Process for forming transparent aerogel insulating arrays

DOEpatents

Tewari, Param H.; Hunt, Arlon J.

1986-01-01

An improved supercritical drying process for forming transparent silica aerogel arrays is described. The process is of the type utilizing the steps of hydrolyzing and condensing aloxides to form alcogels. A subsequent step removes the alcohol to form aerogels. The improvement includes the additional step, after alcogels are formed, of substituting a solvent, such as CO.sub.2, for the alcohol in the alcogels, the solvent having a critical temperature less than the critical temperature of the alcohol. The resulting gels are dried at a supercritical temperature for the selected solvent, such as CO.sub.2, to thereby provide a transparent aerogel array within a substantially reduced (days-to-hours) time period. The supercritical drying occurs at about 40.degree. C. instead of at about 270.degree. C. The improved process provides increased yields of large scale, structurally sound arrays. The transparent aerogel array, formed in sheets or slabs, as made in accordance with the improved process, can replace the air gap within a double glazed window, for example, to provide a substantial reduction in heat transfer. The thus formed transparent aerogel arrays may also be utilized, for example, in windows of refrigerators and ovens, or in the walls and doors thereof or as the active material in detectors for analyzing high energy elementry particles or cosmic rays.

Process for forming transparent aerogel insulating arrays

DOEpatents

Tewari, P.H.; Hunt, A.J.

1985-09-04

An improved supercritical drying process for forming transparent silica aerogel arrays is described. The process is of the type utilizing the steps of hydrolyzing and condensing aloxides to form alcogels. A subsequent step removes the alcohol to form aerogels. The improvement includes the additional step, after alcogels are formed, of substituting a solvent, such as CO/sub 2/, for the alcohol in the alcogels, the solvent having a critical temperature less than the critical temperature of the alcohol. The resulting gels are dried at a supercritical temperature for the selected solvent, such as CO/sub 2/, to thereby provide a transparent aerogel array within a substantially reduced (days-to-hours) time period. The supercritical drying occurs at about 40/sup 0/C instead of at about 270/sup 0/C. The improved process provides increased yields of large scale, structurally sound arrays. The transparent aerogel array, formed in sheets or slabs, as made in accordance with the improved process, can replace the air gap within a double glazed window, for example, to provide a substantial reduction in heat transfer. The thus formed transparent aerogel arrays may also be utilized, for example, in windows of refrigerators and ovens, or in the walls and doors thereof or as the active material in detectors for analyzing high energy elementary particles or cosmic rays.

Light thinning in century-old Douglas-fir.

Treesearch

Robert W. Steele

1948-01-01

A stand-improvement study in century-old Douglas-fir at the Wind River Experimental Forest provides an example of a commercial thinning that gave a substantial intermediate harvest, salvaged considerable material that would have been lost through mortality, greatly increased the net growth rate, and improved the general vigor of the stand, leaving the forest in a more...

Enhancement of perfluoropolyether boundary lubrication performance: I. Preliminary results

NASA Technical Reports Server (NTRS)

Jones, W. R., Jr.; Ajayi, O. O.; Goodell, A. J.; Wedeven, L. D.; Devine, E.; Premore, R. E.

1995-01-01

A ball bearing simulator operating under starved conditions was used to evaluate the boundary lubrication performance of a perfluoropolyether (PFPE) Krytox 143 AB. Several approaches to enhance boundary lubrication were studied. These included: (1) soluble boundary additives, (2) bearing surface modifications, (3) 'run-in' surface films, and (4) ceramic bearing components. In addition, results were compared with two non-perfluorinated liquid lubricant formulations. Based on these preliminary tests, the following tentative conclusions can be made: (1) substantial improvements in boundary lubrication performance were observed with a beta-diketone boundary additive and a tricresyl phosphate (TCP) liquid surface pretreatment; (2) the use of rough Si3N4 balls (Ra = 40 micro-in) also provided substantial improvement but with concomitant abrasive wear; (3) marginal improvements were seen with two boundary additives (a phosphine and a phosphatriazine) and a neat (100%) fluid (a carboxylic acid terminated PFPE); and surface pretreatments with a synthetic hydrocarbon, a PTFE coating, and TiC coated 440C and smooth Si3N4 balls (R(sub a) less than 1 micro-in); and (4) two non-PFPE lubricant formulations (a PAO and a synthetic hydrocarbon) yielded substantial improvements.

AFRC2016-0090-13

NASA Image and Video Library

2016-03-17

NASA Associate Administrator for Aeronautics Jaiwon Shin talked to staff and managers at NASA Armstrong Flight Research Center in California March 17 about the New Horizons initiative. The 10-year plan could substantially improve aviation and provide major economic benefits.

Energy recovery system

DOEpatents

Moore, Albert S.; Verhoff, Francis H.

1980-01-01

The present invention is directed to an improved wet air oxidation system and method for reducing the chemical oxygen demand (COD) of waste water used from scrubbers of coal gasification plants, with this COD reduction being sufficient to effectively eliminate waste water as an environmental pollutant. The improvement of the present invention is provided by heating the air used in the oxidation process to a temperature substantially equal to the temperature in the oxidation reactor before compressing or pressurizing the air. The compression of the already hot air further heats the air which is then passed in heat exchange with gaseous products of the oxidation reaction for "superheating" the gaseous products prior to the use thereof in turbines as the driving fluid. The superheating of the gaseous products significantly minimizes condensation of gaseous products in the turbine so as to provide a substantially greater recovery of mechanical energy from the process than heretofore achieved.

A Wind Tunnel Model to Explore Unsteady Circulation Control for General Aviation Applications

NASA Technical Reports Server (NTRS)

Cagle, Christopher M.; Jones, Gregory S.

2002-01-01

Circulation Control airfoils have been demonstrated to provide substantial improvements in lift over conventional airfoils. The General Aviation Circular Control model is an attempt to address some of the concerns of this technique. The primary focus is to substantially reduce the amount of air mass flow by implementing unsteady flow. This paper describes a wind tunnel model that implements unsteady circulation control by pulsing internal pneumatic valves and details some preliminary results from the first test entry.

Improving Genetics Education in Graduate and Continuing Health Professional Education: Workshop Summary

ERIC Educational Resources Information Center

Berger, Adam C.; Johnson, Samuel G.; Beachy, Sarah H.; Olson, Steve

2015-01-01

Many health care providers do not have either the knowledge or the tools they need in order to apply genetic information in their day-to-day practices. This lack of support is contributing to a substantial delay in the translation of genetic research findings, when appropriate, into improvement in patient outcomes within the health care system.…

Methods for recalibration of mass spectrometry data

DOEpatents

Tolmachev, Aleksey V [Richland, WA; Smith, Richard D [Richland, WA

2009-03-03

Disclosed are methods for recalibrating mass spectrometry data that provide improvement in both mass accuracy and precision by adjusting for experimental variance in parameters that have a substantial impact on mass measurement accuracy. Optimal coefficients are determined using correlated pairs of mass values compiled by matching sets of measured and putative mass values that minimize overall effective mass error and mass error spread. Coefficients are subsequently used to correct mass values for peaks detected in the measured dataset, providing recalibration thereof. Sub-ppm mass measurement accuracy has been demonstrated on a complex fungal proteome after recalibration, providing improved confidence for peptide identifications.

Role of the ruminal microbiome in the production and composition of milk

USDA-ARS?s Scientific Manuscript database

Environmental problems associated with animal agriculture arise primarily from inherent inefficiencies in converting energy in feeds to useful products. Attenuating these inefficiencies provides substantial potential to improve both the economics and environmental footprint of animal agriculture, pa...

Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction

PubMed Central

Swofford, John; Whang, Peter G.; Frank, Clay J.; Glaser, John A.; Limoni, Robert P.; Cher, Daniel J.; Wine, Kathryn D.; Sembrano, Jonathan N.

2016-01-01

Background Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. Objective To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. Methods One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. Results In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. Conclusions In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided study-specific informed consent prior to participation. PMID:27652199

Low contaminant formic acid fuel for direct liquid fuel cell

DOEpatents

Masel, Richard I [Champaign, IL; Zhu, Yimin [Urbana, IL; Kahn, Zakia [Palatine, IL; Man, Malcolm [Vancouver, CA

2009-11-17

A low contaminant formic acid fuel is especially suited toward use in a direct organic liquid fuel cell. A fuel of the invention provides high power output that is maintained for a substantial time and the fuel is substantially non-flammable. Specific contaminants and contaminant levels have been identified as being deleterious to the performance of a formic acid fuel in a fuel cell, and embodiments of the invention provide low contaminant fuels that have improved performance compared to known commercial bulk grade and commercial purified grade formic acid fuels. Preferred embodiment fuels (and fuel cells containing such fuels) including low levels of a combination of key contaminants, including acetic acid, methyl formate, and methanol.

Progress in digestive endoscopy: Flexible Spectral Imaging Colour Enhancement (FICE)-technical review.

PubMed

Negreanu, L; Preda, C M; Ionescu, D; Ferechide, D

2015-01-01

Background. A substantial advance in digestive endoscopy that has been made during the last decade is represented by digital chromoendoscopy, which was developed as a quicker and sometimes better alternative to the gold standard of dye spraying. Fujifilm developed a virtual coloration technique called Flexible spectral Imaging Color Enhancement (FICE). FICE provides a better detection of lesions of "minimal" esophagitis, of dysplasia in Barrett's esophagus and of squamous cell esophageal cancer. The use of FICE resulted in an improvement in the visualization of the early gastric cancer, being less invasive, and time consuming than the classic dye methods. Current evidence does not support FICE for screening purposes in colon cancer but it definitely improves characterization of colonic lesions. Its use in inflammatory bowel disease is still controversial and in video capsule endoscopy is considered a substantial progress. Conclusions. The use of FICE endoscopy in routine clinical practice can increase the diagnostic yield and can provide a better characterization of lesions. Future studies to validate its use, the good choice of channels, and the "perfect indications" and to provide common definitions and classifications are necessary.

