outputs also provide insight into how athletes can better maneuver to prevent injury. Currently, each data collection site collects and stores data with their own methods. There is no standard for data collection, formats, or storage. Video files and quantified results are stored in different formats, structures, and locations such as Dropbox and hard drives. Using imaging informatics-based principles we can develop a platform for multiple institutions that promotes the standardization of sports performance data. In addition, the system will provide user authentication and privacy as in clinical trials, with specific user access rights. Long jump data collected from different field sites will be standardized into specified formats before database storage. Quantified results from image-processing algorithms are stored similar to CAD algorithm results. The system will streamline the current sports performance data workflow and provide a user interface for athletes and coaches to view results of individual collections and also longitudinally across different collections. This streamlined platform and interface is a tool for coaches and athletes to easily access and review data to improve sports performance and prevent injury.

The Business Value of Superior Energy Performance

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

McKane, Aimee; Scheihing, Paul; Evans, Tracy

Industrial facilities participating in the U.S. Department of Energy’s (US DOE) Superior Energy Performance (SEP) program are finding that it provides them with significant business value. This value starts with the implementation of ISO 50001-Energy management system standard, which provides an internationally-relevant framework for integration of energy management into an organization’s business processes. The resulting structure emphasizes effective use of available data and supports continual improvement of energy performance. International relevance is particularly important for companies with a global presence or trading interests, providing them with access to supporting ISO standards and a growing body of certified companies representing themore » collective knowledge of communities of practice. This paper examines the business value of SEP, a voluntary program that builds on ISO 50001, inviting industry to demonstrate an even greater commitment through third-party verification of energy performance improvement to a specified level of achievement. Information from 28 facilities that have already achieved SEP certification will illustrate key findings concerning both the value and the challenges from SEP/ISO 50001 implementation. These include the facilities’ experience with implementation, internal and external value of third-party verification of energy performance improvement; attractive payback periods and the importance of SEP tools and guidance. US DOE is working to bring the program to scale, including the Enterprise-Wide Accelerator (SEP for multiple facilities in a company), the Ratepayer-Funded Program Accelerator (supporting tools for utilities and program administrators to include SEP in their program offerings), and expansion of the program to other sectors and industry supply chains.« less

Change of the layout of an office of a metallurgical company: simple projects, big solutions.

PubMed

Duarte, Luiz Carlos da Silva; Eckhardt, Moacir; da Motta, Giordano Paulo

2012-01-01

The posture, a good organization and the proper layout of the environment and workplaces have a positive influence on the income of an employee. To develop the work it is used a methodology that addressed the study phases of the theory involving the subject, description of the current situation, preparation of conceptions, choice of design, implementation and reporting of results. Through the project of "Change of the layout of an office of a metallurgical company" there was an intervention in these reported aspects providing improvements in the office, regarding ergonomic, layout, workplace and lighting issues, bringing welfare to the official, with the intent to improve its performance within the company and facilitating its actions, as the company's customer service. The results provided improvements in layout, in the workplace and especially in comfort for the human resources that perform their activities.

Improving the occupational skills of students with intellectual disability by applying video prompting combined with dance pads.

PubMed

Lin, Mei-Lan; Chiang, Ming-Shan; Shih, Ching-Hsiang; Li, Meng-Fang

2018-01-01

Individuals with intellectual disability (ID) are prone to inattention, are slow in learning and reaction, and have deficits in memory skills. Providing proper vocational education and training for individuals with intellectual disability is able to enhance their occupational skills. This study applied video prompting to provide instructional prompts to help participants accurately perform an assigned occupational activity. A control system installed with developed software was used to turn a standard dance pad into a sensor to detect the participants' standing position and to automatically trigger video prompting. The results show that the participants' correct performance of the target behaviour improved significantly after their exposure to the video prompting intervention, and this positive outcome remained consistent during the maintenance phase. Video prompting combined with dance pads was a feasible approach to improving the occupational skills of the three students with intellectual disability. © 2017 John Wiley & Sons Ltd.

Improving limited-projection-angle fluorescence molecular tomography using a co-registered x-ray computed tomography scan.

PubMed

Radrich, Karin; Ale, Angelique; Ermolayev, Vladimir; Ntziachristos, Vasilis

2012-12-01

We examine the improvement in imaging performance, such as axial resolution and signal localization, when employing limited-projection-angle fluorescence molecular tomography (FMT) together with x-ray computed tomography (XCT) measurements versus stand-alone FMT. For this purpose, we employed living mice, bearing a spontaneous lung tumor model, and imaged them with FMT and XCT under identical geometrical conditions using fluorescent probes for cancer targeting. The XCT data was employed, herein, as structural prior information to guide the FMT reconstruction. Gold standard images were provided by fluorescence images of mouse cryoslices, providing the ground truth in fluorescence bio-distribution. Upon comparison of FMT images versus images reconstructed using hybrid FMT and XCT data, we demonstrate marked improvements in image accuracy. This work relates to currently disseminated FMT systems, using limited projection scans, and can be employed to enhance their performance.

Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices.

PubMed

Passerotti, Carlo C; Franco, Felipe; Bissoli, Julio C C; Tiseo, Bruno; Oliveira, Caio M; Buchalla, Carlos A O; Inoue, Gustavo N C; Sencan, Arzu; Sencan, Aydin; do Pardo, Rogerio Ruscitto; Nguyen, Hiep T

2015-07-01

Robotic assistance may provide for distinct technical advantages over conventional laparoscopic technique. The goals of this study were (1) to objectively evaluate the difference in the learning curves by novice and expert surgeons in performing fundamental laparoscopic skills using conventional laparoscopic surgery (CLS) and robotic-assisted laparoscopic surgery (RALS) and (2) to evaluate the surgeons' frustration level in performing these tasks. Twelve experienced and 31 novices in laparoscopy were prospectively evaluated in performing three standardized laparoscopic tasks in five consecutive, weekly training sessions. Analysis of the learning curves was based on the magnitude, rate, and quickness in performance improvement. The participant's frustration and mood were also evaluated during and after every session. For the novice participants, RALS allowed for shorter time to task completion and greater accuracy. However, significant and rapid improvement in performance as measured by magnitude, rate, and quickness at each session was also seen with CLS. For the experienced surgeons, RALS only provided a slight improvement in performance. For all participants, the use of RALS was associated with less number of sessions in which they felt frustrated, less number of frustration episodes during a session, lower frustration score during and after the session, and higher good mood score. The advantages of RALS may be of most benefit when doing more complex tasks and by less experienced surgeons. RALS should not be used as a replacement for CLS but rather in specific situations in which it has the greatest advantages.

Assessment of the USCENTCOM Medical Distribution Structure

PubMed Central

Welser, William; Yoho, Keenan D.; Robbins, Marc; Peltz, Eric; Van Roo, Ben D.; Resnick, Adam C.; Harper, Ronald E.

2012-01-01

Abstract This study examined whether there might be a medical supply and distribution structure for U.S. Central Command (USCENTCOM) that would maintain or improve performance while reducing costs. The authors evaluated the likely performance and cost implications of the range of possibilities, considering both the medical and nonmedical logistics structures, for providing medical supplies to support medical activities in USCENTCOM. They found that three options would preserve or improve performance while either lowering or not increasing costs. Additionally, they considered how the value of these solutions would likely change with future shifts in USCENTCOM operations. PMID:28083245

Driving With Hemianopia VI: Peripheral Prisms and Perceptual-Motor Training Improve Detection in a Driving Simulator

PubMed Central

Houston, Kevin E.; Peli, Eli; Goldstein, Robert B.; Bowers, Alex R.

2018-01-01

Purpose Drivers with homonymous hemianopia (HH) were previously found to have impaired detection of blind-side hazards, yet in many jurisdictions they may obtain a license. We evaluated whether oblique 57Δ peripheral prisms (p-prisms) and perceptual-motor training improved blind-side detection rates. Methods Patients with HH (n = 11) wore p-prisms for 2 weeks and then received perceptual-motor training (six visits) detecting and touching stimuli in the prism-expanded vision. In a driving simulator, patients drove and pressed the horn upon detection of pedestrians who ran toward the roadway (26 from each side): (1) without p-prisms at baseline; (2) with p-prisms after 2 weeks acclimation but before training; (3) with p-prisms after training; and (4) 3 months later. Results P-prisms improved blind-side detection from 42% to 56%, which further improved after training to 72% (all P < 0.001). Blind-side timely responses (adequate time to have stopped) improved from 31% without to 44% with p-prisms (P < 0.001) and further improved with training to 55% (P = 0.02). At the 3-month follow-up, improvements from training were maintained for detection (65%; P = 0.02) but not timely responses (P = 0.725). There was wide between-subject variability in baseline detection performance and response to p-prisms. There were no negative effects of p-prisms on vehicle control or seeing-side performance. Conclusions P-prisms improved detection with no negative effects, and training may provide additional benefit. Translational Relevance In jurisdictions where people with HH are legally driving, these data aid in clinical decision making by providing evidence that p-prisms improve performance without negative effects. PMID:29359111

[Technical background of data collection for parametric observation of total mesorectal excision (TME) in rectal cancer].

PubMed

Bláha, M; Hoch, J; Ferko, A; Ryška, A; Hovorková, E

Improvement in any human activity is preconditioned by inspection of results and providing feedback used for modification of the processes applied. Comparison of experts experience in the given field is another indispensable part leading to optimisation and improvement of processes, and optimally to implementation of standards. For the purpose of objective comparison and assessment of the processes, it is always necessary to describe the processes in a parametric way, to obtain representative data, to assess the achieved results, and to provide unquestionable and data-driven feedback based on such analysis. This may lead to a consensus on the definition of standards in the given area of health care. Total mesorectal excision (TME) is a standard procedure of rectal cancer (C20) surgical treatment. However, the quality of performed procedures varies in different health care facilities, which is given, among others, by internal processes and surgeons experience. Assessment of surgical treatment results is therefore of key importance. A pathologist who assesses the resected tissue can provide valuable feedback in this respect. An information system for the parametric assessment of TME performance is described in our article, including technical background in the form of a multicentre clinical registry and the structure of observed parameters. We consider the proposed system of TME parametric assessment as significant for improvement of TME performance, aimed at reducing local recurrences and at improving the overall prognosis of patients. rectal cancer total mesorectal excision parametric data clinical registries TME registry.

Measuring Integration of Cancer Services to Support Performance Improvement: The CSI Survey

PubMed Central

Dobrow, Mark J.; Paszat, Lawrence; Golden, Brian; Brown, Adalsteinn D.; Holowaty, Eric; Orchard, Margo C.; Monga, Neerav; Sullivan, Terrence

2009-01-01

Objective: To develop a measure of cancer services integration (CSI) that can inform clinical and administrative decision-makers in their efforts to monitor and improve cancer system performance. Methods: We employed a systematic approach to measurement development, including review of existing cancer/health services integration measures, key-informant interviews and focus groups with cancer system leaders. The research team constructed a Web-based survey that was field- and pilot-tested, refined and then formally conducted on a sample of cancer care providers and administrators in Ontario, Canada. We then conducted exploratory factor analysis to identify key dimensions of CSI. Results: A total of 1,769 physicians, other clinicians and administrators participated in the survey, responding to a 67-item questionnaire. The exploratory factor analysis identified 12 factors that were linked to three broader dimensions: clinical, functional and vertical system integration. Conclusions: The CSI Survey provides important insights on a range of typically unmeasured aspects of the coordination and integration of cancer services, representing a new tool to inform performance improvement efforts. PMID:20676250

CUDASW++: optimizing Smith-Waterman sequence database searches for CUDA-enabled graphics processing units

PubMed Central

Liu, Yongchao; Maskell, Douglas L; Schmidt, Bertil

2009-01-01

Background The Smith-Waterman algorithm is one of the most widely used tools for searching biological sequence databases due to its high sensitivity. Unfortunately, the Smith-Waterman algorithm is computationally demanding, which is further compounded by the exponential growth of sequence databases. The recent emergence of many-core architectures, and their associated programming interfaces, provides an opportunity to accelerate sequence database searches using commonly available and inexpensive hardware. Findings Our CUDASW++ implementation (benchmarked on a single-GPU NVIDIA GeForce GTX 280 graphics card and a dual-GPU GeForce GTX 295 graphics card) provides a significant performance improvement compared to other publicly available implementations, such as SWPS3, CBESW, SW-CUDA, and NCBI-BLAST. CUDASW++ supports query sequences of length up to 59K and for query sequences ranging in length from 144 to 5,478 in Swiss-Prot release 56.6, the single-GPU version achieves an average performance of 9.509 GCUPS with a lowest performance of 9.039 GCUPS and a highest performance of 9.660 GCUPS, and the dual-GPU version achieves an average performance of 14.484 GCUPS with a lowest performance of 10.660 GCUPS and a highest performance of 16.087 GCUPS. Conclusion CUDASW++ is publicly available open-source software. It provides a significant performance improvement for Smith-Waterman-based protein sequence database searches by fully exploiting the compute capability of commonly used CUDA-enabled low-cost GPUs. PMID:19416548

Influence of Cleats-Surface Interaction on the Performance and Risk of Injury in Soccer: A Systematic Review

PubMed Central

Macedo, Rui; Montes, António Mesquita

2017-01-01

Objective To review the influence of cleats-surface interaction on the performance and risk of injury in soccer athletes. Design Systematic review. Data Sources Scopus, Web of science, PubMed, and B-on. Eligibility Criteria Full experimental and original papers, written in English that studied the influence of soccer cleats on sports performance and injury risk in artificial or natural grass. Results Twenty-three articles were included in this review: nine related to performance and fourteen to injury risk. On artificial grass, the soft ground model on dry and wet conditions and the turf model in wet conditions are related to worse performance. Compared to rounded studs, bladed ones improve performance during changes of directions in both natural and synthetic grass. Cleat models presenting better traction on the stance leg improve ball velocity while those presenting a homogeneous pressure across the foot promote better kicking accuracy. Bladed studs can be considered less secure by increasing plantar pressure on lateral border. The turf model decrease peak plantar pressure compared to other studded models. Conclusion The soft ground model provides lower performance especially on artificial grass, while the turf model provides a high protective effect in both fields. PMID:28684897

Influence of Cleats-Surface Interaction on the Performance and Risk of Injury in Soccer: A Systematic Review.