Periodate and hypobromite modification of Southern pine wood to improve sorption of copper ion

Treesearch

James D. McSweeny; Roger M. Rowell; George C. Chen; Thomas L. Eberhardt; Min Soo-Hong

2008-01-01

Milled southern pine wood was modified with sequential treatments of sodium periodate and sodium hypobromite for the purpose of improving copper ion (Cu2+) sorption capacity of the wood when tested in 24-h equilibrium batch tests. The modified wood provided additional carboxyl groups to those in the native wood and substantially increased Cu2+ uptake over that of...

20 CFR 627.201 - Waivers.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., promote coordination of JTPA programs with other human resource programs, or substantially improve the job...' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR GENERAL PROVISIONS GOVERNING PROGRAMS... services to the hard to serve, increase the level of basic and occupational skills training provided by the...

42 CFR 51.23 - Advisory council.

Code of Federal Regulations, 2014 CFR

2014-10-01

... § 51.8. (b) Members of the council shall include attorneys, mental health professionals, individuals... illness and have demonstrated a substantial commitment to improving mental health services, a provider of mental health services, individuals who have received or are receiving mental health services and family...

42 CFR 51.23 - Advisory council.

Code of Federal Regulations, 2012 CFR

2012-10-01

... § 51.8. (b) Members of the council shall include attorneys, mental health professionals, individuals... illness and have demonstrated a substantial commitment to improving mental health services, a provider of mental health services, individuals who have received or are receiving mental health services and family...

42 CFR 51.23 - Advisory council.

Code of Federal Regulations, 2013 CFR

2013-10-01

... § 51.8. (b) Members of the council shall include attorneys, mental health professionals, individuals... illness and have demonstrated a substantial commitment to improving mental health services, a provider of mental health services, individuals who have received or are receiving mental health services and family...

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

ERIC Educational Resources Information Center

Franckowiak, Bernard M.

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

NASA-427: A New Aluminum Alloy

NASA Technical Reports Server (NTRS)

Nabors, Sammy A.

2015-01-01

NASA's Marshall Space Flight Center researchers have developed a new, stronger aluminum alloy, ideal for cast aluminum products that have powder or paint-baked thermal coatings. With advanced mechanical properties, the NASA-427 alloy shows greater tensile strength and increased ductility, providing substantial improvement in impact toughness. In addition, this alloy improves the thermal coating process by decreasing the time required for heat treatment. With improvements in both strength and processing time, use of the alloy provides reduced materials and production costs, lower product weight, and better product performance. The superior properties of NASA-427 can benefit many industries, including automotive, where it is particularly well-suited for use in aluminum wheels.

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

PubMed

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

2017-10-01

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

Controlled release in transdermal pressure sensitive adhesives using organosilicate nanocomposites.

PubMed

Shaikh, Sohel; Birdi, Anil; Qutubuddin, Syed; Lakatosh, Eric; Baskaran, Harihara

2007-12-01

Polydimethyl siloxane (PDMS) based pressure sensitive adhesives (PSA) incorporating organo-clays at different loadings were fabricated via solution casting. Partially exfoliated nanocomposites were obtained for the hydroxyl terminated PDMS in ethyl acetate solvent as determined by X-ray diffraction and atomic force microscopy. Drug release studies showed that the initial burst release was substantially reduced and the drug release could be controlled by the addition of organo-clay. Shear strength and shear adhesion failure temperature (SAFT) measurements indicated substantial improvement in adhesive properties of the PSA nanocomposite adhesives. Shear strength showed more than 200% improvement at the lower clay loadings and the SAFT increased by about 21% due to the reinforcement provided by the nano-dispersed clay platelets. It was found that by optimizing the level of the organosilicate additive to the polymer matrix, superior control over drug release kinetics and simultaneous improvements in adhesive properties could be attained for a transdermal PSA formulation.

An Improved Framework for Confound Regression and Filtering for Control of Motion Artifact in the Preprocessing of Resting-State Functional Connectivity Data

PubMed Central

Satterthwaite, Theodore D.; Elliott, Mark A.; Gerraty, Raphael T.; Ruparel, Kosha; Loughead, James; Calkins, Monica E.; Eickhoff, Simon B.; Hakonarson, Hakon; Gur, Ruben C.; Gur, Raquel E.; Wolf, Daniel H.

2013-01-01

Several recent reports in large, independent samples have demonstrated the influence of motion artifact on resting-state functional connectivity MRI (rsfc-MRI). Standard rsfc-MRI preprocessing typically includes regression of confounding signals and band-pass filtering. However, substantial heterogeneity exists in how these techniques are implemented across studies, and no prior study has examined the effect of differing approaches for the control of motion-induced artifacts. To better understand how in-scanner head motion affects rsfc-MRI data, we describe the spatial, temporal, and spectral characteristics of motion artifacts in a sample of 348 adolescents. Analyses utilize a novel approach for describing head motion on a voxelwise basis. Next, we systematically evaluate the efficacy of a range of confound regression and filtering techniques for the control of motion-induced artifacts. Results reveal that the effectiveness of preprocessing procedures on the control of motion is heterogeneous, and that improved preprocessing provides a substantial benefit beyond typical procedures. These results demonstrate that the effect of motion on rsfc-MRI can be substantially attenuated through improved preprocessing procedures, but not completely removed. PMID:22926292

Economic and Nutritional Analyses Offer Substantial Synergies for Understanding Human Nutrition1

PubMed Central

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

2007-01-01

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

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

PubMed

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

2007-03-01

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

Bayesian Estimation of Small Effects in Exercise and Sports Science.

PubMed

Mengersen, Kerrie L; Drovandi, Christopher C; Robert, Christian P; Pyne, David B; Gore, Christopher J

2016-01-01

The aim of this paper is to provide a Bayesian formulation of the so-called magnitude-based inference approach to quantifying and interpreting effects, and in a case study example provide accurate probabilistic statements that correspond to the intended magnitude-based inferences. The model is described in the context of a published small-scale athlete study which employed a magnitude-based inference approach to compare the effect of two altitude training regimens (live high-train low (LHTL), and intermittent hypoxic exposure (IHE)) on running performance and blood measurements of elite triathletes. The posterior distributions, and corresponding point and interval estimates, for the parameters and associated effects and comparisons of interest, were estimated using Markov chain Monte Carlo simulations. The Bayesian analysis was shown to provide more direct probabilistic comparisons of treatments and able to identify small effects of interest. The approach avoided asymptotic assumptions and overcame issues such as multiple testing. Bayesian analysis of unscaled effects showed a probability of 0.96 that LHTL yields a substantially greater increase in hemoglobin mass than IHE, a 0.93 probability of a substantially greater improvement in running economy and a greater than 0.96 probability that both IHE and LHTL yield a substantially greater improvement in maximum blood lactate concentration compared to a Placebo. The conclusions are consistent with those obtained using a 'magnitude-based inference' approach that has been promoted in the field. The paper demonstrates that a fully Bayesian analysis is a simple and effective way of analysing small effects, providing a rich set of results that are straightforward to interpret in terms of probabilistic statements.

Anhydrous hydrogen fluoride electrolyte battery. [Patent application

DOEpatents

Not Available

1972-06-26

It is an object of the invention to provide a primary cell or battery using ammonium fluoride--anhydrous hydrogen fluoride electrolyte having improved current and power production capabilities at low temperatures. It is operable at temperatures substantially above the boiling point of hydrogen fluoride. (GRA)

Testing the construct validity of willingness to pay valuations using objective information about risk and health benefit.

PubMed

Philips, Zoë; Whynes, David K; Avis, Mark

2006-02-01

This paper describes an experiment to test the construct validity of contingent valuation, by eliciting women's valuations for the NHS cervical cancer screening programme. It is known that, owing to low levels of knowledge of cancer and screening in the general population, women both over-estimate the risk of disease and the efficacy of screening. The study is constructed as a randomised experiment, in which one group is provided with accurate information about cervical cancer screening, whilst the other is not. The first hypothesis supporting construct validity, that controls who perceive greater benefits from screening will offer higher valuations, is substantiated. Both groups are then provided with objective information on an improvement to the screening programme, and are asked to value the improvement as an increment to their original valuations. The second hypothesis supporting construct validity, that controls who perceive the benefits of the programme to be high already will offer lower incremental valuations, is also substantiated. Copyright 2005 John Wiley & Sons, Ltd.

Can Better Outdoor Environments Lead to Cost Benefits in Assisted Living Facilities Through Increased Word-of-Mouth Referrals?