PubMed

Silva, Diogo C F; Santos, Rubim; Vilas-Boas, João Paulo; Macedo, Rui; Montes, António Mesquita; Sousa, Andreia S P

2017-01-01

To review the influence of cleats-surface interaction on the performance and risk of injury in soccer athletes. Systematic review. Scopus, Web of science, PubMed, and B-on. Full experimental and original papers, written in English that studied the influence of soccer cleats on sports performance and injury risk in artificial or natural grass. Twenty-three articles were included in this review: nine related to performance and fourteen to injury risk. On artificial grass, the soft ground model on dry and wet conditions and the turf model in wet conditions are related to worse performance. Compared to rounded studs, bladed ones improve performance during changes of directions in both natural and synthetic grass. Cleat models presenting better traction on the stance leg improve ball velocity while those presenting a homogeneous pressure across the foot promote better kicking accuracy. Bladed studs can be considered less secure by increasing plantar pressure on lateral border. The turf model decrease peak plantar pressure compared to other studded models. The soft ground model provides lower performance especially on artificial grass, while the turf model provides a high protective effect in both fields.

The Einstein Suite: A Web-Based Tool for Rapid and Collaborative Engineering Design and Analysis

NASA Technical Reports Server (NTRS)

Palmer, Richard S.

1997-01-01

Taken together the components of the Einstein Suite provide two revolutionary capabilities - they have the potential to change the way engineering and financial engineering are performed by: (1) providing currently unavailable functionality, and (2) providing a 10-100 times improvement over currently available but impractical or costly functionality.

Some Innovative Methods to Improve Profiles Derivation

ERIC Educational Resources Information Center

Pei, Lai Kwan

2008-01-01

As the government aimed to provide appropriate education to all children (No Child Left Behind Act), it is important that the education providers can assess the performance of the students correctly so that they can provide the appropriate education for the students. Profile analysis is a very useful tool to interpret test scores and measure…

[Radiology in managed care environment: opportunities for cost savings in an HMO].

PubMed

Schmidt, C; Mohr, A; Möller, J; Levin-Scherz, J; Heller, M

2003-09-01

A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these initiatives are similar to the reforms to reduce cost and improve quality that are already implemented or proposed within the German healthcare system.

The American Society for Clinical Pathology resident in-service examination: does resident performance provide insight into the effectiveness of clinical pathology education?

PubMed

McKenna, Barbara J

2007-06-01

The resident in-service examination in pathology is an in-training exercise that is taken by virtually all pathology residents in the United States as well as by some participants in Canada, Ireland, and Lebanon. Although all of the anatomic pathology topics in the examination, with only one exception-forensic pathology, show significant improvement in scores over the 4 years of residency training, three areas of clinical pathology training (laboratory administration, clinical chemistry, and microbiology) show significantly lower improvement in performance over the years of residency training. By contrast, transfusion medicine, hematopathology and the special topics section of the examination all demonstrate improved performance by residents over time. While the reason behind these differences must remain speculative at this time, these findings suggest that measures to improve effectiveness in clinical pathology training might be suggested by examining the differences between residency training practices between higher and lower performing areas of clinical pathology.

Real-time Kinematic Positioning of INS Tightly Aided Multi-GNSS Ionospheric Constrained PPP

PubMed Central

Gao, Zhouzheng; Shen, Wenbin; Zhang, Hongping; Niu, Xiaoji; Ge, Maorong

2016-01-01

Real-time Precise Point Positioning (PPP) technique is being widely applied for providing precise positioning services with the significant improvement on satellite precise products accuracy. With the rapid development of the multi-constellation Global Navigation Satellite Systems (multi-GNSS), currently, about 80 navigation satellites are operational in orbit. Obviously, PPP performance is dramatically improved with all satellites compared to that of GPS-only PPP. However, the performance of PPP could be evidently affected by unexpected and unavoidable severe observing environments, especially in the dynamic applications. Consequently, we apply Inertial Navigation System (INS) to the Ionospheric-Constrained (IC) PPP to overcome such drawbacks. The INS tightly aided multi-GNSS IC-PPP model can make full use of GNSS and INS observations to improve the PPP performance in terms of accuracy, availability, continuity, and convergence speed. Then, a set of airborne data is analyzed to evaluate and validate the improvement of multi-GNSS and INS on the performance of IC-PPP. PMID:27470270

Real-time Kinematic Positioning of INS Tightly Aided Multi-GNSS Ionospheric Constrained PPP.

PubMed

Gao, Zhouzheng; Shen, Wenbin; Zhang, Hongping; Niu, Xiaoji; Ge, Maorong

2016-07-29

Real-time Precise Point Positioning (PPP) technique is being widely applied for providing precise positioning services with the significant improvement on satellite precise products accuracy. With the rapid development of the multi-constellation Global Navigation Satellite Systems (multi-GNSS), currently, about 80 navigation satellites are operational in orbit. Obviously, PPP performance is dramatically improved with all satellites compared to that of GPS-only PPP. However, the performance of PPP could be evidently affected by unexpected and unavoidable severe observing environments, especially in the dynamic applications. Consequently, we apply Inertial Navigation System (INS) to the Ionospheric-Constrained (IC) PPP to overcome such drawbacks. The INS tightly aided multi-GNSS IC-PPP model can make full use of GNSS and INS observations to improve the PPP performance in terms of accuracy, availability, continuity, and convergence speed. Then, a set of airborne data is analyzed to evaluate and validate the improvement of multi-GNSS and INS on the performance of IC-PPP.

Exploring the Role of Flow Experience, Learning Performance and Potential Behavior Clusters in Elementary Students' Game-Based Learning

ERIC Educational Resources Information Center

Hsieh, Ya-Hui; Lin, Yi-Chun; Hou, Huei-Tse

2016-01-01

Well-designed game-based learning can provide students with an innovative environment that may enhance students' motivation and engagement in learning and thus improve their learning performance. The purpose of this study was to examine the relationships among elementary school students' flow experience and learning performances. We also…

Evaluation of Teaching Performance of English Courses by Applying Data Envelopment Analysis and Two-Phase Segmentation

ERIC Educational Resources Information Center

Montoneri, Bernard

2013-01-01

Effective teaching performance is a crucial factor contributing to students' learning improvement. Students' ratings of teachers at the end of each semester can indirectly provide valuable information about teachers' performance. This paper selects classes of freshmen students taking a course of English in a university of Taiwan from the academic…

Designing Scholarships to Improve College Success: Final Report on the Performance-Based Scholarship Demonstration

ERIC Educational Resources Information Center

Mayer, Alexander K.; Patel, Reshma; Rudd, Timothy; Ratledge, Alyssa

2015-01-01

Performance-based scholarships have two main goals: (1) to give students more money for college; and (2) to provide incentives for academic progress. MDRC launched the Performance-Based Scholarship (PBS) Demonstration in 2008 to evaluate the effectiveness of these scholarships in a diverse set of states, institutions, and low-income student…

Individual Characteristics and Unit Performance: A Review of Research and Methods

DTIC Science & Technology

1985-02-01

behavioral segments, improves performance. Simu- lation exercises , especially those employing new high-technology devices, provide surrogate...high-technology training simulation exercise MOB Military Occupational Specialty ORTT Operational Readiness Training Test-a field test REALTRAIN A...REAListic TRAINing simulation exercise SAM Surface-to-Air Missile SAT Scholastic Aptitude Test SQT Skill Qualification Test-an Army performance meas

Spring performance tester for miniature extension springs

DOEpatents

Salzbrenner, Bradley; Boyce, Brad

2017-05-16

A spring performance tester and method of testing a spring are disclosed that has improved accuracy and precision over prior art spring testers. The tester can perform static and cyclic testing. The spring tester can provide validation for product acceptance as well as test for cyclic degradation of springs, such as the change in the spring rate and fatigue failure.

Motor Skill Assessment of Children: Is There an Association between Performance-Based, Child-Report, and Parent-Report Measures of Children's Motor Skills?

ERIC Educational Resources Information Center

Kennedy, Johanna; Brown, Ted; Chien, Chi-Wen

2012-01-01

Client-centered practice requires therapists to actively seek the perspectives of children and families. Several assessment tools are available to facilitate this process. However, when evaluating motor skill performance, therapists typically concentrate on performance-based assessment. To improve understanding of the information provided by the…

Dynamic online peer evaluations to improve group assignments in nursing e-learning environment.

PubMed

Adwan, Jehad

2016-06-01

The purpose of this research was to evaluate the use of online peer evaluation forms for online group activities in improving group project outcomes. The investigator developed and used a web-based Google Forms® self and peer evaluation form of 2 group assignments' rubric for junior and senior nursing students. The form covered elements of the assignments including: research activity, analysis of the literature, writing of report, participation in making of presentation, overall contribution to the project, and participation in the weekly group discussions. Items were rated from 1 (did not contribute) to 5 (outstanding contribution) in addition to NA when one activity did not apply. The self and peer evaluation process was conducted twice: once after group assignment 1 and once after group assignment 2. The group assignments final products were done in the form of VoiceThread online presentations that were shared with the rest of the class reflecting the groups' work on a health informatics topic of interest. Data collected as the students completed self and peer evaluations for group assignments 1 and 2. Also, optional comments regarding member performance were collected to add contextual information in addition to ratings. Students received credit for completing the peer evaluations and the grade for the particular assignment was affected by their performance based on peer evaluations of their contributions. Students' peer evaluations showed in a color-coded spreadsheet which enabled the course faculty to view real time results of students' ratings after each assignment. The faculty provided timely and tailored feedback to groups or individuals as needed, using positive feedback and commending high performance while urging struggling individual students and groups to improve lower ratings in specific areas. Comparing evaluations of both assignments, there were statistically significant improvements among all students. The mean scores of the entire sample were skewed toward the higher end of the scale, suggesting an overall high performance group. However, analysis of the lower performing individuals showed consistent and statistically significant improvements in all areas of the evaluation criteria. Anonymous peer evaluation activities and timely faculty feedback in e-Learning environment can be a useful tool to faculty to improve group performance over time by engaging the learners within their groups. Peer evaluations provided real time view of group mid-semester formative evaluations that allowed the faculty to provide timely and tailored feedback on student performance which allowed for better outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Physician groups' use of data from patient experience surveys.

PubMed

Friedberg, Mark W; SteelFisher, Gillian K; Karp, Melinda; Schneider, Eric C

2011-05-01

In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. To examine whether and how physician groups are using patient experience data to improve patient care. During 2008, we conducted semi-structured interviews with the leaders of 72 participating physician groups (out of 117 groups receiving patient experience reports). Based on leaders' responses, we identified three levels of engagement with patient experience reporting: no efforts to improve (level 1), efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and efforts to improve group-wide performance (level 3). Groups' level of engagement and specific efforts to improve patient care. Forty-four group leaders (61%) reported group-wide improvement efforts (level 3), 16 (22%) reported efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and 12 (17%) reported no performance improvement efforts (level 1). Level 3 groups were more likely than others to have an integrated medical group organizational model (84% vs. 31% at level 2 and 33% at level 1; P < 0.005) and to employ the majority of their physicians (69% vs. 25% and 20%; P < 0.05). Among level 3 groups, the most common targets for improvement were access, communication with patients, and customer service. The most commonly reported improvement initiatives were changing office workflow, providing additional training for nonclinical staff, and adopting or enhancing an electronic health record. Despite statewide public reporting, physician groups' use of patient experience data varied widely. Integrated organizational models were associated with greater engagement, and efforts to enhance clinicians' interpersonal skills were uncommon, with groups predominantly focusing on office workflow and support staff.

Rapid core measure improvement through a "business case for quality".

PubMed

Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

2014-01-01

Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

Enhancing and evaluating researcher performance : WisDOT RD&T peer, May 18-20, 2010.

DOT National Transportation Integrated Search

2010-05-01

The peer exchange covered a range of topics related to measuring and improving researcher : performance. On the first day, state panel participants provided overviews of their programs and the : challenges they face in keeping the quality of research...

Improving Student Performance Outcomes and Graduation Rates through Institutional Partnerships

ERIC Educational Resources Information Center

Roggow, Michael J.

2014-01-01

This chapter explores a grant-sponsored program and examines the role of departmental and institutional collaborations in advancing student performance outcomes. It provides a theoretical framework and a description of best practices for ensuring the success of first-generation urban community college students.

Relationship between meaningful work and job performance in nurses.

PubMed

Tong, Ling

2018-04-01

The present study was designed to determine the relationship between meaningful work and job performance, and the impact of meaningful work on nursing care quality. Meaningful work has been suggested as a significant factor affecting job performance, but the relationship has never been studied in nurses in China. A descriptive correlational study was designed to assess the level of meaningful work, tasks, and contextual performance as well as their relationships. We used a stratified random-sampling approach to enrol nurses from hospitals. Multivariate regression analysis was applied to determine the relationship between meaningful work and their demographic data. There were significant, positive relationships between meaningful work and task performance and contextual performance. Education level, work unit, and employment type influenced meaningful work. The work motivation score of the nurses was lower than that of the other 2 dimensions, and a negative work motivation score negatively influenced job performance. Improving meaningful work and providing more support and assistance could improve nurse performance, thereby improving the quality of nursing care. © 2018 John Wiley & Sons Australia, Ltd.

Detection of fatigue cracks by nondestructive testing methods

NASA Technical Reports Server (NTRS)

Anderson, R. T.; Delacy, T. J.; Stewart, R. C.

1973-01-01

The effectiveness was assessed of various NDT methods to detect small tight cracks by randomly introducing fatigue cracks into aluminum sheets. The study included optimizing NDT methods calibrating NDT equipment with fatigue cracked standards, and evaluating a number of cracked specimens by the optimized NDT methods. The evaluations were conducted by highly trained personnel, provided with detailed procedures, in order to minimize the effects of human variability. These personnel performed the NDT on the test specimens without knowledge of the flaw locations and reported on the flaws detected. The performance of these tests was measured by comparing the flaws detected against the flaws present. The principal NDT methods utilized were radiographic, ultrasonic, penetrant, and eddy current. Holographic interferometry, acoustic emission monitoring, and replication methods were also applied on a reduced number of specimens. Generally, the best performance was shown by eddy current, ultrasonic, penetrant and holographic tests. Etching provided no measurable improvement, while proof loading improved flaw detectability. Data are shown that quantify the performances of the NDT methods applied.

Assessing healthcare quality using routine data: evaluating the performance of the national tuberculosis programme in South Africa.

PubMed

McLaren, Zoë M; Sharp, Alana R; Zhou, Jifang; Wasserman, Sean; Nanoo, Ananta

2017-02-01

To assess the performance of healthcare facilities by means of indicators based on guidelines for clinical care of TB, which is likely a good measure of overall facility quality. We assessed quality of care in all public health facilities in South Africa using graphical, correlation and locally weighted kernel regression analysis of routine TB test data. Facility performance falls short of national standards of care. Only 74% of patients with TB provided a second specimen for testing, 18% received follow-up testing and 14% received drug resistance testing. Only resistance testing rates improved over time, tripling between 2004 and 2011. National awareness campaigns and changes in clinical guidelines had only a transient impact on testing rates. The poorest performing facilities remained at the bottom of the rankings over the period of study. The optimal policy strategy requires both broad-based policies and targeted resources to poor performers. This approach to assessing facility quality of care can be adapted to other contexts and also provides a low-cost method for evaluating the effectiveness of proposed interventions. Devising targeted policies based on routine data is a cost-effective way to improve the quality of public health care provided. © 2016 John Wiley & Sons Ltd.

Importance and performance of managerial skills in the Australian aged care sector - a middle managers' perspective.

PubMed

Meissner, Ellen; Radford, Katrina

2015-09-01

This study examined the importance and performance of middle managers' skills to provide a starting point for a sector-wide leadership and management framework. There is an increasing consensus that the quality of management, leadership and performance of any organisation is directly linked to the capabilities of its middle managers and the preparation and on-going training they receive. A total of 199 middle managers from three aged care organisations in Australia participated in a questionnaire conducted during 2010-2011. This study found that middle managers perceived the need to develop their communication skills, self-awareness, change management, conflict resolution and leadership skills. Middle managers perceive a discrepancy between performance and importance of various managerial skills. This study demonstrated that provision of training needs to go beyond clinical skills development and further investigation into managers' needs is necessary, particularly considering the diversity of this critical group in organisations. Future training opportunities provided to middle managers need to address the 'softer' skills (e.g. communication) rather than 'technical' skills (e.g. clinical skills). The provision of training in these skills may improve their performance, which may also lead to increased job satisfaction, continuity in leadership and management and ultimately improvements in the quality of care provided. © 2014 John Wiley & Sons Ltd.

Practice-based learning can improve osteoporosis care.

PubMed

Hess, Brian J; Johnston, Mary M; Iobst, William F; Lipner, Rebecca S

2013-10-01

To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis. Retrospective cohort study. Internal medicine and subspecialty clinics. Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty. Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review. Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement. Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Quality Physical Education. NASPE Resource Brief

ERIC Educational Resources Information Center

National Association for Sport and Physical Education, 2013

2013-01-01

A quality physical education program provides learning opportunities, appropriate instruction, meaningful and challenging content, and student and program assessment. In addition, a quality physical education improves mental alertness, academic performance, and readiness and enthusiasm for learning in the nation's youth. This brief provides a list…

Modeling Enclosure Design in Above-Grade Walls

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

Lstiburek, J.; Ueno, K.; Musunuru, S.

2016-03-01

This report describes the modeling of typical wall assemblies that have performed well historically in various climate zones. The WUFI (Warme und Feuchte instationar) software (Version 5.3) model was used. A library of input data and results are provided. The provided information can be generalized for application to a broad population of houses, within the limits of existing experience. The WUFI software model was calibrated or tuned using wall assemblies with historically successful performance. The primary performance criteria or failure criteria establishing historic performance was moisture content of the exterior sheathing. The primary tuning parameters (simulation inputs) were airflow andmore » specifying appropriate material properties. Rational hygric loads were established based on experience - specifically rain wetting and interior moisture (RH levels). The tuning parameters were limited or bounded by published data or experience. The WUFI templates provided with this report supply useful information resources to new or less-experienced users. The files present various custom settings that will help avoid results that will require overly conservative enclosure assemblies. Overall, better material data, consistent initial assumptions, and consistent inputs among practitioners will improve the quality of WUFI modeling, and improve the level of sophistication in the field.« less

Can a virtual reality surgical simulation training provide a self-driven and mentor-free skills learning? Investigation of the practical influence of the performance metrics from the virtual reality robotic surgery simulator on the skill learning and associated cognitive workloads.

PubMed

Lee, Gyusung I; Lee, Mija R

2018-01-01

While it is often claimed that virtual reality (VR) training system can offer self-directed and mentor-free skill learning using the system's performance metrics (PM), no studies have yet provided evidence-based confirmation. This experimental study investigated what extent to which trainees achieved their self-learning with a current VR simulator and whether additional mentoring improved skill learning, skill transfer and cognitive workloads in robotic surgery simulation training. Thirty-two surgical trainees were randomly assigned to either the Control-Group (CG) or Experiment-Group (EG). While the CG participants reviewed the PM at their discretion, the EG participants had explanations about PM and instructions on how to improve scores. Each subject completed a 5-week training using four simulation tasks. Pre- and post-training data were collected using both a simulator and robot. Peri-training data were collected after each session. Skill learning, time spent on PM (TPM), and cognitive workloads were compared between groups. After the simulation training, CG showed substantially lower simulation task scores (82.9 ± 6.0) compared with EG (93.2 ± 4.8). Both groups demonstrated improved physical model tasks performance with the actual robot, but the EG had a greater improvement in two tasks. The EG exhibited lower global mental workload/distress, higher engagement, and a better understanding regarding using PM to improve performance. The EG's TPM was initially long but substantially shortened as the group became familiar with PM. Our study demonstrated that the current VR simulator offered limited self-skill learning and additional mentoring still played an important role in improving the robotic surgery simulation training.

Project officer's perspective: quality assurance as a management tool.

PubMed

Heiby, J

1993-06-01

Advances in the management of health programs in less developed countries (LDC) have not kept pace with the progress of the technology used. The US Agency for International Development mandated the Quality Assurance Project (QAP) to provide quality improvement technical assistance to primary health care systems in LDCs while developing appropriate quality assurance (QA) strategies. The quality of health care in recent years in the US and Europe focused on the introduction of management techniques developed for industry into health systems. The experience of the QAP and its predecessor, the PRICOR Project, shows that quality improvement techniques facilitate measurement of quality of care. A recently developed WHO model for the management of the sick child provides scientifically based standards for actual care. Since 1988, outside investigators measuring how LDC clinicians perform have revealed serious deficiencies in quality compared with the program's own standards. This prompted developed of new QA management initiatives: 1) communicating standards clearly to the program staff; 2) actively monitoring actual performance corresponds to these standards; and 3) taking action to improve performance. QA means that managers are expected to monitor service delivery, undertake problem solving, and set specific targets for quality improvement. Quality improvement methods strengthen supervision as supervisors can objectively assess health worker performance. QA strengthens the management functions that support service delivery, e.g., training, records management, finance, logistics, and supervision. Attention to quality can contribute to improved health worker motivation and effective incentive programs by recognition for a job well done and opportunities for learning new skills. These standards can also address patient satisfaction. QA challenges managers to aim for the optimal level of care attainable.

The effect of a loss of model structural detail due to network skeletonization on contamination warning system design: case studies.

PubMed

Davis, Michael J; Janke, Robert

2018-01-04

The effect of limitations in the structural detail available in a network model on contamination warning system (CWS) design was examined in case studies using the original and skeletonized network models for two water distribution systems (WDSs). The skeletonized models were used as proxies for incomplete network models. CWS designs were developed by optimizing sensor placements for worst-case and mean-case contamination events. Designs developed using the skeletonized network models were transplanted into the original network model for evaluation. CWS performance was defined as the number of people who ingest more than some quantity of a contaminant in tap water before the CWS detects the presence of contamination. Lack of structural detail in a network model can result in CWS designs that (1) provide considerably less protection against worst-case contamination events than that obtained when a more complete network model is available and (2) yield substantial underestimates of the consequences associated with a contamination event. Nevertheless, CWSs developed using skeletonized network models can provide useful reductions in consequences for contaminants whose effects are not localized near the injection location. Mean-case designs can yield worst-case performances similar to those for worst-case designs when there is uncertainty in the network model. Improvements in network models for WDSs have the potential to yield significant improvements in CWS designs as well as more realistic evaluations of those designs. Although such improvements would be expected to yield improved CWS performance, the expected improvements in CWS performance have not been quantified previously. The results presented here should be useful to those responsible for the design or implementation of CWSs, particularly managers and engineers in water utilities, and encourage the development of improved network models.

The effect of a loss of model structural detail due to network skeletonization on contamination warning system design: case studies

NASA Astrophysics Data System (ADS)

Davis, Michael J.; Janke, Robert

2018-05-01

The effect of limitations in the structural detail available in a network model on contamination warning system (CWS) design was examined in case studies using the original and skeletonized network models for two water distribution systems (WDSs). The skeletonized models were used as proxies for incomplete network models. CWS designs were developed by optimizing sensor placements for worst-case and mean-case contamination events. Designs developed using the skeletonized network models were transplanted into the original network model for evaluation. CWS performance was defined as the number of people who ingest more than some quantity of a contaminant in tap water before the CWS detects the presence of contamination. Lack of structural detail in a network model can result in CWS designs that (1) provide considerably less protection against worst-case contamination events than that obtained when a more complete network model is available and (2) yield substantial underestimates of the consequences associated with a contamination event. Nevertheless, CWSs developed using skeletonized network models can provide useful reductions in consequences for contaminants whose effects are not localized near the injection location. Mean-case designs can yield worst-case performances similar to those for worst-case designs when there is uncertainty in the network model. Improvements in network models for WDSs have the potential to yield significant improvements in CWS designs as well as more realistic evaluations of those designs. Although such improvements would be expected to yield improved CWS performance, the expected improvements in CWS performance have not been quantified previously. The results presented here should be useful to those responsible for the design or implementation of CWSs, particularly managers and engineers in water utilities, and encourage the development of improved network models.

Using Electronic Assessment Systems to Enhance Instruction

ERIC Educational Resources Information Center

Domagala, Jospeh F.