PubMed

Rodiek, Susan; Boggess, May M; Lee, Chanam; Booth, Geoffrey J; Morris, Alisan

2013-01-01

This study explores how better outdoor environments may produce cost benefits for assisted living providers by raising occupancy levels through increased resident satisfaction and word-of-mouth referrals. Older adults who spend even minimal time outdoors may reap substantial health benefits. However, many existing outdoor areas in assisted living facilities are reportedly underutilized, in part because of design issues. Providers may be more willing to improve outdoor areas if they produce cost benefits for provider organizations. This study used data from a recent assisted living survey to assess the relationship between satisfaction with outdoor spaces, time spent outdoors, and resulting improvements in mood. A financial analysis was developed to estimate potential benefits from improved outdoor areas attributable to increased occupancy and decreased marketing costs associated with increased word-of-mouth referrals. Increasing resident satisfaction with outdoor areas (from approximately 29% to 96%) results in residents spending more time outdoors (increase of 1½ hours per week per resident) and improved psychological well-being (12% increase in feeling better). This greater overall satisfaction leads to 8% more residents willing to refer potential residents to their community. Because word-of-mouth referrals by current residents are a major factor in resident recruitment, improving outdoors areas leads to an estimated 4% increase in new residents, resulting in over $170,000 of increased revenue per year for a community of 100 residents. Improved outdoor space can provide substantial cost benefits for assisted living providers. Increasing resident well-being and satisfaction, and thereby generating additional word-of-mouth referrals, can result in higher occupancy levels. Outdoor environments, assisted living, cost benefits, resident satisfaction, occupancy levels, seniors, rental income, word-of-mouth referralPreferred Citation: Rodiek, S., Boggess, M. M., Lee, C., Booth, G. J., & Morris, A. (2013). Can better outdoor environments lead to cost benefits in assisted living facilities through increased word-of-mouth referrals? Health Environments Research & Design Journal 6(2), pp. 12-26.

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

PubMed

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

2018-03-01

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

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

ERIC Educational Resources Information Center

Fry-Ahearn, Betty; Collins, David

2016-01-01

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

Teaching Insect Retinal Physiology with Newly Designed, Inexpensive Micromanipulators

ERIC Educational Resources Information Center

Krans, Jacob; Gilbert, Cole; Hoy, Ron

2006-01-01

In this article, we detail how to produce two inexpensive micromanipulators that offer high precision (approximately 25 micrometers) along a single axis of movement. The more expensive of the designs provides improved versatility along multiple axes. Both manipulators offer substantial savings over commercially available micromanipulators with…

2007-08 Distance Education Report

ERIC Educational Resources Information Center

Nevada System of Higher Education, 2008

2008-01-01

This report focuses on distance education within the Nevada System of Higher Education (NSHE) for the 2007-08 academic year and provides documentation of the substantial growth of distance education within all colleges and universities. Distance education is a field of continuous improvement and change, and NSHE institutions are constantly…

High velocity pulsed wire-arc spray

NASA Technical Reports Server (NTRS)

Kincaid, Russell W. (Inventor); Witherspoon, F. Douglas (Inventor); Massey, Dennis W. (Inventor)

1999-01-01

Wire arc spraying using repetitively pulsed, high temperature gas jets, usually referred to as plasma jets, and generated by capillary discharges, substantially increases the velocity of atomized and entrained molten droplets. The quality of coatings produced is improved by increasing the velocity with which coating particles impact the coated surface. The effectiveness of wire-arc spraying is improved by replacing the usual atomizing air stream with a rapidly pulsed high velocity plasma jet. Pulsed power provides higher coating particle velocities leading to improved coatings. 50 micron aluminum droplets with velocities of 1500 m/s are produced. Pulsed plasma jet spraying provides the means to coat the insides of pipes, tubes, and engine block cylinders with very high velocity droplet impact.

Integral low-energy thermite igniter

DOEpatents

Gibson, A.; Haws, L.D.; Mohler, J.H.

1983-05-13

In a thermite igniter/heat source comprising a container holding an internal igniter load, there is provided the improvement wherein the container consists essentially of consumable consolidated thermite having a low gas output upon combustion, whereby upon ignition, substantially all of the container and said load is consumed with low gas production.

The Gene Pool Concept Applied to Crop Wild Relatives: An Evolutionary Perspective

USDA-ARS?s Scientific Manuscript database

Crop wild relatives (CWR) can provide important resources for the genetic improvement of cultivated species. Because crops are often closely related to many wild species, and because exploration of CWR for useful traits can take many years and substantial resources, the categorization of CWR based o...

Professional Capital as Accountability

ERIC Educational Resources Information Center

Fullan, Michael; Rincón-Gallardo, Santiago; Hargreaves, Andy

2015-01-01

This paper seeks to clarify and spells out the responsibilities of policy makers to create the conditions for an effective accountability system that produces substantial improvements in student learning, strengthens the teaching profession, and provides transparency of results to the public. The authors point out that U.S. policy makers will need…

Relegation and Reversion: Longitudinal Analysis of School Turnaround and Decline

ERIC Educational Resources Information Center

Hochbein, Craig

2012-01-01

School turnaround has become a popular strategy for improvement of chronically low-performing schools. Research related to school turnaround has relied substantially upon case studies. These case studies often focus on successful turnarounds and report immediate outcomes, failing to provide information about the sustainability of the results. In…

Integral low-energy thermite igniter

DOEpatents

Gibson, Albert; Haws, Lowell D.; Mohler, Jonathan H.

1984-08-14

In a thermite igniter/heat source comprising a container holding an internal igniter load, there is provided the improvement wherein the container consists essentially of consumable consolidated thermite having a low gas output upon combustion, whereby upon ignition, substantially all of the container and said load is consumed with low gas production.

Fact Sheet: Vulnerable Young Children

ERIC Educational Resources Information Center

Shaw, Evelyn, Comp.; Goode, Sue, Comp.

2008-01-01

This fact sheet provides data on infants, toddlers and young children who are experiencing high stress as a result of a number of risk factors specifically identified in the Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004), including substantiated abuse or neglect, foster care placement, homelessness, exposure to family…

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

ERIC Educational Resources Information Center

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

2018-01-01

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

Talking, Listening, Learning

ERIC Educational Resources Information Center

Myhill, Debra; Jones, Susan; Hopper, Rosemary

2005-01-01

This book looks at an issue which is at the heart of every classroom, the role that talk plays in children's learning. Drawing on a substantial research base, the book provides useful suggestions to facilitate successful talk between teachers and children to improve learning and raise standards. Through analysing the talk that goes on in primary…

Grasp Preparation Improves Change Detection for Congruent Objects

ERIC Educational Resources Information Center

Symes, Ed; Tucker, Mike; Ellis, Rob; Vainio, Lari; Ottoboni, Giovanni

2008-01-01

A series of experiments provided converging support for the hypothesis that action preparation biases selective attention to action-congruent object features. When visual transients are masked in so-called "change-blindness scenes," viewers are blind to substantial changes between 2 otherwise identical pictures that flick back and forth. The…

Rinse trough with improved flow

DOEpatents

O'Hern, Timothy J.; Grasser, Thomas W.

1998-01-01

Novel rinse troughs accomplish thorough uniform rinsing. The troughs are suitable for one or more essentially planar objects having substantially the same shape. The troughs ensure that each surface is rinsed uniformly. The new troughs provide uniform rinse fluid flow over the objects' surfaces to accomplish a more thorough rinse than prior art troughs.

Mycorrhizae in forest tree nurseries

Treesearch

Michelle M. Cram; R. Kasten Dumroese

2012-01-01

Mycorrhizae are symbiotic fungus-root associations. The colonization of roots by mycorrhizal fungi can benefit the host by improving nutrient and water uptake. In exchange, the host plant provides the mycorrhizal fungi carbohydrates (carbon) from photosynthesis. A substantial portion of this carbon is ultimately transferred to the rhizosphere and is estimated to...

Conceptualizing Essential Components of Effective High Schools

ERIC Educational Resources Information Center

Preston, Courtney; Goldring, Ellen; Guthrie, J. Edward; Ramsey, Russell; Huff, Jason

2017-01-01

Three decades of reform aimed at improving disadvantaged student achievement have not substantially narrowed achievement and graduation gaps. This article reviews the research around eight essential components of effective high schools emerging from a review of the effective schools and high school reform literature, and provides a framework for…

Contracting out Public Schools and Academic Performance: Evidence from Colombia

ERIC Educational Resources Information Center

Bonilla-Angel, Juan D.

2011-01-01

Contracting out public schools to private institutions is an instrument for reforming public education as it may facilitate academic innovation and improve student academic performance through higher school accountability and autonomy. The degree of autonomy that different providers have may vary substantially depending on the contractual and…

Optimizing a liquid propellant rocket engine with an automated combustor design code (AUTOCOM)

NASA Technical Reports Server (NTRS)

Hague, D. S.; Reichel, R. H.; Jones, R. T.; Glatt, C. R.

1972-01-01

A procedure for automatically designing a liquid propellant rocket engine combustion chamber in an optimal fashion is outlined. The procedure is contained in a digital computer code, AUTOCOM. The code is applied to an existing engine, and design modifications are generated which provide a substantial potential payload improvement over the existing design. Computer time requirements for this payload improvement were small, approximately four minutes in the CDC 6600 computer.

Method and apparatus for operating an improved thermocline storage unit

DOEpatents

Copeland, R.J.

1982-09-30

A method and apparatus for operating a thermocline storage unit in which an insulated barrier member is provided substantially at the interface region between the hot and cold liquids in the storage tank. The barrier member physically and thermally separates the hot and cold liquids substantially preventing any diffusing or mixing between them and substantially preventing any heat transfer there between. The barrier member follows the rise and fall of the interface region between the liquids as the tank is charged and discharged. Two methods of maintaining it in the interface region are disclosed. With the structure and operation of the present invention and in particular the significant reduction in diffusing or mixing between the hot and cold liquids as well as the significant reduction in the thermal heat transfer between them, the performance of the storage tank is improved. More specifically, the stability of the interface region or thermocline is enhanced and the thickness of the thermocline is reduced producing a corresponding increase in the steepness of the temperature gradient across the thermocline and a more efficiently operating thermocline storage unit.