2017-01-01

Teachers in the classroom need to be able to modify instruction in a meaningful way that helps students to improve academically. School districts provide electronic assessment data which helps teachers identify areas for improvement within their instruction. Electronic performance assessment systems can be an effective means of assisting schools…

Improving Access to Data While Protecting Confidentiality: Prospects for the Future.

ERIC Educational Resources Information Center

Duncan, George T.; Pearson, Robert W.

Providing researchers, especially those in the social sciences, with access to publicly collected microdata furthers research while advancing public policy goals in a democratic society. However, while technological improvements have eased remote access to these databases and enabled computer using researchers to perform sophisticated statistical…

Minding Their Business: What Employers Look for in School-to-Career Programs.

ERIC Educational Resources Information Center

Kazis, Richard

1999-01-01

Besides providing work experiences, employers can help educators improve student performance by influencing public-policy decisions and changing their own employment policies. Employers' reasons for participating in work-based-learning programs include philanthropic interest, particular labor needs, and desire to improve a community's labor…

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

ERIC Educational Resources Information Center

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

2010-01-01

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

Spatial image modulation to improve performance of computed tomography imaging spectrometer

NASA Technical Reports Server (NTRS)

Bearman, Gregory H. (Inventor); Wilson, Daniel W. (Inventor); Johnson, William R. (Inventor)

2010-01-01

Computed tomography imaging spectrometers ("CTIS"s) having patterns for imposing spatial structure are provided. The pattern may be imposed either directly on the object scene being imaged or at the field stop aperture. The use of the pattern improves the accuracy of the captured spatial and spectral information.

The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand.

PubMed

Turner, Nikki M; Charania, Nadia A; Chong, Angela; Stewart, Joanna; Taylor, Lynn

2017-01-01

Immunisation coverage rates vary considerably at the local level across New Zealand and challenges remain with effectively translating best available research evidence into public health practice. This study aimed to translate best practices from high performing general practices into strategies to improve childhood immunisation coverage among low performing practices. An intervention study was undertaken of general practices with low immunisation coverage rates and a high percentage of the enrolled population being of Māori ethnicity. Intervention groups received customised action plans and support for a 12 month period while control groups received 'business as usual' support. Structured interviews were conducted with key informants from all participating practices to understand current aspects related to childhood immunisation delivery and surveys were conducted to understand how the intervention worked. Collected data were thematically analysed. Ten sites were randomised to either intervention ( n  = 6) or control group ( n  = 4). Positive aspects of childhood immunisation delivery included high prioritisation at the practice and staff being pro-immunisation and knowledgeable. Key challenges experienced included inaccurate family contact information and discrepancies with referral processes to other providers. Other challenges noted were building rapport with families and vaccine hesitancy. The action plans included various strategies aimed to improve processes at the practice, contact and engagement with parents, and partnership development with local service providers. Creating customised action plans and providing support to providers were considered as helpful approaches when attempting to improve childhood immunisation coverage rates. Our study supports the notion that one strategy will not solely by itself improve childhood immunisation rates and highlights the importance of having a toolkit of strategies from which to draw from.

Improved probabilistic inference as a general learning mechanism with action video games.

PubMed

Green, C Shawn; Pouget, Alexandre; Bavelier, Daphne

2010-09-14

Action video game play benefits performance in an array of sensory, perceptual, and attentional tasks that go well beyond the specifics of game play [1-9]. That a training regimen may induce improvements in so many different skills is notable because the majority of studies on training-induced learning report improvements on the trained task but limited transfer to other, even closely related, tasks ([10], but see also [11-13]). Here we ask whether improved probabilistic inference may explain such broad transfer. By using a visual perceptual decision making task [14, 15], the present study shows for the first time that action video game experience does indeed improve probabilistic inference. A neural model of this task [16] establishes how changing a single parameter, namely the strength of the connections between the neural layer providing the momentary evidence and the layer integrating the evidence over time, captures improvements in action-gamers behavior. These results were established in a visual, but also in a novel auditory, task, indicating generalization across modalities. Thus, improved probabilistic inference provides a general mechanism for why action video game playing enhances performance in a wide variety of tasks. In addition, this mechanism may serve as a signature of training regimens that are likely to produce transfer of learning. Copyright © 2010 Elsevier Ltd. All rights reserved.

Evaluating brain-computer interface performance using color in the P300 checkerboard speller.

PubMed

Ryan, D B; Townsend, G; Gates, N A; Colwell, K; Sellers, E W

2017-10-01

Current Brain-Computer Interface (BCI) systems typically flash an array of items from grey to white (GW). The objective of this study was to evaluate BCI performance using uniquely colored stimuli. In addition to the GW stimuli, the current study tested two types of color stimuli (grey to color [GC] and color intensification [CI]). The main hypotheses were that in a checkboard paradigm, unique color stimuli will: (1) increase BCI performance over the standard GW paradigm; (2) elicit larger event-related potentials (ERPs); and, (3) improve offline performance with an electrode selection algorithm (i.e., Jumpwise). Online results (n=36) showed that GC provides higher accuracy and information transfer rate than the CI and GW conditions. Waveform analysis showed that GC produced higher amplitude ERPs than CI and GW. Information transfer rate was improved by the Jumpwise-selected channel locations in all conditions. Unique color stimuli (GC) improved BCI performance and enhanced ERPs. Jumpwise-selected electrode locations improved offline performance. These results show that in a checkerboard paradigm, unique color stimuli increase BCI performance, are preferred by participants, and are important to the design of end-user applications; thus, could lead to an increase in end-user performance and acceptance of BCI technology. Copyright © 2017 International Federation of Clinical Neurophysiology. All rights reserved.

A neural network controller for automated composite manufacturing

NASA Technical Reports Server (NTRS)

Lichtenwalner, Peter F.

1994-01-01

At McDonnell Douglas Aerospace (MDA), an artificial neural network based control system has been developed and implemented to control laser heating for the fiber placement composite manufacturing process. This neurocontroller learns an approximate inverse model of the process on-line to provide performance that improves with experience and exceeds that of conventional feedback control techniques. When untrained, the control system behaves as a proportional plus integral (PI) controller. However after learning from experience, the neural network feedforward control module provides control signals that greatly improve temperature tracking performance. Faster convergence to new temperature set points and reduced temperature deviation due to changing feed rate have been demonstrated on the machine. A Cerebellar Model Articulation Controller (CMAC) network is used for inverse modeling because of its rapid learning performance. This control system is implemented in an IBM compatible 386 PC with an A/D board interface to the machine.

Tracking accuracy assessment for concentrator photovoltaic systems

NASA Astrophysics Data System (ADS)

Norton, Matthew S. H.; Anstey, Ben; Bentley, Roger W.; Georghiou, George E.

2010-10-01

The accuracy to which a concentrator photovoltaic (CPV) system can track the sun is an important parameter that influences a number of measurements that indicate the performance efficiency of the system. This paper presents work carried out into determining the tracking accuracy of a CPV system, and illustrates the steps involved in gaining an understanding of the tracking accuracy. A Trac-Stat SL1 accuracy monitor has been used in the determination of pointing accuracy and has been integrated into the outdoor CPV module test facility at the Photovoltaic Technology Laboratories in Nicosia, Cyprus. Results from this work are provided to demonstrate how important performance indicators may be presented, and how the reliability of results is improved through the deployment of such accuracy monitors. Finally, recommendations on the use of such sensors are provided as a means to improve the interpretation of real outdoor performance.

Units of Distinction: Creating a Blueprint for Recognition of High-Performing Medical-Surgical Nursing Units.

PubMed

Jeffery, Alvin D; Mosier, Sammie; Baker, Allison; Korwek, Kimberly; Borum, Cindy; Englebright, Jane

2018-02-01

Hospital medical-surgical (M/S) nursing units are responsible for up to 28 million encounters annually, yet receive little attention from professional organizations and national initiatives targeted to improve quality and performance. We sought to develop a framework recognizing high-performing units within our large hospital system. This was a retrospective data analysis of M/S units throughout a 168-hospital system. Measures represented patient experience, employee engagement, staff scheduling, nursing-sensitive patient outcomes, professional practices, and clinical process measures. Four hundred ninety units from 129 hospitals contributed information to test the framework. A manual scoring system identified the top 5% and recognized them as a "Unit of Distinction." Secondary analyses with machine learning provided validation of the proposed framework. Similar to external recognition programs, this framework and process provide a holistic evaluation useful for meaningful recognition and lay the groundwork for benchmarking in improvement efforts.

Statewide health information: a tool for improving hospital accountability.

PubMed

Epstein, M H; Kurtzig, B S

1994-07-01

By early 1994, 38 states had invested in data collection, analysis, and dissemination on the use, cost, effectiveness, and performance of hospitals. States use these data to control costs, encourage prudent purchasing, monitor effectiveness and outcomes of health care, guide health policy, and promote informed decision making. Experience in several states suggests that public release of hospital-specific data influences hospital performance. The value of state data organizations' databases to address issues of quality and accountability can be strengthened by ensuring the stability and growth of statewide health information systems, supporting research on information dissemination techniques, and promoting comparisons among hospitals. Information to measure provider performance must be placed in the public domain--to help ensure prudent and cost-effective health care purchasing and to give providers comparable information for improvement of care. State-level health databases are an essential component of the information infrastructure needed to support health reform.

Performance measurement for ambulatory care: moving towards a new agenda.

PubMed

Roski, J; Gregory, R

2001-12-01

Despite a shift in care delivery from inpatient to ambulatory care, performance measurement efforts for the different levels in ambulatory care settings such as individual physicians, individual clinics and physician organizations have not been widely instituted in the United States (U.S.). The Health Plan Employer Data and Information Set (HEDIS), the most widely used performance measurement set in the U.S., includes a number of measures that evaluate preventive and chronic care provided in ambulatory care facilities. While HEDIS has made important contributions to the tracking of ambulatory care quality, it is becoming increasingly apparent that the measurement set could be improved by providing quality of care information at the levels of greatest interest to consumers and purchasers of care, namely for individual physicians, clinics and physician organizations. This article focuses on the improvement opportunities for quality performance measurement systems in ambulatory care. Specific challenges to creating a sustainable performance measurement system at the level of physician organizations, such as defining the purpose of the system, the accountability logic, information and reporting needs and mechanisms for sustainable implementation, are discussed.

Age and automation interact to influence performance of a simulated luggage screening task.

PubMed

Wiegmann, Douglas; McCarley, Jason S; Kramer, Arthur F; Wickens, Christopher D

2006-08-01

An experiment examined the impact of automation on young and old adults' abilities to detect threat objects in a simulated baggage-screening task. Younger and older adult participants viewed X-ray images of cluttered baggage, 20% of which contained a hidden knife. Some participants were provided an automated aid with a hit rate of 0.90 and a false alarm rate of 0.25. The aid provided assistance to participants in one of three forms: a text message that appeared before the stimulus image; a text message that appeared following the stimulus image; or a spatial cue concurrent with the stimulus image. Control participants performed the task with no assistance from an aid. Spatial cuing improved performance for both age groups. Text cuing improved young adults' performance, but had no benefit for older participants. Effects were similar whether the text cue preceded or followed the search stimulus itself. Results indicate that spatial cuing rather than text alerts may be more effective in aiding performance during a baggage screening task and such benefits are likely to occur regardless of operator age.

Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

PubMed

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

Effect of Olympic and traditional resistance training on vertical jump improvement in high school boys.

PubMed

Channell, Brian T; Barfield, J P

2008-09-01

The purpose of this study was to compare the effects of a ballistic resistance training program of Olympic lifts with those of a traditional resistance training program of power lifts on vertical jump improvement in male high school athletes. Twenty-seven male student athletes were recruited from a high school football program at a small, rural school in the Southeast. The subjects were divided into an Olympic training group (OT, n = 11), a power training group (PT, n = 10), and a control group (n = 6). Analysis of variance was used to determine whether a significant mean difference existed among groups on vertical jump improvement after 8 weeks of group-specific training. Effect size of vertical jump improvement between groups, and correlations between strength and vertical jump performance, were also examined. There was no significant mean difference (p >or= 0.05) among OT, PT, and control groups, but large effect sizes between OT and control (d = 1.06) and PT and control (d = 0.94) demonstrate that both OT and PT are effective in improving vertical jump performance in male high school athletes. Moderate to high correlations were noted between squat score and vertical jump after adjusting for body weight (r = 0.42) and between power clean and vertical jump after adjusting for body weight (r = 0.75). Findings from the current study indicate that Olympic lifts as well as power lifts provide improvement in vertical jump performance and that Olympic lifts may provide a modest advantage over power lifts for vertical jump improvement in high school athletes.

A Spike Cocktail Approach to Improve Microbial Performance Monitoring for Water Reuse.

PubMed

Zimmerman, Brian D; Korajkic, Asja; Brinkman, Nichole E; Grimm, Ann C; Ashbolt, Nicholas J; Garland, Jay L

  Water reuse, via either centralized treatment of traditional wastewater or decentralized treatment and on-site reuse, is becoming an increasingly important element of sustainable water management. Despite advances in waterborne pathogen detection methods, low and highly variable pathogen levels limit their utility for routine evaluation of health risks in water reuse systems. Therefore, there is a need to improve our understanding of the linkage between pathogens and more readily measured process indicators during treatment. This paper describes an approach for constructing spiking experiments to relate the behavior of viral, bacterial, and protozoan pathogens with relevant process indicators. General issues are reviewed, and the spiking protocol is applied as a case study example to improve microbial performance monitoring and health risk evaluation in a water reuse system. This approach provides a foundation for the development of novel approaches to improve real or near-real time performance monitoring of water recycling systems.

Optimisation of Healthcare Contracts: Tensions Between Standardisation and Innovation

PubMed Central

Mikkers, Misja; Ryan, Padhraig

2016-01-01

An important determinant of health system performance is contracting. Providers often respond to financial incentives, despite the ethical underpinnings of medicine, and payers can craft contracts to influence performance. Yet contracting is highly imperfect in both single-payer and multi-payer health systems. Arguably, in a competitive, multi-payer environment, contractual innovation may occur more rapidly than in a single-payer system. This innovation in contract design could enhance performance. However, contractual innovation often fails to improve performance as payer incentives are misaligned with public policy objectives. Numerous countries seek to improve healthcare contracts, but thus far no health system has demonstrably crafted the necessary blend of incentives to stimulate optimal contracting. PMID:26927400

Neural predictors of individual differences in response to math tutoring in primary-grade school children

PubMed Central

Supekar, Kaustubh; Swigart, Anna G.; Tenison, Caitlin; Jolles, Dietsje D.; Rosenberg-Lee, Miriam; Fuchs, Lynn; Menon, Vinod

2013-01-01

Now, more than ever, the ability to acquire mathematical skills efficiently is critical for academic and professional success, yet little is known about the behavioral and neural mechanisms that drive some children to acquire these skills faster than others. Here we investigate the behavioral and neural predictors of individual differences in arithmetic skill acquisition in response to 8-wk of one-to-one math tutoring. Twenty-four children in grade 3 (ages 8–9 y), a critical period for acquisition of basic mathematical skills, underwent structural and resting-state functional MRI scans pretutoring. A significant shift in arithmetic problem-solving strategies from counting to fact retrieval was observed with tutoring. Notably, the speed and accuracy of arithmetic problem solving increased with tutoring, with some children improving significantly more than others. Next, we examined whether pretutoring behavioral and brain measures could predict individual differences in arithmetic performance improvements with tutoring. No behavioral measures, including intelligence quotient, working memory, or mathematical abilities, predicted performance improvements. In contrast, pretutoring hippocampal volume predicted performance improvements. Furthermore, pretutoring intrinsic functional connectivity of the hippocampus with dorsolateral and ventrolateral prefrontal cortices and the basal ganglia also predicted performance improvements. Our findings provide evidence that individual differences in morphometry and connectivity of brain regions associated with learning and memory, and not regions typically involved in arithmetic processing, are strong predictors of responsiveness to math tutoring in children. More generally, our study suggests that quantitative measures of brain structure and intrinsic brain organization can provide a more sensitive marker of skill acquisition than behavioral measures. PMID:23630286

Neural predictors of individual differences in response to math tutoring in primary-grade school children.

PubMed

Supekar, Kaustubh; Swigart, Anna G; Tenison, Caitlin; Jolles, Dietsje D; Rosenberg-Lee, Miriam; Fuchs, Lynn; Menon, Vinod

2013-05-14

Now, more than ever, the ability to acquire mathematical skills efficiently is critical for academic and professional success, yet little is known about the behavioral and neural mechanisms that drive some children to acquire these skills faster than others. Here we investigate the behavioral and neural predictors of individual differences in arithmetic skill acquisition in response to 8-wk of one-to-one math tutoring. Twenty-four children in grade 3 (ages 8-9 y), a critical period for acquisition of basic mathematical skills, underwent structural and resting-state functional MRI scans pretutoring. A significant shift in arithmetic problem-solving strategies from counting to fact retrieval was observed with tutoring. Notably, the speed and accuracy of arithmetic problem solving increased with tutoring, with some children improving significantly more than others. Next, we examined whether pretutoring behavioral and brain measures could predict individual differences in arithmetic performance improvements with tutoring. No behavioral measures, including intelligence quotient, working memory, or mathematical abilities, predicted performance improvements. In contrast, pretutoring hippocampal volume predicted performance improvements. Furthermore, pretutoring intrinsic functional connectivity of the hippocampus with dorsolateral and ventrolateral prefrontal cortices and the basal ganglia also predicted performance improvements. Our findings provide evidence that individual differences in morphometry and connectivity of brain regions associated with learning and memory, and not regions typically involved in arithmetic processing, are strong predictors of responsiveness to math tutoring in children. More generally, our study suggests that quantitative measures of brain structure and intrinsic brain organization can provide a more sensitive marker of skill acquisition than behavioral measures.

A statistical model for predicting muscle performance

NASA Astrophysics Data System (ADS)

Byerly, Diane Leslie De Caix

The objective of these studies was to develop a capability for predicting muscle performance and fatigue to be utilized for both space- and ground-based applications. To develop this predictive model, healthy test subjects performed a defined, repetitive dynamic exercise to failure using a Lordex spinal machine. Throughout the exercise, surface electromyography (SEMG) data were collected from the erector spinae using a Mega Electronics ME3000 muscle tester and surface electrodes placed on both sides of the back muscle. These data were analyzed using a 5th order Autoregressive (AR) model and statistical regression analysis. It was determined that an AR derived parameter, the mean average magnitude of AR poles, significantly correlated with the maximum number of repetitions (designated Rmax) that a test subject was able to perform. Using the mean average magnitude of AR poles, a test subject's performance to failure could be predicted as early as the sixth repetition of the exercise. This predictive model has the potential to provide a basis for improving post-space flight recovery, monitoring muscle atrophy in astronauts and assessing the effectiveness of countermeasures, monitoring astronaut performance and fatigue during Extravehicular Activity (EVA) operations, providing pre-flight assessment of the ability of an EVA crewmember to perform a given task, improving the design of training protocols and simulations for strenuous International Space Station assembly EVA, and enabling EVA work task sequences to be planned enhancing astronaut performance and safety. Potential ground-based, medical applications of the predictive model include monitoring muscle deterioration and performance resulting from illness, establishing safety guidelines in the industry for repetitive tasks, monitoring the stages of rehabilitation for muscle-related injuries sustained in sports and accidents, and enhancing athletic performance through improved training protocols while reducing injury.

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

Turner, Tom; Watson, Stuart

This paper describes how the level of environmental sustainability at the Solid Waste Processing plant at Research Sites Restoration Ltd (RSRL) Harwell was measured and improved. It provides reasons to improve environmental performance in an organisation, states best practice on how improvement should be conducted, and gives first-hand experience on how changes were implemented. In this paper sustainability is defined as 'meeting the needs of the present without compromising the ability of future generations to meet their own needs'. A baseline for environmental sustainability was created, by looking at multiple attributes. From this, a matrix was created to show howmore » the baseline environmental performance compared to best practice, and a gap analysis was performed. Results from this analysis showed areas for potential systematic improvement, and actions were created. Nearly all actions were implemented within one year, and environmental sustainability improved significantly. Most improvements cost no money to implement, and the few that did had to pass criteria in a business case. Results from a company-wide survey showed that the vast majority of employees felt that environmental issues were important, and that they were willing to help improve performance. Environmental awareness training was given to everyone in the department, and individuals were given measurable improvement targets. A focus group was set up and met regularly to agree improvements and monitor results. Environmental performance was publicised regularly to highlight successes and seek further engagement and improvement. Improvement ideas were encouraged and managed in a transparent way which showed clear prioritisation and accountability. The culture of environmental improvement changed visibly and results at the end of the first year showed that electricity consumption had reduced by 12.5%, and gas consumption had reduced by 7.3%. In less than two years over UK Pound 60,000 was saved on utility bills in the Waste Processing Plant. (authors)« less

Do mobile clinics provide high-quality antenatal care? A comparison of care delivery, knowledge outcomes and perception of quality of care between fixed and mobile clinics in central Haiti.

PubMed

Phillips, Erica; Stoltzfus, Rebecca J; Michaud, Lesly; Pierre, Gracia Lionel Fils; Vermeylen, Francoise; Pelletier, David

2017-10-16

Antenatal care (ANC) is an important health service for women in developing countries, with numerous proven benefits. Global coverage of ANC has steadily increased over the past 30 years, in part due to increased community-based outreach. However, commensurate improvements in health outcomes such as reductions in the prevalence of maternal anemia and infants born small-for-gestational age have not been achieved, even with increased coverage, indicating that quality of care may be inadequate. Mobile clinics are one community-based strategy used to further improve coverage of ANC, but their quality of care delivery has rarely been evaluated. To determine the quality of care of ANC in central Haiti, we compared adherence to national guidelines between fixed and mobile clinics by performing direct observations of antenatal care consultations and exit interviews with recipients of care using a multi-stage random sampling procedure. Outcome variables were eight components of care, and women's knowledge and perception of care quality. There were significant differences in the predicted proportion or probability of recommended services for four of eight care components, including intake, laboratory examinations, infection control, and supplies, iron folic acid supplements and Tetanus Toxoid vaccine provided to women. These care components were more likely performed in fixed clinics, except for distribution of supplies, iron-folic acid supplements, and Tetanus Toxoid vaccine, more likely provided in mobile clinics. There were no differences between clinic type for the proportion of total physical exam procedures performed, health and communication messages delivered, provider communication or documentation. Women's knowledge about educational topics was poor, but women perceived extremely high quality of care in both clinic models. Although adherence to guidelines differed by clinic type for half of the care components, both clinics had a low percentage of overall services delivered. Efforts to improve provider performance and quality are therefore needed in both models. Mobile clinics must deliver high-quality ANC to improve health and nutrition outcomes.

Enabling the use of enhanced medical SOPs by an mLearning training solution.

PubMed

Papakonstantinou, Despina; Poulymenopoulou, Mikaela; Malamateniou, Flora; Vassilacopoulos, George

2013-01-01

Standard Operating Procedures (SOPs) has been introduced as a way to provide direction, improve communication, reduce training time and improve work consistency. In healthcare, SOPs may be considered as a means that can fundamentally change the way healthcare is provided, affecting all types of healthcare stakeholders and improving healthcare decisions and patient safety. Nowadays, providing ehealth services is a necessity, even though some healthcare organizations are reluctant to fully use them. An online mobile training facility embedded within ehealth services may increase the likelihood of their adoption by healthcare professionals, who feel that, when needed, they are provided the necessary support for performing each task, as handheld devices and other mobile technologies are showing increased adoption rates. This paper presents a mobile service that provides training content on SOPs, that can be embedded in a relevant ehealth service and can be accessed by authorized healthcare professionals where and when needed.

Using spatialized sound cues in an auditorily rich environment

NASA Astrophysics Data System (ADS)

Brock, Derek; Ballas, James A.; Stroup, Janet L.; McClimens, Brian

2004-05-01

Previous Navy research has demonstrated that spatialized sound cues in an otherwise quiet setting are useful for directing attention and improving performance by 16.8% or more in the decision component of a complex dual-task. To examine whether the benefits of this technique are undermined in the presence of additional, unrelated sounds, a background recording of operations in a Navy command center and a voice communications response task [Bolia et al., J. Acoust. Soc. Am. 107, 1065-1066 (2000)] were used to simulate the conditions of an auditorily rich military environment. Without the benefit of spatialized sound cues, performance in the presence of this extraneous auditory information, as measured by decision response times, was an average of 13.6% worse than baseline performance in an earlier study. Performance improved when the cues were present by an average of 18.3%, but this improvement remained below the improvement observed in the baseline study by an average of 11.5%. It is concluded that while the two types of extraneous sound information used in this study degrade performance in the decision task, there is no interaction with the relative performance benefit provided by the use of spatialized auditory cues. [Work supported by ONR.

New insights into non-precious metal catalyst layer designs for proton exchange membrane fuel cells: Improving performance and stability

NASA Astrophysics Data System (ADS)

Banham, Dustin; Kishimoto, Takeaki; Sato, Tetsutaro; Kobayashi, Yoshikazu; Narizuka, Kumi; Ozaki, Jun-ichi; Zhou, Yingjie; Marquez, Emil; Bai, Kyoung; Ye, Siyu

2017-03-01

The activity of non-precious metal catalysts (NPMCs) has now reached a stage at which they can be considered as possible alternatives to Pt for some proton exchange membrane fuel cell (PEMFC) applications. However, despite significant efforts over the past 50 years on catalyst development, only limited studies have been performed on NPMC-based cathode catalyst layer (CCL) designs. In this work, an extensive ionomer study is performed to investigate the impact of ionomer equivalent weight on performance, which has uncovered two crucial findings. Firstly, it is demonstrated that beyond a critical CCL conductance, no further improvement in performance is observed. The procedure used to determine this critical conductance can be used by other researchers in this field to aid in their design of high performing NPMC-based CCLs. Secondly, it is shown that the stability of NPMC-based CCLs can be improved through the use of low equivalent weight ionomers. This represents a completely unexplored pathway for further stability improvements, and also provides new insights into the possible degradation mechanisms occurring in NPMC-based CCLs. These findings have broad implications on all future NPMC-based CCL designs.