Method and apparatus for operating an improved thermocline storage unit

DOEpatents

Copeland, Robert J.

1985-01-01

A method and apparatus for operating a thermocline storage unit in which an insulated barrier member is provided substantially at the interface region between the hot and cold liquids in the storage tank. The barrier member physically and thermally separates the hot and cold liquids substantially preventing any diffusing or mixing between them and substantially preventing any heat transfer therebetween. The barrier member follows the rise and fall of the interface region between the liquids as the tank is charged and discharged. Two methods of maintaining it in the interface region are disclosed. With the structure and operation of the present invention and in particular the significant reduction in diffusing or mixing between the hot and cold liquids as well as the significant reduction in the thermal heat transfer between them, the performance of the storage tank is improved. More specifically, the stability of the interface region or thermocline is enhanced and the thickness of the thermocline is reduced producing a corresponding increase in the steepness of the temperature gradient across the thermocline and a more efficiently operating thermocline storage unit.

Compact electrostatic comb actuator

DOEpatents

Rodgers, M. Steven; Burg, Michael S.; Jensen, Brian D.; Miller, Samuel L.; Barnes, Stephen M.

2000-01-01

A compact electrostatic comb actuator is disclosed for microelectromechanical (MEM) applications. The actuator is based upon a plurality of meshed electrostatic combs, some of which are stationary and others of which are moveable. One or more restoring springs are fabricated within an outline of the electrostatic combs (i.e. superposed with the moveable electrostatic combs) to considerably reduce the space required for the actuator. Additionally, a truss structure is provided to support the moveable electrostatic combs and prevent bending or distortion of these combs due to unbalanced electrostatic forces or external loading. The truss structure formed about the moveable electrostatic combs allows the spacing between the interdigitated fingers of the combs to be reduced to about one micron or less, thereby substantially increasing the number of active fingers which can be provided in a given area. Finally, electrostatic shields can be used in the actuator to substantially reduce unwanted electrostatic fields to further improve performance of the device. As a result, the compact electrostatic comb actuator of the present invention occupies only a fraction of the space required for conventional electrostatic comb actuators, while providing a substantial increase in the available drive force (up to one-hundred times).

Cardio-oncology: Concepts and practice

PubMed Central

Cubbon, Richard M.; Lyon, Alexander R.

2016-01-01

Substantial progress in cancer therapy increasingly allows higher cure rates, and even advanced disease can be stabilized, allowing improved survival with quality of life for months to years, meaning comorbid diseases are a growing determinant of outcome. Cardiovascular events substantially contribute to long-term morbidity and mortality in people living with or surviving cancer. In recognition of this, the subspecialty of cardio-oncology has emerged, and aims to promote cardiovascular heath, whilst facilitating the most effective cancer therapy. This review describes the concept of cardio-oncology, and illustrates the role played by a specialist team in improving outcomes, using heart failure secondary to breast cancer treatment as an example. We aim to highlight pivotal original research and comprehensive summaries of the most relevant topics, providing an overview for cardiologists and oncologists about this increasingly important medical problem. PMID:27056658

Controlled Release in Transdermal Pressure Sensitive Adhesives using Organosilicate Nanocomposites

PubMed Central

Shaikh, Sohel; Birdi, Anil; Qutubuddin, Syed; Lakatosh, Eric; Baskaran, Harihara

2010-01-01

Polydimethyl siloxane (PDMS) based pressure sensitive adhesives (PSA) incorporating organo-clays at different loadings were fabricated via solution casting. Partially exfoliated nanocomposites were obtained for the hydroxyl terminated PDMS in ethyl acetate solvent as determined by X-ray diffraction (XRD) and atomic force microscopy (AFM). Drug release studies showed that the initial burst release was substantially reduced and the drug release could be controlled by the addition of organo-clay. Shear strength and shear adhesion failure temperature (SAFT) measurements indicated substantial improvement in adhesive properties of the PSA nanocomposite adhesives. Shear strength showed more than 200 % improvement at the lower clay loadings and the SAFT increased by about 21% due to the reinforcement provided by the nano-dispersed clay platelets. It was found that by optimizing the level of the organosilicate additive to the polymer matrix, superior control over drug release kinetics and simultaneous improvements in adhesive properties could be attained for a transdermal PSA formulation. PMID:17786555

Alfalfa N credits to second-year corn larger than expected

USDA-ARS?s Scientific Manuscript database

Alfalfa can provide substantial amounts of nitrogen (N) to the first crop that follows it. Recent field research on first-year corn confirms that it is highly likely that grain yields will not improve with added fertilizer N, except on very sandy and very clayey soils. It is less clear how much fert...

What Works in Coaching and Sport Instructor Certification Programs? The Participants' View

ERIC Educational Resources Information Center

Mccullick, Bryan A.; Belcher, Don; Schempp, Paul G.

2005-01-01

Coaching and sport instructor certification (CSIC) programs provide teachers with a substantial content and pedagogical knowledge base. Continual improvement of these programs helps ensure that those certified are effective and competent. The purpose of this study was to ascertain the strengths of a CSIC program based on the perceptions of the…

Access to Microsoft Windows 95 for Persons with Low Vision: An Overview.

ERIC Educational Resources Information Center

Shragai, Y.

1995-01-01

This article examines Windows 95, pointing out differences and improvements from Windows 3.1 for persons with low vision. Windows 95 is seen as providing substantially greater accessibility than Windows 3.1, though the graphical user interface may still pose serious problems for some users with low vision. (DB)

Integrating Emerging Data Sources into Operational Practice: Capabilities and Limitations of Devices to Collect, Compile, Save, and Share Messages from CAVs and Connected Travelers

DOT National Transportation Integrated Search

2018-03-01

Connected and automated vehicles (CAVs) and connected travelers will be providing substantially increased levels of data which will be available for agencies to consider using to improve the management and operation of the surface transportation syst...

The effects of climate change and extreme wildfire events on runoff erosion over a mountain watershed

Treesearch

Mingliang Liu; Michael E. Barber; Keith A. Cherkauer; Pete Robichaud; Jennifer C. Adam

2016-01-01

Increases in wildfire occurrence and severity under an altered climate can substantially impact terrestrial ecosystems through enhancing runoff erosion. Improved prediction tools that provide high resolution spatial information are necessary for location-specific soil conservation and watershed management. However, quantifying the magnitude of soil erosion and...

Self-Reported Learning from Co-Teaching Primary Science Lessons to Peers at University

ERIC Educational Resources Information Center

Hudson, Peter; Nykvist, Shaun; Mukherjee, Michelle

2016-01-01

Universities are challenged continuously in reviews to improve teacher education, which includes providing substantial theory-practice connections for undergraduates. This study investigated second year preservice teachers' (n = 48) self-reported learning as a result of co-teaching primary science to their peers within the university setting. From…

Providing a Head Start: Improving Access to Early Childhood Education for Refugees

ERIC Educational Resources Information Center

Morland, Lyn; Ives, Nicole; McNeely, Clea; Allen, Chenoa

2016-01-01

The current research on the benefits of high-quality early childhood education and care (ECEC) leaves little doubt that early interventions have both short- and long-term advantages. Quality ECEC can have substantial positive impacts on young children's social, emotional, cognitive, and language development, with long-term effects on educational…

Elementary Principal Perceptions on Key Leadership Responsibilities Associated with Increased Student Achievement

ERIC Educational Resources Information Center

Hopper, Lora E.

2009-01-01

Although research has provided a substantial amount of information about key characteristics of effective school leaders, there is a growing need for continued improvement and reflective practice on the continuous development of instructional leaders. The purpose of this study was to determine to what extent elementary principals perceive they are…

Practitioner Review: When Parent Training Doesn't Work--Theory-Driven Clinical Strategies

ERIC Educational Resources Information Center

Scott, Stephen; Dadds, Mark R.

2009-01-01

Improving the parent-child relationship by using strategies based on social learning theory has become the cornerstone for the treatment of conduct problems in children. Over the past 40 years, interventions have expanded greatly from small, experimental procedures to substantial, systematic programmes that provide clear guidelines in detailed…

Rinse trough with improved flow

DOEpatents

O`Hern, T.J.; Grasser, T.W.

1998-08-11

Novel rinse troughs accomplish thorough uniform rinsing. The troughs are suitable for one or more essentially planar objects having substantially the same shape. The troughs ensure that each surface is rinsed uniformly. The new troughs provide uniform rinse fluid flow over the objects` surfaces to accomplish a more thorough rinse than prior art troughs. 5 figs.

RELEASE NOTES FOR MODELS-3 VERSION 4.1 PATCH: SMOKE TOOL AND FILE CONVERTER

EPA Science Inventory

This software patch to the Models-3 system corrects minor errors in the Models-3 framework, provides substantial improvements in the ASCII to I/O API format conversion of the File Converter utility, and new functionalities for the SMOKE Tool. Version 4.1 of the Models-3 system...

Urban tree effects on fine particulate matter and human health

Treesearch

David J. Nowak

2014-01-01

Overall, city trees reduce particulate matter and provide substantial health benefits; but under certain conditions, they can locally increase particulate matter concentrations. Urban foresters need to understand how trees affect particulate matter so they can select proper species and create appropriate designs to improve air quality. This article details trees'...

The Proliferation of Legalized Gambling: Implications for Health Education

ERIC Educational Resources Information Center

Golaszewski, Thomas

2004-01-01

Legalized gambling is growing substantially and provides both a dilemma and an opportunity for those in the health promoting professions. Gambling represents a form of economic development and, for certain segments of society, improved health and quality of life. On the other hand, gambling is a known addiction, with a host of sociological…

Five-Segment Solid Rocket Motor Development Status

NASA Technical Reports Server (NTRS)

Priskos, Alex S.