High Resolution Anatomic and Elastographic Transrectal Ultrasound for Improved Diagnosis of Prostate Cancer

DTIC Science & Technology

2008-08-01

Elastographic Transrectal Ultrasound for Improved Diagnosis of Prostate Cancer PRINCIPAL INVESTIGATOR: John A. Hossack, Ph.D...January 21, 2004 – July 20, 2008 4. Title and Subtitle High Resolution Anatomic and Elastographic Transrectal Ultrasound for Improved Diagnosis of...can cer. In this work, we perform ultrasound elasticity imaging, using a slightly inflated latex sheath (to provide a source of moderate pressure

Your Audit and Financial Controls.

ERIC Educational Resources Information Center

Hatch, Mary B.; And Others

Audits should be performed on school accounting systems because they are required by law and they provide independent reviews of school financial procedures and suggestions for improvement. A licensed certified public accountant, public accountant, or an accountant who has met the Continuation of Education requirement should perform the audit.…

The E-business Revolution and Human Performance.

ERIC Educational Resources Information Center

Harmon, Paul

2001-01-01

Provides an overview of the electronic business (e-business) revolution and suggests ways it will affect human performance improvement professionals. Highlights include customer reliance on the Web; use of the Internet and associated software to link employees, applications, and companies; information access and sharing; business-to-consumer and…

PFE Report Specifications.

ERIC Educational Resources Information Center

California Community Colleges, Sacramento. Office of the Chancellor.

This document was prepared primarily for managers, researchers, and management information staff at California Community Colleges who need to duplicate the results of the Performance for Excellence (PFE) reports in order to aid in the improvement of performance goals at their respective institutions. It is hoped that by providing this document,…

Pushing the MAX IV 3 GeV storage ring brightness and coherence towards the limit of its magnetic lattice

NASA Astrophysics Data System (ADS)

Leemann, S. C.; Wurtz, W. A.

2018-03-01

The MAX IV 3 GeV storage ring is presently being commissioned and crucial parameters such as machine functions, emittance, and stored current have either already been reached or are approaching their design specifications. Once the baseline performance has been achieved, a campaign will be launched to further improve the brightness and coherence of this storage ring for typical X-ray users. During recent years, several such improvements have been designed. Common to these approaches is that they attempt to improve the storage ring performance using existing hardware provided for the baseline design. Such improvements therefore present more short-term upgrades. In this paper, however, we investigate medium-term improvements assuming power supplies can be exchanged in an attempt to push the brightness and coherence of the storage ring to the limit of what can be achieved without exchanging the magnetic lattice itself. We outline optics requirements, the optics optimization process, and summarize achievable parameters and expected performance.

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

RSNA Diagnosis Live: A Novel Web-based Audience Response Tool to Promote Evidence-based Learning.

PubMed

Awan, Omer A; Shaikh, Faiq; Kalbfleisch, Brian; Siegel, Eliot L; Chang, Paul

2017-01-01

Audience response systems have become more commonplace in radiology residency programs in the last 10 years, as a means to engage learners and promote improved learning and retention. A variety of systems are currently in use. RSNA Diagnosis Live™ provides unique features that are innovative, particularly for radiology resident education. One specific example is the ability to annotate questions with subspecialty tags, which allows resident performance to be tracked over time. In addition, deficiencies in learning can be monitored for each trainee and analytics can be provided, allowing documentation of resident performance improvement. Finally, automated feedback is given not only to the instructor, but also to the trainee. Online supplemental material is available for this article. © RSNA, 2017.

The Kubler-Ross model, physician distress, and performance reporting.

PubMed

Smaldone, Marc C; Uzzo, Robert G

2013-07-01

Physician performance reporting has been proposed as an essential component of health-care reform, with the aim of improving quality by providing transparency and accountability. Despite strong evidence demonstrating regional variation in practice patterns and lack of evidence-based care, public outcomes reporting has been met with resistance from medical professionals. Application of the Kubler-Ross 'five stages of grief' model--a conceptual framework consisting of a series of emotional stages (denial, anger, bargaining, depression, and acceptance) inspired by work with terminally ill patients--could provide some insight into why physicians are reluctant to accept emerging quality-reporting mechanisms. Physician-led quality-improvement initiatives are vital to contemporary health-care reform efforts and applications in urology, as well as other medical disciplines, are currently being explored.

Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.

PubMed

Cosimi, Lisa A; Dam, Huong V; Nguyen, Thai Q; Ho, Huyen T; Do, Phuong T; Duc, Duat N; Nguyen, Huong T; Gardner, Bridget; Libman, Howard; Pollack, Todd; Hirschhorn, Lisa R

2015-07-17

The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

ADAPTmap: International coordinated data resource for improving goat production effiency

USDA-ARS?s Scientific Manuscript database

Goats provide vital food and economic security, particularly in developing countries. We created a database that is a nexus for all performance, type, geographic information system (GIS), production environment, and genome information on goats. This resource provides a platform for meta-analysis tha...

Health professionals' perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units.

PubMed

Gude, Wouter T; Roos-Blom, Marie-José; van der Veer, Sabine N; Dongelmans, Dave A; de Jonge, Evert; Francis, Jill J; Peek, Niels; de Keizer, Nicolette F

2018-02-17

Audit and feedback aims to guide health professionals in improving aspects of their practice that need it most. Evidence suggests that feedback fails to increase accuracy of professional perceptions about clinical performance, which likely reduces audit and feedback effectiveness. This study investigates health professionals' perceptions about their clinical performance and the influence of feedback on their intentions to change practice. We conducted an online laboratory experiment guided by Control Theory with 72 intensive care professionals from 21 units. For each of four new pain management indicators, we collected professionals' perceptions about their clinical performance; peer performance; targets; and improvement intentions before and after receiving first-time feedback. An electronic audit and feedback dashboard provided ICU's own performance, median and top 10% peer performance, and improvement recommendations. The experiment took place approximately 1 month before units enrolled into a cluster-randomised trial assessing the impact of adding a toolbox with suggested actions and materials to improve intensive care pain management. During the experiment, the toolbox was inaccessible; all participants accessed the same version of the dashboard. We analysed 288 observations. In 53.8%, intensive care professionals overestimated their clinical performance; but in only 13.5%, they underestimated it. On average, performance was overestimated by 22.9% (on a 0-100% scale). Professionals similarly overestimated peer performance, and set targets 20.3% higher than the top performance benchmarks. In 68.4% of cases, intentions to improve practice were consistent with actual gaps in performance, even before professionals had received feedback; which increased to 79.9% after receiving feedback (odds ratio, 2.41; 95% CI, 1.53 to 3.78). However, in 56.3% of cases, professionals still wanted to improve care aspects at which they were already top performers. Alternatively, in 8.3% of cases, they lacked improvement intentions because they did not consider indicators important; did not trust the data; or deemed benchmarks unrealistic. Audit and feedback helps health professionals to work on aspects for which improvement is recommended. Given the abundance of professionals' prior good improvement intentions, the limited effects typically found by audit and feedback studies are likely predominantly caused by barriers to translation of intentions into actual change in clinical practice. ClinicalTrials.gov NCT02922101 . Registered 26 September 2016.

Xuefu zhuyu decoction improves cognitive impairment in experimental traumatic brain injury via synaptic regulation

PubMed Central

Zhou, Jing; Liu, Tao; Cui, Hanjin; Fan, Rong; Zhang, Chunhu; Peng, Weijun; Yang, Ali; Zhu, Lin; Wang, Yang; Tang, Tao

2017-01-01

An overarching consequence of traumatic brain injury (TBI) is the cognitive impairment. It may hinder individual performance of daily tasks and determine people's subjective well-being. The damage to synaptic plasticity, one of the key mechanisms of cognitive dysfunction, becomes the potential therapeutic strategy of TBI. In this study, we aimed to investigate whether Xuefu Zhuyu Decoction (XFZYD), a traditional Chinese medicine, provided a synaptic regulation to improve cognitive disorder following TBI. Morris water maze and modified neurological severity scores were performed to assess the neurological and cognitive abilities. The PubChem Compound IDs of the major compounds of XFZYD were submitted into BATMAN-TCM, an online bioinformatics analysis tool, to predict the druggable targets related to synaptic function. Furthermore, we validated the prediction through immunohistochemical, RT-PCR and western blot analyses. We found that XFZYD enhanced neuroprotection, simultaneously improved learning and memory performances in controlled cortical impact rats. Bioinformatics analysis revealed that the improvements of XFZYD implied the Long-term potentiation relative proteins including NMDAR1, CaMKII and GAP-43. The further confirmation of molecular biological studies confirmed that XFZYD upregulated the mRNA and protein levels of NMDAR1, CaMKII and GAP-43. Pharmacological synaptic regulation of XFZYD could provide a novel therapeutic strategy for cognitive impairment following TBI. PMID:29069769

Optimization of Processing and Modeling Issues for Thin Film Solar Cell Devices Including Concepts for The Development of Polycrystalline Multijunctions: Annual Report; 24 August 1998-23 August 1999

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

Birkmire, R.W.; Phillips, J.E.; Shafarman, W.N.

2000-08-25

This report describes results achieved during phase 1 of a three-phase subcontract to develop and understand thin-film solar cell technology associated to CuInSe{sub 2} and related alloys, a-Si and its alloys, and CdTe. Modules based on all these thin films are promising candidates to meet DOE long-range efficiency, reliability, and manufacturing cost goals. The critical issues being addressed under this program are intended to provide the science and engineering basis for the development of viable commercial processes and to improve module performance. The generic research issues addressed are: (1) quantitative analysis of processing steps to provide information for efficient commercial-scalemore » equipment design and operation; (2) device characterization relating the device performance to materials properties and process conditions; (3) development of alloy materials with different bandgaps to allow improved device structures for stability and compatibility with module design; (4) development of improved window/heterojunction layers and contacts to improve device performance and reliability; and (5) evaluation of cell stability with respect to illumination, temperature, and ambient and with respect to device structure and module encapsulation.« less

User testing and performance evaluation of the Electronic Quality Improvement Platform for Plans and Pharmacies.

PubMed

Pringle, Janice L; Kearney, Shannon M; Grasso, Kim; Boyer, Annette D; Conklin, Mark H; Szymanski, Keith A

2015-01-01

To user-test and evaluate a performance information management platform that makes standardized, benchmarked medication use quality data available to both health plans and community pharmacy organizations. Multiple health/drug plans and multiple chain and independent pharmacies across the United States. During the first phase of the study, user experience was measured via user satisfaction surveys and interviews with key personnel (pharmacists, pharmacy leaders, and health plan leadership). Improvements were subsequently made to the platform based on these findings. During the second phase of the study, the platform was implemented in a greater number of pharmacies and by a greater number of payers. User experience was then reevaluated to gather information for further improvements. The surveys and interviews revealed that users found the Web-based platform easy to use and beneficial in terms of understanding and comparing performance metrics. Primary concerns included lack of access to real-time data and patient-specific data. Many users also expressed uncertainty as to how they could use the information and data provided by the platform. The study findings indicate that while information management platforms can be used effectively in both pharmacy and health plan settings, future development is needed to ensure that the provided data can be transferred to pharmacy best practices and improved quality care.

Implementation of renal key performance indicators: promoting improved clinical practice.

PubMed

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

2015-03-01

In the Australian state of Victoria, the Renal Health Clinical Network (RHCN) of the Department of Health Victoria established a Renal Key Performance Indicator (KPI) Working Group in 2011. The group developed four KPIs related to chronic kidney disease and dialysis. A transplant working group of the RHCN developed two additional KPIs. The aim was to develop clinical indicators to measure performance of renal services to drive service improvement. A data collection and benchmarking programme was established, with data provided monthly to the Department using a purpose-designed website portal. The KPI Working Group is responsible for analysing data each quarter and ensuring indicators remain accurate and relevant. Each indicator has clear definitions and targets, and assess (i) patient education, (ii) timely creation of vascular access for haemodialysis, (iii) proportion of patients dialysing at home, (iv) incidence of dialysis-related peritonitis, (v) incidence of pre-emptive renal transplantation, and (vi) timely listing of patients for deceased donor transplantation. Most KPIs have demonstrated improved performance over time with limited gains notably in two: the proportion of patients dialysing at home (KPI 3) and timely listing patients for transplantation (KPI 6). KPI implementation has been established in Victoria for 2 years, providing performance data without additional funding. The six Victorian KPIs are measurable, relevant and modifiable, and implementation relies on enthusiasm and goodwill of physicians and nurses involved in collecting data. The KPIs require further evaluation, but adoption of a similar programme by other jurisdictions could lead to improved national outcomes. © 2014 Asian Pacific Society of Nephrology.

Physician level reporting of surgical and pathology performance indicators: a regional study to assess feasibility and impact on quality.

PubMed

McFadyen, Craig; Lankshear, Sara; Divaris, Dimitrios; Berry, Mark; Hunter, Amber; Srigley, John; Irish, Jonathan

2015-02-01

There is increased awareness that, to minimize variation in clinician practice and improve quality, performance reporting should be implemented at the provider level. This optimizes physician engagement and creates a sense of professional responsibility for quality and performance measurement at the individual and organizational levels. Individual provider level reporting was implemented within a provincial health region involving 56 clinicians (general surgeons, surgical oncologists, urologists and pathologists). The 2 surgical pathology indicators chosen were colorectal cancer (CRC) lymph node retrieval rate and pT2 prostate cancer margin positivity rate. Surgical resections for all prostate and colorectal cancer performed between Jan. 1, 2011, and Mar. 30, 2012, were included. We used a pre- and postsurvey design to obtain physician perceptions and focus groups with program leadership to determine organizational impact. Survey results showed that respondents felt the data provided in the reports were valid (67%), consistent with expectations (70%), maintained confidentiality (80%) and were not used in a punitive manner (77%). During the study period the pT2 prostate margin positivity rate decreased from 57.1% to 27.5%. For the CRC lymph node retrieval rate indicator, high baseline performance was maintained. We developed a robust process for providing physicians with confidential, individualized surgical and pathology quality indicator reports. Our results reinforce the importance of individual physician feedback as a strategy for improving and sustaining quality in surgical and diagnostic oncology.

Performance Basis for Airborne Separation

NASA Technical Reports Server (NTRS)

Wing, David J.

2008-01-01

Emerging applications of Airborne Separation Assistance System (ASAS) technologies make possible new and powerful methods in Air Traffic Management (ATM) that may significantly improve the system-level performance of operations in the future ATM system. These applications typically involve the aircraft managing certain components of its Four Dimensional (4D) trajectory within the degrees of freedom defined by a set of operational constraints negotiated with the Air Navigation Service Provider. It is hypothesized that reliable individual performance by many aircraft will translate into higher total system-level performance. To actually realize this improvement, the new capabilities must be attracted to high demand and complexity regions where high ATM performance is critical. Operational approval for use in such environments will require participating aircraft to be certified to rigorous and appropriate performance standards. Currently, no formal basis exists for defining these standards. This paper provides a context for defining the performance basis for 4D-ASAS operations. The trajectory constraints to be met by the aircraft are defined, categorized, and assessed for performance requirements. A proposed extension of the existing Required Navigation Performance (RNP) construct into a dynamic standard (Dynamic RNP) is outlined. Sample data is presented from an ongoing high-fidelity batch simulation series that is characterizing the performance of an advanced 4D-ASAS application. Data of this type will contribute to the evaluation and validation of the proposed performance basis.

Systems for hybrid cars

NASA Astrophysics Data System (ADS)

Bitsche, Otmar; Gutmann, Guenter

Not only sharp competition but also legislation are pushing development of hybrid drive trains. Based on conventional internal combustion engine (ICE) vehicles, these drive trains offer a wide range of benefits from reduced fuel consumption and emission to multifaceted performance improvements. Hybrid electric drive trains may also facilitate the introduction of fuel cells (FC). The battery is the key component for all hybrid drive trains, as it dominates cost and performance issues. The selection of the right battery technology for the specific automotive application is an important task with an impact on costs of development and use. Safety, power, and high cycle life are a must for all hybrid applications. The greatest pressure to reduce cost is in soft hybrids, where lead-acid embedded in a considerate management presents the cheapest solution, with a considerable improvement in performance needed. From mild to full hybridization, an improvement in specific power makes higher costs more acceptable, provided that the battery's service life is equivalent to the vehicle's lifetime. Today, this is proven for the nickel-metal hydride system. Lithium ion batteries, which make use of a multiple safety concept, and with some development anticipated, provide even better prospects in terms of performance and costs. Also, their scalability permits their application in battery electric vehicles—the basis for better performance and enhanced user acceptance. Development targets for the batteries are discussed with a focus on system aspects such as electrical and thermal management and safety.

NASA HPCC Technology for Aerospace Analysis and Design

NASA Technical Reports Server (NTRS)

Schulbach, Catherine H.

1999-01-01

The Computational Aerosciences (CAS) Project is part of NASA's High Performance Computing and Communications Program. Its primary goal is to accelerate the availability of high-performance computing technology to the US aerospace community-thus providing the US aerospace community with key tools necessary to reduce design cycle times and increase fidelity in order to improve safety, efficiency and capability of future aerospace vehicles. A complementary goal is to hasten the emergence of a viable commercial market within the aerospace community for the advantage of the domestic computer hardware and software industry. The CAS Project selects representative aerospace problems (especially design) and uses them to focus efforts on advancing aerospace algorithms and applications, systems software, and computing machinery to demonstrate vast improvements in system performance and capability over the life of the program. Recent demonstrations have served to assess the benefits of possible performance improvements while reducing the risk of adopting high-performance computing technology. This talk will discuss past accomplishments in providing technology to the aerospace community, present efforts, and future goals. For example, the times to do full combustor and compressor simulations (of aircraft engines) have been reduced by factors of 320:1 and 400:1 respectively. While this has enabled new capabilities in engine simulation, the goal of an overnight, dynamic, multi-disciplinary, 3-dimensional simulation of an aircraft engine is still years away and will require new generations of high-end technology.

Air traffic management as principled negotiation between intelligent agents

NASA Technical Reports Server (NTRS)

Wangermann, J. P.

1994-01-01

The major challenge facing the world's aircraft/airspace system (AAS) today is the need to provide increased capacity, while reducing delays, increasing the efficiency of flight operations, and improving safety. Technologies are emerging that should improve the performance of the system, but which could also introduce uncertainty, disputes, and inefficiency if not properly implemented. The aim of our research is to apply techniques from intelligent control theory and decision-making theory to define an Intelligent Aircraft/Airspace System (IAAS) for the year 2025. The IAAS would make effective use of the technical capabilities of all parts of the system to meet the demand for increased capacity with improved performance.

Algorithm Improvement Program Nuclide Identification Algorithm Scoring Criteria And Scoring Application - DNDO.

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

Enghauser, Michael

2015-02-01

The goal of the Domestic Nuclear Detection Office (DNDO) Algorithm Improvement Program (AIP) is to facilitate gamma-radiation detector nuclide identification algorithm development, improvement, and validation. Accordingly, scoring criteria have been developed to objectively assess the performance of nuclide identification algorithms. In addition, a Microsoft Excel spreadsheet application for automated nuclide identification scoring has been developed. This report provides an overview of the equations, nuclide weighting factors, nuclide equivalencies, and configuration weighting factors used by the application for scoring nuclide identification algorithm performance. Furthermore, this report presents a general overview of the nuclide identification algorithm scoring application including illustrative examples.

The Pharmacology of Actoprotectors: Practical Application for Improvement of Mental and Physical Performance

PubMed Central

Oliynyk, Sergiy; Oh, Seikwan

2012-01-01

Actoprotectors are preparations that enhance body stability against physical loads without increasing oxygen consumption or heat production. Or, in short, actoprotectors are synthetic adaptogens with a significant capacity to improve physical performance. This paper explores the history of actoprotectors’development, their pharmacological properties, mechanism of action, and practical application to the improvement of mental and physical performance. A brief summary of the clinico-pharmacological characteristics of the main representatives of this class (bemitil and bromantane) is provided. Some other synthesized compounds, and even natural ones such as ginseng, also are regarded as potential actoprotectors, and these are treated herein as well. Actoprotectors, owing to their wide-ranging pharmacological activities, high efficiency and safety, can be applied under either normal or extreme conditions. PMID:24009833

Base fluid in improving heat transfer for EV car battery

NASA Astrophysics Data System (ADS)

Bin-Abdun, Nazih A.; Razlan, Zuradzman M.; Shahriman, A. B.; Wan, Khairunizam; Hazry, D.; Ahmed, S. Faiz; Adnan, Nazrul H.; Heng, R.; Kamarudin, H.; Zunaidi, I.

2015-05-01

This study examined the effects of base fluid (as coolants) channeling inside the heat exchanger in the process of the increase in thermal conductivity between EV car battery and the heat exchanger. The analysis showed that secondary cooling system by means of water has advantages in improving the heat transfer process and reducing the electric power loss on the form of thermal energy from batteries. This leads to the increase in the efficiency of the EV car battery, hence also positively reflecting the performance of the EV car. The present work, analysis is performed to assess the design and use of heat exchanger in increasing the performance efficiency of the EV car battery. This provides a preface to the use this design for nano-fluids which increase and improve from heat transfer.

New Vectorial Propulsion System and Trajectory Control Designs for Improved AUV Mission Autonomy.

PubMed

Masmitja, Ivan; Gonzalez, Julian; Galarza, Cesar; Gomariz, Spartacus; Aguzzi, Jacopo; Del Rio, Joaquin

2018-04-17

Autonomous Underwater Vehicles (AUV) are proving to be a promising platform design for multidisciplinary autonomous operability with a wide range of applications in marine ecology and geoscience. Here, two novel contributions towards increasing the autonomous navigation capability of a new AUV prototype (the Guanay II) as a mix between a propelled vehicle and a glider are presented. Firstly, a vectorial propulsion system has been designed to provide full vehicle maneuverability in both horizontal and vertical planes. Furthermore, two controllers have been designed, based on fuzzy controls, to provide the vehicle with autonomous navigation capabilities. Due to the decoupled system propriety, the controllers in the horizontal plane have been designed separately from the vertical plane. This class of non-linear controllers has been used to interpret linguistic laws into different zones of functionality. This method provided good performance, used as interpolation between different rules or linear controls. Both improvements have been validated through simulations and field tests, displaying good performance results. Finally, the conclusion of this work is that the Guanay II AUV has a solid controller to perform autonomous navigation and carry out vertical immersions.

Point-of-Prescription Interventions to Improve Antimicrobial Stewardship

PubMed Central

Hamilton, Keith W.; Gerber, Jeffrey S.; Moehring, Rebekah; Anderson, Deverick J.; Calderwood, Michael S.; Han, Jennifer H.; Mehta, Jimish M.; Pollack, Lori A.; Zaoutis, Theoklis; Srinivasan, Arjun; Camins, Bernard C.; Schwartz, David N.; Lautenbach, Ebbing

2015-01-01

Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious antimicrobial use is the responsibility of every healthcare provider. Antimicrobial stewardship programs (ASPs) have made headway in improving antimicrobial prescribing using such “top-down” methods as formulary restriction and prospective audit with feedback; however, engagement of prescribers has not been fully explored. Strategies that include frontline prescribers and other unit-based healthcare providers have the potential to expand stewardship, both to augment existing centralized ASPs and to provide alternative approaches to perform stewardship at healthcare facilities with limited resources. This review discusses interventions focusing on antimicrobial prescribing at the point of prescription as well as a pilot project to engage unit-based healthcare providers in antimicrobial stewardship. PMID:25595748

The art of customer service.

PubMed

Williams, Jeni

2007-10-01

Strategies for improving the consumer service skills of finance staff include: Hire employees who have a customer service background. Work with your human resources department to provide customer service training. Monitor new hires extensively. Offer front-end employees scripted language for situations they may face on the job. Measure the quality of customer service provided. Provide incentives for performance.

Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

PubMed Central

Zhang, Jing; Ashfaq, Shazia; Bell, Kristin; Calvitti, Alan; Farber, Neil J; Gabuzda, Mark T; Gray, Barbara; Liu, Lin; Rick, Steven; Street, Richard L; Zheng, Kai; Zuest, Danielle; Agha, Zia

2016-01-01

Objective Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish “patient-centeredness” in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. Methods and Materials Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. Results The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. Discussion and Conclusion This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing “best” practices to improve patient-centered care in today’s highly “wired” health environment. These findings also show that more user-centered EHR design is needed to improve system usability. PMID:26568605

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

Elliott, C.

The Rocky Flats Environmental Technology Site (RFETS) has initiated a major work process improvement campaign using the tools of formalized benchmarking and streamlining. This paper provides insights into some of the process improvement activities performed at Rocky Flats from November 1995 through December 1996. It reviews the background, motivation, methodology, results, and lessons learned from this ongoing effort. The paper also presents important gains realized through process analysis and improvement including significant cost savings, productivity improvements, and an enhanced understanding of site work processes.