2012-01-01

In support of the National Aeronautics and Space Administration (NASA), Marshall Space Flight Center (MSFC) is developing a new, more powerful solid rocket motor for space launch applications. To minimize technical risks and development costs, NASA chose to use the Space Shuttle s solid rocket boosters as a starting point in the design and development. The new, five segment motor provides a greater total impulse with improved, more environmentally friendly materials. To meet the mass and trajectory requirements, the motor incorporates substantial design and system upgrades, including new propellant grain geometry with an additional segment, new internal insulation system, and a state-of-the art avionics system. Significant progress has been made in the design, development and testing of the propulsion, and avionics systems. To date, three development motors (one each in 2009, 2010, and 2011) have been successfully static tested by NASA and ATK s Launch Systems Group in Promontory, UT. These development motor tests have validated much of the engineering with substantial data collected, analyzed, and utilized to improve the design. This paper provides an overview of the development progress on the first stage propulsion system.

MOC Efficiency Improvements Using a Jacobi Inscatter Approximation

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

Stimpson, Shane; Collins, Benjamin; Kochunas, Brendan

2016-08-31

In recent weeks, attention has been given to resolving the convergence issues encountered with TCP 0 by trying a Jacobi (J) inscatter approach when group sweeping, where the inscatter source is constructed using the previous iteration flux. This is in contrast to a Gauss-Seidel (GS) approach, which has been the default to-date, where the scattering source uses the most up-to-date flux values. The former is consistent with CASMO, which has no issues with TCP 0 convergence. Testing this out on a variety of problems has demonstrated that the Jacobi approach does indeed provide substantially more stability, though can take moremore » outer iterations to converge. While this is not surprising, there are improvements that can be made to the MOC sweeper to capitalize on the Jacobi approximation and provide substantial speedup. For example, the loop over groups, which has traditionally been the outermost loop in MPACT, can be moved to the interior, avoiding duplicate modular ray trace and coarse ray trace setup (mapping coarse mesh surface indexes), which needs to be performed repeatedly when group is outermost.« less

The business case for patient safety.

PubMed

Hwang, Raymond W; Herndon, James H

2007-04-01

Recent trends have focused attention on improving patient safety in the United States healthcare system. Lapses in patient safety create undue, often preventable, morbidity. These include adverse drug events, adverse surgical events and nosocomial infections. From an organizational perspective, these events are both inefficient and expensive. Many safe practices and quality enhancing improvements, such as computer provider order entry, proper infection surveillance, telemedicine intensive care, and registered nurse staffing are in fact cost-effective. However, in order to fully achieve higher quality, better adverse event reporting and a culture of safety must first be developed. Increased provider recognition, models of success, public awareness and consumer demand are propelling improvements. As we will outline in this review of the current literature, the business case for patient safety is a compelling one, offering substantial economic incentives for achieving the necessary goal of improved patient outcomes.

National Aeronautics and Space Administration: Leadership and Systems Needed to Effect Financial Management Improvements

DTIC Science & Technology

2002-03-20

financial reporting requirements-an unqualified opinion on its financial statements, no material internal control weaknesses, and financial management systems that are in substantial compliance the requirements of the Federal Financial Management Improvement Act (FFMIA). This implied that NASA not only could generate reliable information once a year for external financial reporting purposes but also could provide accurate, reliable information for day-today decision-making. In contrast with the unqualified or clean audit opinions of its previous

Dual-rotor, radial-flux, toroidally-wound, permanent-magnet machine

DOEpatents

Qu, Ronghai; Lipo, Thomas A.

2005-08-02

The present invention provides a novel dual-rotor, radial-flux, toroidally-wound, permanent-magnet machine. The present invention improves electrical machine torque density and efficiency. At least one concentric surface-mounted permanent magnet dual-rotor is located inside and outside of a torus-shaped stator with back-to-back windings, respectively. The machine substantially improves machine efficiency by reducing the end windings and boosts the torque density by at least doubling the air gap and optimizing the machine aspect ratio.

The contribution of microbial biotechnology to economic growth and employment creation.

PubMed

Timmis, Kenneth; de Lorenzo, Victor; Verstraete, Willy; Ramos, Juan Luis; Danchin, Antoine; Brüssow, Harald; Singh, Brajesh K; Timmis, James Kenneth

2017-09-01

Our communication discusses the profound impact of bio-based economies - in particular microbial biotechnologies - on SDG 8: Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all. A bio-based economy provides significant potential for improving labour supply, education and investment, and thereby for substantially increasing the demographic dividend. This, in turn, improves the sustainable development of economies. © 2017 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

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

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

Brown, D; Mundt, A; Einck, J

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

Improving substance abuse screening and intervention in a primary care clinic.

PubMed

Neushotz, Lori A; Fitzpatrick, Joyce J

2008-04-01

Despite recent efforts to educate primary care providers in the identification and management of patients presenting with substance abuse problems, many opportunities to identify and intervene with these patients are overlooked. This project was designed to identify factors that interfere with rates of screening and brief intervention (SBI) of substance abuse problems in a primary care clinic in a major academic medical center in New York City. Six informants representing the disciplines of medicine, nursing, and social work in the primary care clinic provided information regarding SBI. Analysis was focused on substantiation of the need for enhanced diffusion of knowledge related to screening for substance abuse problems to improve rates of SBI in primary care. Recommendations for improvement included continued promotion of SBI by influential role models and opinion leaders, improvement in primary care providers' perceptions of the perceived characteristics of SBI to improve rates of adoption, implementation of interdisciplinary educational initiatives toward the goal of improving rates of SBI in the primary care clinic, and initiation of translational research at the clinic supporting SBI in primary care.

A Comparison of Center/TRACON Automation System and Airline Time of Arrival Predictions

NASA Technical Reports Server (NTRS)

Heere, Karen R.; Zelenka, Richard E.

2000-01-01

Benefits from information sharing between an air traffic service provider and a major air carrier are evaluated. Aircraft arrival time schedules generated by the NASA/FAA Center/TRACON Automation System (CTAS) were provided to the American Airlines System Operations Control Center in Fort Worth, Texas, during a field trial of a specialized CTAS display. A statistical analysis indicates that the CTAS schedules, based on aircraft trajectories predicted from real-time radar and weather data, are substantially more accurate than the traditional airline arrival time estimates, constructed from flight plans and en route crew updates. The improvement offered by CTAS is especially advantageous during periods of heavy traffic and substantial terminal area delay, allowing the airline to avoid large predictive errors with serious impact on the efficiency and profitability of flight operations.

Laboratory medicine: challenges and opportunities.

PubMed

Bossuyt, Xavier; Verweire, Kurt; Blanckaert, Norbert

2007-10-01

Technologic innovations have substantially improved the productivity of clinical laboratories, but the services provided by clinical laboratories are increasingly becoming commoditized. We reflect on how current developments may affect the future of laboratory medicine and how to deal with these changes. We argue that to be prepared for the future, clinical laboratories should enhance efficiency and reduce costs by forming alliances and networks; consolidating, integrating, or outsourcing; and more importantly, create additional value by providing knowledge services related to in vitro diagnostics.

Rural Health Care Information Access and the Use of the Internet: Opportunity for University Extension

ERIC Educational Resources Information Center

Das, Biswa R.; Leatherman, John C.; Bressers, Bonnie M.

2015-01-01

The Internet has potential for improving health information delivery and strengthening connections between rural populations and local health service providers. An exploratory case study six rural health care markets in Kansas showed that about 70% of adults use the Internet, with substantial use for accessing health information. While there are…

Engaging Pupils in the Science, Engineering and Technology of a Low-Energy School

ERIC Educational Resources Information Center

Charnley, Fiona; Fleming, Paul; Fleming, Margaret; Mill, Greig

2010-01-01

The UK Government's Building Schools for the Future programme has provided schools with a unique opportunity to improve education for sustainable development substantially by giving pupils the chance to study within a real-life context. This article documents an engagement project in which experts in low-energy building design are facilitating…

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Policy Implications of a Proposed Framework to Improve the Accessibility and Effectiveness of Internships in Accounting

ERIC Educational Resources Information Center

Capka, John; Foltin, Craig

2017-01-01

Accounting internships provide substantial benefits to employers and students alike. However, opportunities for students are not equitable across all populations due to the existing policies that exist for placing interns. This inequity is particularly true for students from community colleges where there is a larger proportion of underrepresented…

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

ERIC Educational Resources Information Center

Marks, Ellen L.; Graham, Elliott T.

2004-01-01

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

New Methods for Personal Exposure Monitoring for Airborne Particles

PubMed Central

Koehler, Kirsten A.; Peters, Thomas

2016-01-01

Airborne particles have been associated with a range of adverse cardiopulmonary outcomes, which has driven its monitoring at stationary, central sites throughout the world. Individual exposures, however, can differ substantially from concentrations measured at central sites due to spatial variability across a region and sources unique to the individual, such as cooking or cleaning in homes, traffic emissions during commutes, and widely varying sources encountered at work. Personal monitoring with small, battery-powered instruments enables the measurement of an individual’s exposure as they go about their daily activities. Personal monitoring can substantially reduce exposure misclassification and improve the power to detect relationships between particulate pollution and adverse health outcomes. By partitioning exposures to known locations and sources, it may be possible to account for variable toxicity of different sources. This review outlines recent advances in the field of personal exposure assessment for particulate pollution. Advances in battery technology have improved the feasibility of 24-hour monitoring, providing the ability to more completely attribute exposures to microenvironment (e.g., work, home, commute). New metrics to evaluate the relationship between particulate matter and health are also being considered, including particle number concentration, particle composition measures, and particle oxidative load. Such metrics provide opportunities to develop more precise associations between airborne particles and health and may provide opportunities for more effective regulations. PMID:26385477

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

PubMed

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

2014-06-01

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

Properties of Polymer-Infiltrated Carbon Foams

NASA Astrophysics Data System (ADS)

Adams, W. A.; Bunning, T. J.; Farmer, B. L.; Kearns, K. M.; Anderson, D. A.; Roy, A. K.; Banerjee, T.; Jeon, H. G.