The Effects of Peer Tutoring on the Reading Comprehension Performance of Secondary Students with Disabilities: A Systematic Review

ERIC Educational Resources Information Center

Alzahrani, Turkey; Leko, Melinda

2018-01-01

The purposes of this review were to examine the effects of peer tutoring models on the reading comprehension performance of secondary students with disabilities and to provide evidence of the extent to which peer tutoring can be considered an evidence-based practice (EBP) for improving reading comprehension performance among secondary students…

Performance Improvement: Applying a Human Performance Model to Organizational Processes in a Military Training Environment

ERIC Educational Resources Information Center

Aaberg, Wayne; Thompson, Carla J.; West, Haywood V.; Swiergosz, Matthew J.

2009-01-01

This article provides a description and the results of a study that utilized the human performance (HP) model and methods to explore and analyze a training organization. The systemic and systematic practices of the HP model are applicable to military training organizations as well as civilian organizations. Implications of the study for future…

An Application of the Impact Evaluation Process for Designing a Performance Measurement and Evaluation Framework in K-12 Environments

ERIC Educational Resources Information Center

Guerra-Lopez, Ingrid; Toker, Sacip

2012-01-01

This article illustrates the application of the Impact Evaluation Process for the design of a performance measurement and evaluation framework for an urban high school. One of the key aims of this framework is to enhance decision-making by providing timely feedback about the effectiveness of various performance improvement interventions. The…

Improving indoor air quality through the use of continual multipoint monitoring of carbon dioxide and dew point.

PubMed

Bearg, D W

1998-09-01

This article summarizes an approach for improving the indoor air quality (IAQ) in a building by providing feedback on the performance of the ventilation system. The delivery of adequate quantities of ventilation to all building occupants is necessary for the achievement of good IAQ. Feedback on the performance includes information on the adequacy of ventilation provided, the effectiveness of the distribution of this air, the adequacy of the duration of operation of the ventilation system, and the identification of leakage into the return plenum, either of outdoor or supply air. Keeping track of ventilation system performance is important not only in terms of maintaining good IAQ, but also making sure that this system continues to perform as intended after changes in building use. Information on the performance of the ventilation system is achieved by means of an automated sampling system that draws air from multiple locations and delivers it to both a carbon dioxide monitor and dew point sensor. The use of single shared sensors facilitates calibration checks as well as helps to guarantee data integrity. This approach to monitoring a building's ventilation system offers the possibility of achieving sustainable performance of this important aspect of good IAQ.

Application of waterproof breathable fabric in thermal protective clothing exposed to hot water and steam

NASA Astrophysics Data System (ADS)

Su, Y.; Li, R.; Song, G.; Li, J.

2017-10-01

A hot water and steam tester was used to examine thermal protective performance of waterproof and breathable fabric against hot water and steam hazards. Time to cause skin burn and thermal energy absorbed by skin during exposure and cooling phases was employed to characterize the effect of configuration, placing order and properties of waterproof and breathable fabric on the thermal protective performance. The difference of thermal protective performance due to hot water and steam hazards was discussed. The result showed that the configuration of waterproof and breathable fabric presented a significant effect on the thermal protective performance of single- and double-layer fabric system, while the difference between different configurations in steam hazard was greater than that in hot water hazard. The waterproof and breathable fabric as outer layer provided better protection than that as inner layer. Increasing thickness and moisture regain improved the thermal protective performance of fabric system. Additionally, the thermal energy absorbed by skin during the cooling phase was affected by configuration, thickness and moisture regain of fabric. The findings will provide technical data to improve performance of thermal protective clothing in hot water and steam hazards.

Motor Imagery and Tennis Serve Performance: The External Focus Efficacy

PubMed Central

Guillot, Aymeric; Desliens, Simon; Rouyer, Christelle; Rogowski, Isabelle

2013-01-01

There is now ample evidence that motor imagery (MI) contributes to enhance motor performance. Previous research also demonstrated that directing athletes’ attention to the effects of their movements on the environment is more effective than focusing on the action per se. The present study aimed therefore at evaluating whether adopting an external focus during MI contributes to enhance tennis serve performance. Twelve high-level young tennis players were included in a test-retest procedure. The effects of regular training were first evaluated. Then, players were subjected to a MI intervention during which they mentally focused on ball trajectory and specifically visualized the space above the net where the serve can be successfully hit. Serve performance was evaluated during both a validated serve test and a real match. The main results showed a significant increase in accuracy and velocity during the ecological serve test after MI practice, as well as a significant improvement in successful first serves and won points during the match. Present data therefore confirmed the efficacy of MI in combination of physical practice to improve tennis serve performance, and further provided evidence that it is feasible to adopt external attentional focus during MI. Practical applications are discussed. Key Points Motor imagery contributes to enhance tennis serve performance. Data provided evidence of the benefits of adopting an external focus of attention during imagery. Results showed significant improvement in successful first serves and won points during a real match. PMID:24149813

Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems.

PubMed

Blair, C S; Fordyce, M; Barney, S M

1993-10-01

For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards.

Enhancing Documentation of Pressure Ulcer Prevention Interventions: A Quality Improvement Strategy to Reduce Pressure Ulcers.

PubMed

Jacobson, Therese M; Thompson, Susan L; Halvorson, Anna M; Zeitler, Kristine

2016-01-01

Prevention of hospital-acquired pressure ulcers requires the implementation of evidence-based interventions. A quality improvement project was conducted to provide nurses with data on the frequency with which pressure ulcer prevention interventions were performed as measured by documentation. Documentation reports provided feedback to stakeholders, triggering reminders and reeducation. Intervention reports and modifications to the documentation system were effective both in increasing the documentation of pressure ulcer prevention interventions and in decreasing the number of avoidable hospital-acquired pressure ulcers.

Use of Traditional and Novel Methods to Evaluate the Influence of an EVA Glove on Hand Performance

NASA Technical Reports Server (NTRS)

Benson, Elizabeth A.; England, Scott A.; Mesloh, Miranda; Thompson, Shelby; ajulu, Sudhakar

2010-01-01

The gloved hand is one of an astronaut s primary means of interacting with the environment, and any restrictions imposed by the glove can strongly affect performance during extravehicular activity (EVA). Glove restrictions have been the subject of study for decades, yet previous studies have generally been unsuccessful in quantifying glove mobility and tactility. Past studies have tended to focus on the dexterity, strength, and functional performance of the gloved hand; this provides only a circumspect analysis of the impact of each type of restriction on the glove s overall capability. The aim of this study was to develop novel capabilities to provide metrics for mobility and tactility that can be used to assess the performance of a glove in a way that could enable designers and engineers to improve their current designs. A series of evaluations were performed to compare unpressurized and pressurized (4.3 psi) gloved conditions with the ungloved condition. A second series of evaluations were performed with the Thermal Micrometeoroid Garment (TMG) removed. This series of tests provided interesting insight into how much of an effect the TMG has on gloved mobility - in some cases, the presence of the TMG restricted glove mobility as much as pressurization did. Previous hypotheses had assumed that the TMG would have a much lower impact on mobility, but these results suggest that an improvement in the design of the TMG could have a significant impact on glove performance. Tactility testing illustrated the effect of glove pressurization, provided insight into the design of hardware that interfaces with the glove, and highlighted areas of concern. The metrics developed in this study served to benchmark the Phase VI EVA glove and to develop requirements for the next-generation glove for the Constellation program.

Method to Increase Performance of Foil Bearings Through Passive Thermal Management

NASA Technical Reports Server (NTRS)

Bruckner, Robert

2013-01-01

This invention is a new approach to designing foil bearings to increase their load capacity and improve their reliability through passive thermal management. In the present case, the bearing is designed in such a way as to prevent the carryover of lubricant from the exit of one sector to the inlet of the ensuing sector of the foil bearing. When such passive thermal management techniques are used, bearing load capacity is improved by multiples, and reliability is enhanced when compared to current foil bearings. This concept has recently been tested and validated, and shows that load capacity performance of foil bearings can be improved by a factor of two at relatively low speeds with potentially greater relative improvements at higher speeds. Such improvements in performance with respect to speed are typical of foil bearings. Additionally, operation of these newly conceived bearings shows much more reliability and repeatable performance. This trait can be exploited in machine design to enhance safety, reliability, and overall performance. Finally, lower frictional torque has been demonstrated when operating at lower (non-load capacity) loads, thus providing another improvement above the current state of the art. The objective of the invention is to incorporate features into a foil bearing that both enhance passive thermal management and temperature control, while at the same time improve the hydrodynamic (load capacity) performance of the foil bearing. Foil bearings are unique antifriction devices that can utilize the working fluid of a machine as a lubricant (typically air for turbines and motors, liquids for pumps), and as a coolant to remove excess energy due to frictional heating. The current state of the art of foil bearings utilizes forced cooling of the bearing and shaft, which represents poor efficiency and poor reliability. This invention embodies features that utilize the bearing geometry in such a manner as to both support load and provide an inherent and passive cooling mechanism. This cooling mechanism functions in such a way as to prevent used (higher temperature) lubricant from being carried over from the exit of one sector into the entry of the next sector of the foil bearing. The disclosed innovation is an improved foil bearing design that reduces or eliminates the need for force cooling of the bearing, while at the same time improving the load capacity of the bearing by at least a factor of two. These improvements are due to the elimination of lubricant carryover from the trailing edge of one sector into the leading edge of the next, and the mixing of used lubricant with the surrounding ambient fluid.

A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes.

PubMed

Driessen, Sara R C; Van Zwet, Erik W; Haazebroek, Pascal; Sandberg, Evelien M; Blikkendaal, Mathijs D; Twijnstra, Andries R H; Jansen, Frank Willem

2016-12-01

The current health care system has an urgent need for tools to measure quality. A wide range of quality indicators have been developed in an attempt to differentiate between high-quality and low-quality health care processes. However, one of the main issues of currently used indicators is the lack of case-mix correction and improvement possibilities. Case-mix is defined as specific (patient) characteristics that are known to potentially affect (surgical) outcome. If these characteristics are not taken into consideration, comparisons of outcome among health care providers may not be valid. The objective of the study was to develop and test a quality assessment tool for laparoscopic hysterectomy, which can serve as a new outcome quality indicator. This is a prospective, international, multicenter implementation study. A web-based application was developed with 3 main goals: (1) to measure the surgeon's performance using 3 primary outcomes (blood loss, operative time, and complications); (2) to provide immediate individual feedback using cumulative observed-minus-expected graphs; and (3) to detect consistently suboptimal performance after correcting for case-mix characteristics. All gynecologists who perform laparoscopic hysterectomies were requested to register their procedures in the application. A patient safety risk factor checklist was used by the surgeon for reflection. Thereafter a prospective implementation study was performed, and the application was tested using a survey that included the System Usability Scale. A total of 2066 laparoscopic hysterectomies were registered by 81 gynecologists. Mean operative time was 100 ± 39 minutes, blood loss 127 ± 163 mL, and the complication rate 6.1%. The overall survey response rate was 75%, and the mean System Usability Scale was 76.5 ± 13.6, which indicates that the application was good to excellent. The majority of surgeons reported that the application made them more aware of their performance, the outcomes, and patient safety, and they noted that the application provided motivation for improving future performance. We report the development and test of a real-time, dynamic, quality assessment tool for measuring individual surgical outcome for laparoscopic hysterectomy. Importantly, this tool provides opportunities for improving surgical performance. Our study provides a foundation for helping clinicians develop evidence-based quality indicators for other surgical procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Using ROI to Demonstrate Performance Value in the Public Sector

ERIC Educational Resources Information Center

Phillips, Jack J.; Phillips, Patti

2009-01-01

The demand for accountability through measurement continues to increase. Although much progress has been made, it remains an issue that challenges even the most sophisticated and progressive performance improvement function. This article provides an overview of best practices in the return-on-investment process and describes how applying these…

Evidence Based Education Request Desk. EBE #555

ERIC Educational Resources Information Center

Regional Educational Laboratory Southeast, 2009

2009-01-01

This Evidence Based Education (EBE) Request seeks to provide an overview of recent research regarding school improvement and reform with special concentration on turning around chronically low-performing schools. The response is divided into four main sections: Research on Effective Methods for Turning Around Low-Performing Schools, Frameworks for…

School Gardens Enhance Academic Performance and Dietary Outcomes in Children

ERIC Educational Resources Information Center

Berezowitz, Claire K.; Bontrager Yoder, Andrea B.; Schoeller, Dale A.

2015-01-01

Background: Schools face increasing demands to provide education on healthy living and improve core academic performance. Although these appear to be competing concerns, they may interact beneficially. This article focuses on school garden programs and their effects on students' academic and dietary outcomes. Methods: Database searches in CABI,…

20 CFR 628.325 - Incentive grants, capacity building, and technical assistance.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., exceeding title II performance standards (section 106(b)(7)). (2) Incentive grant funds under this section... give consideration to recognizing the performance of service providers within the State. (5) SDA's... capacity building and technical assistance efforts aimed at improving the competencies of the personnel who...