2001-03-01

There is considerable interest in extending the use-temperatures of both commodity and high performance polymers. There is also interest in improving the mechanical strength of carbon foams. Composites prepared by infiltrating carbon foam with polymers may offer significant improvements in both, the polymer helping to rigidize the foam and the foam providing thermal protection by virtue of its high thermal conductivity. The mechanical properties and thermal stability of carbon foams of various densities infiltrated with polyurethane have been studied. When used with a heat sink, the composite is able to maintain a substantial thermal gradient which provides stability of the polymer nominally above its decomposition temperature. The composite also has much improved strength properties without sacrificing tensile modulus. The composites may be very well suited for thermal management applications.

Leveraging finances for public health system improvement: results from the Turning Point initiative.

PubMed

Bekemeier, Betty; Riley, Catharine M; Berkowitz, Bobbie

2007-01-01

Reforming the public health infrastructure requires substantial system changes at the state level; state health agencies, however, often lack the resources and support for strategic planning and systemwide improvement. The Turning Point Initiative provided support for states to focus on large-scale system changes that resulted in increased funding for public health capacity and infrastructure development. Turning Point provides a test case for obtaining financial and institutional resources focused on systems change and infrastructure development-areas for which it has been historically difficult to obtain long-term support. The purpose of this exploratory, descriptive survey research was to enumerate the actual resources leveraged toward public health system improvement through the partnerships, planning, and implementation activities funded by the Robert Wood Johnson Foundation as a part of the Turning Point Initiative.

Are we in the dark ages of environmental toxicology?

PubMed

McCarty, L S

2013-12-01

Environmental toxicity is judged to be in a "dark ages" period due to longstanding limitations in the implementation of the simple conceptual model that is the basis of current aquatic toxicity testing protocols. Fortunately, the environmental regulatory revolution of the last half-century is not substantially compromised as development of past regulatory guidance was designed to deal with limited amounts of relatively poor quality toxicity data. However, as regulatory objectives have substantially increased in breadth and depth, aquatic toxicity data derived with old testing methods are no longer adequate. In the near-term explicit model description and routine assumption validation should be mandatory. Updated testing methods could provide some improvements in toxicological data quality. A thorough reevaluation of toxicity testing objectives and methods resulting in substantially revised standard testing methods, plus a comprehensive scheme for classification of modes/mechanisms of toxic action, should be the long-term objective. Copyright © 2013 Elsevier Inc. All rights reserved.

Enhancement of Perfluoropolyether Boundary Lubrication Performance

NASA Technical Reports Server (NTRS)

Jones, W. R., Jr.; Ajayi, O. O.; Wedeven, L. D.

1996-01-01

A ball bearing simulator operating under starved conditions was used to perform screening tests to evaluate the boundary lubrication performance of a branched perfluoropolyether (PFPE), K-143 AB. Several approaches to enhance boundary lubrication were studied. These included: (1) soluble boundary additives, (2) bearing surface modifications, (3) 'run-in' surface films, and (4) ceramic bearing components. In addition, results were compared with two non-perfluorinated liquid lubricant formulations. Based on these tests, the following tentative conclusions can be made: (1) Substantial improvements in boundary lubrication performance were observed with a beta-diketone boundary additive and a tricresyl phosphate (TCP) liquid surface pretreatment, (2) the use of rough Si3N4 balls (R(sub a) = 40 micro-inch) also provided increases in test duration, but with concomitant abrasive wear, (3) moderate improvements were seen with two boundary additives (a phosphine and a phosphatriazine) and a neat (100%) fluid (a carboxylic acid terminated PFPE); and small improvements with surface pretreatments with synthetic hydrocarbons, a polytetrafluoroethylene (PTFE) coating, and TiC coated 440 C and smooth Si3N4 balls (R(sub a) = 1 micro-inch), and (4) two non-PFPE lubricant formulations (a polyalphaolefin (PAO) and synthetic hydrocarbon) yielded substantial improvements.

Magnetic Properties Improvement of Die-upset Nd-Fe-B Magnets by Dy-Cu Press Injection and Subsequent Heat Treatment

NASA Astrophysics Data System (ADS)

Wang, Zexuan; Ju, Jinyun; Wang, Jinzhi; Yin, Wenzong; Chen, Renjie; Li, Ming; Jin, Chaoxiang; Tang, Xu; Lee, Don; Yan, Aru

2016-12-01

Ultrafine-grained die-upset Nd-Fe-B magnets are of importance because they provide a wide researching space to redesign the textured structures. Here is presented a route to obtain a new die-upset magnet with substantially improved magnetic properties. After experiencing the optimized heat treatment, both the coercivity and remanent magnetization of the Dy-Cu press injected magnets increased substantially in comparison with those of the annealed reference magnets, which is distinct from the reported experimental results on heavy rare-earth diffusion. To study the mechanism, we analyzed the texture evolution in high-temperature annealed die-upset magnets, which had significant impact on the improvement of remanent magnetization. On basis of the results, we find that the new structures are strongly interlinked with the initial structures. With injecting Dy-Cu eutectic alloy, an optimized initial microstructure was achieved in the near-surface diffused regions, which made preparations for the subsequent texture improvement. Besides, the Dy gradient distribution of near-surface regions of the Dy-Cu press injected magnets was also investigated. By controlling the initial microstructure and subsequent diffusion process, a higher performance magnet is expected to be obtained.

Magnetic Properties Improvement of Die-upset Nd-Fe-B Magnets by Dy-Cu Press Injection and Subsequent Heat Treatment

PubMed Central

Wang, Zexuan; Ju, Jinyun; Wang, Jinzhi; Yin, Wenzong; Chen, Renjie; Li, Ming; Jin, Chaoxiang; Tang, Xu; Lee, Don; Yan, Aru

2016-01-01

Ultrafine-grained die-upset Nd-Fe-B magnets are of importance because they provide a wide researching space to redesign the textured structures. Here is presented a route to obtain a new die-upset magnet with substantially improved magnetic properties. After experiencing the optimized heat treatment, both the coercivity and remanent magnetization of the Dy-Cu press injected magnets increased substantially in comparison with those of the annealed reference magnets, which is distinct from the reported experimental results on heavy rare-earth diffusion. To study the mechanism, we analyzed the texture evolution in high-temperature annealed die-upset magnets, which had significant impact on the improvement of remanent magnetization. On basis of the results, we find that the new structures are strongly interlinked with the initial structures. With injecting Dy-Cu eutectic alloy, an optimized initial microstructure was achieved in the near-surface diffused regions, which made preparations for the subsequent texture improvement. Besides, the Dy gradient distribution of near-surface regions of the Dy-Cu press injected magnets was also investigated. By controlling the initial microstructure and subsequent diffusion process, a higher performance magnet is expected to be obtained. PMID:27922060

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.

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

NASA Technical Reports Server (NTRS)

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

1974-01-01

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

Extension of a Computer Assisted Decision Support (CADS) Study to Improve Outcomes in Patients with Type 2 DM Treated by Primary Care Providers (short title, CADS-X). Addendum

DTIC Science & Technology

2014-12-01

Hypertension is one of the most common co-morbidities associated with DM and substantially contributes to the macrovascular disease that occurs in...After Numera terminated the contract to provide glucometer download support Estenda activated the patient portal , Diabetes Mellitus Everywhere...several patients. Problem areas include having to download JAVA with first upload and accessing the DME portal . d. PO has downloaded glucose

Polynuclear aromatic hydrocarbons for fullerene synthesis in flames

DOEpatents

Alford, J. Michael; Diener, Michael D.

2006-12-19

This invention provides improved methods for combustion synthesis of carbon nanomaterials, including fullerenes, employing multiple-ring aromatic hydrocarbon fuels selected for high carbon conversion to extractable fullerenes. The multiple-ring aromatic hydrocarbon fuels include those that contain polynuclear aromatic hydrocarbons. More specifically, multiple-ring aromatic hydrocarbon fuels contain a substantial amount of indene, methylnapthalenes or mixtures thereof. Coal tar and petroleum distillate fractions provide low cost hydrocarbon fuels containing polynuclear aromatic hydrocarbons, including without limitation, indene, methylnapthalenes or mixtures thereof.

Understanding Core Skills and Influences in Primary School Science Learning: Taking a Scientific Approach

ERIC Educational Resources Information Center

Tolmie, Andy

2012-01-01

Recent years have seen substantial improvements in the teaching of reading and early arithmetic based on rigorous analysis of the component learning skills involved in these areas and of the ways they are developed. Despite the importance attached to science, there has been very little comparable work that might provide a steer to primary school…

Options for Improving the Military Child Care System. Occasional Paper

ERIC Educational Resources Information Center

Zellman, Gail; Gates, Susan M.; Cho, Michelle; Shaw, Rebecca

2008-01-01

The evidence presented in this paper questions whether the current U.S. Department of Defense (DoD) system of in-kind subsidies for child care is meeting DoD recruitment, readiness, and retention goals or service member needs in an optimal way. DoD appears to be reaping limited benefits from the substantial subsidies provided to families that use…

Options for Improving the Military Child Care System. Occasional Paper Summary

ERIC Educational Resources Information Center

Zellman, Gail L.; Gates, Susan M.; Cho, Michelle; Shaw, Rebecca

2008-01-01

This document summarizes a report that questions whether the current U.S. Department of Defense (DoD) system of in-kind subsidies for child care is meeting DoD recruitment, readiness, and retention goals or service member needs in an optimal way. DoD appears to be reaping limited benefits from the substantial subsidies provided to families that…

Team Up for 21st Century Teaching and Learning: What Research and Practice Reveal about Professional Learning. Condensed Excerpts

ERIC Educational Resources Information Center

Carroll, Thomas G., Ed.; Fulton, Kathleen, Ed.; Doerr, Hanna, Ed.

2010-01-01

This document contains excerpts from Team Up for 21st Century Teaching & Learning. This document includes the excerpts of five articles that provide a substantial evidence-based argument for the power of collaborative communities to improve teaching and learning. These articles are: (1) Professional Communities and the Artisan Model of…

The Electrooculogram and a New Blink Detection Algorithm

DTIC Science & Technology

2015-10-30

applications, and physiological monitoring has proven quite helpful with this assessment. One such physiological signal , the electrooculogram ( EOG ...significantly improve performance. One such physiological signal , the electrooculogram ( EOG ), can provide blink rate and blink duration measures. Blink...that such variability substantiates the need for blink detection algorithms, using the EOG signal , that are robust to noise, artifacts, and intra- and

An Analysis of the Relationship between Information and Communication Technology (ICT) and Scientific Literacy in Canada and Australia

ERIC Educational Resources Information Center

Luu, King; Freeman, John G.

2011-01-01

Despite the lack of substantial evidence for improvement in the quality of teaching and learning with information and communication technology (ICT), governmental organizations have pushed ICT as a means of providing broad-scale training to meet the demand for a skilled workforce, centred upon a hypothesized ICT-scientific literacy relationship.…

Why an alternative to blood transfusion?

PubMed

Shander, Aryeh; Goodnough, Lawrence Tim

2009-04-01

Allogeneic blood transfusions have been associated with several risks and complications and with worse outcomes in a substantial number of patient populations and clinical scenarios. Allogeneic blood is costly and difficult to procure, transport, and store. Global and local shortages are imminent. Alternatives to transfusion provide many advantages, and their use is likely to improve outcomes as safer and more effective agents are developed.

Promoting Innovation to Improve College Access and Completion: Testimony Submitted to the Advisory Committee on Student Financial Assistance

ERIC Educational Resources Information Center

Mayer, Alexander K.; Richburg-Hayes, Lashawn; Diamond, John

2015-01-01

MDRC is pleased to provide testimony on college access and completion to the Advisory Committee on Student Financial Assistance. Access to college has increased substantially over the last 50 years, but student success--defined as the combination of academic success and degree or certificate completion--has not kept pace. Student success,…

Resistive hydrogen sensing element

DOEpatents

Lauf, Robert J.

2000-01-01

Systems and methods are described for providing a hydrogen sensing element with a more robust exposed metallization by application of a discontinuous or porous overlay to hold the metallization firmly on the substrate. An apparatus includes: a substantially inert, electrically-insulating substrate; a first Pd containing metallization deposited upon the substrate and completely covered by a substantially hydrogen-impermeable layer so as to form a reference resistor on the substrate; a second Pd containing metallization deposited upon the substrate and at least a partially accessible to a gas to be tested, so as to form a hydrogen-sensing resistor; a protective structure disposed upon at least a portion of the second Pd containing metallization and at least a portion of the substrate to improve the attachment of the second Pd containing metallization to the substrate while allowing the gas to contact said the second Pd containing metallization; and a resistance bridge circuit coupled to both the first and second Pd containing metallizations. The circuit determines the difference in electrical resistance between the first and second Pd containing metallizations. The hydrogen concentration in the gas may be determined. The systems and methods provide advantages because adhesion is improved without adversely effecting measurement speed or sensitivity.

The long-term dynamics of mortality benefits from improved water and sanitation in less developed countries.

PubMed

Jeuland, Marc A; Fuente, David E; Ozdemir, Semra; Allaire, Maura C; Whittington, Dale

2013-01-01

The problem of inadequate access to water, sanitation and hygiene (WASH) in less-developed nations has received much attention over the last several decades (most recently in the Millennium Development Goals), largely because diseases associated with such conditions contribute substantially to mortality in poor countries. We present country-level projections for WASH coverage and for WASH-related mortality in developing regions over a long time horizon (1975-2050) and provide dynamic estimates of the economic value of potential reductions in this WASH-related mortality, which go beyond the static results found in previous work. Over the historical period leading up to the present, our analysis shows steady and substantial improvements in WASH coverage and declining mortality rates across many developing regions, namely East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. The economic value of potential health gains from eliminating mortality attributable to poor water and sanitation has decreased substantially, and in the future will therefore be modest in these regions. Where WASH-related deaths remain high (in parts of South Asia and much of Sub-Saharan Africa), if current trends continue, it will be several decades before economic development and investments in improved water and sanitation will result in the capture of these economic benefits. The fact that health losses will likely remain high in these two regions over the medium term suggests that accelerated efforts are needed to improve access to water and sanitation, though the costs and benefits of such efforts in specific locations should be carefully assessed.

Lipid and other plasma markers are associated with anxiety, depression, and fatigue.

PubMed

Lieberman, Harris R; Kellogg, Mark D; Kramer, F Matthew; Bathalon, Gaston P; Lesher, Larry L

2012-03-01

Few peripheral metabolites have been shown to be associated with mood in healthy individuals or patients with central nervous system diseases. During military basic combat training (BCT), mood state, physical performance and body composition substantially improve, providing an opportunity to examine relationships between mood and nutritional and hormonal biomarkers. Thirty-five females enrolled in U.S. Marine BCT, an intense physically and mentally challenging 12-week course, were studied. Every 4 weeks, mood was assessed with the Profile of Mood States (POMS), as were nutritional, metabolic and hormonal plasma markers. Mood and fitness improved over BCT, and there were substantial changes in biochemical markers. Multiple regression demonstrated that, in combination, cholesterol (HDL, LDL), fructosamine, triglycerides, free fatty acids (FFA), dehydroepiandrosterone-sulfate (DHEA-S), ACTH, and substance P accounted for 44% of variation in anxiety, 40% confusion, 37% fatigue, 27% depression and 40% in total mood (p < .0001). Increased HDL, FFA, DHEA-S, and substance P were associated with degraded mood (p < .05). Increased LDL, triglycerides, fructosamine, and ACTH were associated with improved mood (p < .05). Other markers, including glucose, cortisol, and C-reactive protein were not associated with mood. Normal human mood state was associated with 8 plasma markers. Increased HDL and lower LDL, which are associated with improved cardiovascular status, were associated with negative affect. Fructosamine and substance P, not previously known to be related to mood, were associated with it. We are not aware of any biological parameters that in aggregate predict such a substantial proportion of variation in normal mood.

The Long-Term Dynamics of Mortality Benefits from Improved Water and Sanitation in Less Developed Countries

PubMed Central

Jeuland, Marc A.; Fuente, David E.; Ozdemir, Semra; Allaire, Maura C.; Whittington, Dale

2013-01-01

The problem of inadequate access to water, sanitation and hygiene (WASH) in less-developed nations has received much attention over the last several decades (most recently in the Millennium Development Goals), largely because diseases associated with such conditions contribute substantially to mortality in poor countries. We present country-level projections for WASH coverage and for WASH-related mortality in developing regions over a long time horizon (1975–2050) and provide dynamic estimates of the economic value of potential reductions in this WASH-related mortality, which go beyond the static results found in previous work. Over the historical period leading up to the present, our analysis shows steady and substantial improvements in WASH coverage and declining mortality rates across many developing regions, namely East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. The economic value of potential health gains from eliminating mortality attributable to poor water and sanitation has decreased substantially, and in the future will therefore be modest in these regions. Where WASH-related deaths remain high (in parts of South Asia and much of Sub-Saharan Africa), if current trends continue, it will be several decades before economic development and investments in improved water and sanitation will result in the capture of these economic benefits. The fact that health losses will likely remain high in these two regions over the medium term suggests that accelerated efforts are needed to improve access to water and sanitation, though the costs and benefits of such efforts in specific locations should be carefully assessed. PMID:24116011

Carbon Nanotube Electron Gun

NASA Technical Reports Server (NTRS)

Ribaya, Bryan P. (Inventor); Nguyen, Cattien V. (Inventor)

2013-01-01

An electron gun, an electron source for an electron gun, an extractor for an electron gun, and a respective method for producing the electron gun, the electron source and the extractor are disclosed. Embodiments provide an electron source utilizing a carbon nanotube (CNT) bonded to a substrate for increased stability, reliability, and durability. An extractor with an aperture in a conductive material is used to extract electrons from the electron source, where the aperture may substantially align with the CNT of the electron source when the extractor and electron source are mated to form the electron gun. The electron source and extractor may have alignment features for aligning the electron source and the extractor, thereby bringing the aperture and CNT into substantial alignment when assembled. The alignment features may provide and maintain this alignment during operation to improve the field emission characteristics and overall system stability of the electron gun.

Carbon nanotube electron gun

NASA Technical Reports Server (NTRS)

Nguyen, Cattien V. (Inventor); Ribaya, Bryan P. (Inventor)

2010-01-01

An electron gun, an electron source for an electron gun, an extractor for an electron gun, and a respective method for producing the electron gun, the electron source and the extractor are disclosed. Embodiments provide an electron source utilizing a carbon nanotube (CNT) bonded to a substrate for increased stability, reliability, and durability. An extractor with an aperture in a conductive material is used to extract electrons from the electron source, where the aperture may substantially align with the CNT of the electron source when the extractor and electron source are mated to form the electron gun. The electron source and extractor may have alignment features for aligning the electron source and the extractor, thereby bringing the aperture and CNT into substantial alignment when assembled. The alignment features may provide and maintain this alignment during operation to improve the field emission characteristics and overall system stability of the electron gun.

Induction melter apparatus

DOEpatents

Roach, Jay A [Idaho Falls, ID; Richardson, John G [Idaho Falls, ID; Raivo, Brian D [Idaho Falls, ID; Soelberg, Nicholas R [Idaho Falls, ID

2008-06-17

Apparatus and methods of operation are provided for a cold-crucible-induction melter for vitrifying waste wherein a single induction power supply may be used to effect a selected thermal distribution by independently energizing at least two inductors. Also, a bottom drain assembly may be heated by an inductor and may include an electrically resistive heater. The bottom drain assembly may be cooled to solidify molten material passing therethrough to prevent discharge of molten material therefrom. Configurations are provided wherein the induction flux skin depth substantially corresponds with the central longitudinal axis of the crucible. Further, the drain tube may be positioned within the induction flux skin depth in relation to material within the crucible or may be substantially aligned with a direction of flow of molten material within the crucible. An improved head design including four shells forming thermal radiation shields and at least two gas-cooled plenums is also disclosed.

Operating an induction melter apparatus

DOEpatents

Roach, Jay A.; Richardson, John G.; Raivo, Brian D.; Soelberg, Nicholas R.

2006-01-31

Apparatus and methods of operation are provided for a cold-crucible-induction melter for vitrifying waste wherein a single induction power supply may be used to effect a selected thermal distribution by independently energizing at least two inductors. Also, a bottom drain assembly may be heated by an inductor and may include an electrically resistive heater. The bottom drain assembly may be cooled to solidify molten material passing therethrough to prevent discharge of molten material therefrom. Configurations are provided wherein the induction flux skin depth substantially corresponds with the central longitudinal axis of the crucible. Further, the drain tube may be positioned within the induction flux skin depth in relation to material within the crucible or may be substantially aligned with a direction of flow of molten material within the crucible. An improved head design including four shells forming thermal radiation shields and at least two gas-cooled plenums is also disclosed.

Distributed data transmitter

DOEpatents

Brown, Kenneth Dewayne [Grain Valley, MO; Dunson, David [Kansas City, MO

2006-08-08

A distributed data transmitter (DTXR) which is an adaptive data communication microwave transmitter having a distributable architecture of modular components, and which incorporates both digital and microwave technology to provide substantial improvements in physical and operational flexibility. The DTXR has application in, for example, remote data acquisition involving the transmission of telemetry data across a wireless link, wherein the DTXR is integrated into and utilizes available space within a system (e.g., a flight vehicle). In a preferred embodiment, the DTXR broadly comprises a plurality of input interfaces; a data modulator; a power amplifier; and a power converter, all of which are modularly separate and distinct so as to be substantially independently physically distributable and positionable throughout the system wherever sufficient space is available.

Distributed data transmitter

DOEpatents

Brown, Kenneth Dewayne [Grain Valley, MO; Dunson, David [Kansas City, MO

2008-06-03

A distributed data transmitter (DTXR) which is an adaptive data communication microwave transmitter having a distributable architecture of modular components, and which incorporates both digital and microwave technology to provide substantial improvements in physical and operational flexibility. The DTXR has application in, for example, remote data acquisition involving the transmission of telemetry data across a wireless link, wherein the DTXR is integrated into and utilizes available space within a system (e.g., a flight vehicle). In a preferred embodiment, the DTXR broadly comprises a plurality of input interfaces; a data modulator; a power amplifier; and a power converter, all of which are modularly separate and distinct so as to be substantially independently physically distributable and positionable throughout the system wherever sufficient space is available.

Compressive creep behavior of alloys based on B2 FeAl

NASA Technical Reports Server (NTRS)

Mantravadi, N.; Vedula, K.; Gaydosh, D.; Titran, R. H.

1986-01-01

Alloys based on FeAl are attractive alternate materials for environmental resistance at intermediate temperatures. Addition of small amounts of Nb, Hf, Ta, Mo, Zr, and B were shown to improve the compressive creep of this alloy at 1100 K. Boron, in particular, was found to have a synergistic effect along with Zr in providing properties substantially better than the binary alloy. This improvement seems to be related to the higher activation energy found for this alloy, suggesting a modification in the diffusion behavior due to the alloying additions.

Compressive creep behavior of alloys based on B2 FeAl

NASA Technical Reports Server (NTRS)

Mantravadi, N.; Vedula, K.; Gaydosh, D.; Titran, R. H.

1987-01-01

Alloys based on FeAl are attractive alternative materials for environmental resistance at intermediate temperatures. Addition of small amounts of Nb, Hf, Ta, Mo, Zr, and B were shown to improve the compressive creep of this alloy at 1100 K. Boron, in particular, was found to have a synergistic effect along with Zr in providing properties substantially better than the binary alloy. This improvement seems to be related to the higher activation energy found for this alloy, suggesting a modification in the diffusion behavior due to the alloying additions.

Apparatus for improving the working time of the XeBr laser

DOEpatents

Sander, R.K.; Balog, G.; Seegmiller, E.T.

1980-03-04

In XeBr lasers which make use of HBr as the source of bromine, it has been found that the working life of the laser is limited because of dissociation of the HBr in the lasing region to form H/sub 2/ and Br/sub 2/. Accordingly, apparatus is disclosed for substantially improving the working time of the XeBr laser wherein means are provided for recombining H/sub 2/ and Br/sub 2/ into HBr and for continuously circulating the gaseous working medium from the lasing region through the recombination region.

Innovative technology conserves resources and generates savings: a case study from the Sunnybrook Regional Processing Centre.

PubMed

Karim, Abdool Z

2009-01-01

The regional processing centre at Sunnybrook Health Sciences Centre recently faced the substantial challenge of increasing cleaning capacity to meet the current workload and anticipated future demand without increasing its operating budget. The solution, upgrading its cleaning and decontamination system to a highly automated system, met both objectives. An analysis of the impact of the change found that the new system provided additional benefits, including improved productivity and cleaning quality; decreased costs; reduced water, electricity and chemical use; improved worker safety and morale; and decreased overtime. Investing in innovative technology improved key departmental outcomes while meeting institutional environmental and cost savings objectives.

Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending

PubMed Central

Song, Zirui; Rose, Sherri; Chernew, Michael E.; Safran, Dana Gelb

2018-01-01

As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations. PMID:28069849

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

PubMed Central

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

2015-01-01

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

Remote sensing inputs to landscape models which predict future spatial land use patterns for hydrologic models

NASA Technical Reports Server (NTRS)

Miller, L. D.; Tom, C.; Nualchawee, K.

1977-01-01

A tropical forest area of Northern Thailand provided a test case of the application of the approach in more natural surroundings. Remote sensing imagery subjected to proper computer analysis has been shown to be a very useful means of collecting spatial data for the science of hydrology. Remote sensing products provide direct input to hydrologic models and practical data bases for planning large and small-scale hydrologic developments. Combining the available remote sensing imagery together with available map information in the landscape model provides a basis for substantial improvements in these applications.

24 CFR 968.105 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... purpose of funding physical and management improvements. Modernization program. A PHA's program for... substantially the same kind does qualify, but reconstruction, substantial improvement in the quality or kind of... resident participation in each of the required program components. PHMAP. The Public Housing Management...

Resolving prokaryotic taxonomy without rRNA: longer oligonucleotide word lengths improve genome and metagenome taxonomic classification.

PubMed

Alsop, Eric B; Raymond, Jason

2013-01-01

Oligonucleotide signatures, especially tetranucleotide signatures, have been used as method for homology binning by exploiting an organism's inherent biases towards the use of specific oligonucleotide words. Tetranucleotide signatures have been especially useful in environmental metagenomics samples as many of these samples contain organisms from poorly classified phyla which cannot be easily identified using traditional homology methods, including NCBI BLAST. This study examines oligonucleotide signatures across 1,424 completed genomes from across the tree of life, substantially expanding upon previous work. A comprehensive analysis of mononucleotide through nonanucleotide word lengths suggests that longer word lengths substantially improve the classification of DNA fragments across a range of sizes of relevance to high throughput sequencing. We find that, at present, heptanucleotide signatures represent an optimal balance between prediction accuracy and computational time for resolving taxonomy using both genomic and metagenomic fragments. We directly compare the ability of tetranucleotide and heptanucleotide world lengths (tetranucleotide signatures are the current standard for oligonucleotide word usage analyses) for taxonomic binning of metagenome reads. We present evidence that heptanucleotide word lengths consistently provide more taxonomic resolving power, particularly in distinguishing between closely related organisms that are often present in metagenomic samples. This implies that longer oligonucleotide word lengths should replace tetranucleotide signatures for most analyses. Finally, we show that the application of longer word lengths to metagenomic datasets leads to more accurate taxonomic binning of DNA scaffolds and have the potential to substantially improve taxonomic assignment and assembly of metagenomic data.

Helical Fiber Amplifier

DOEpatents

Koplow, Jeffrey P.; Kliner, Dahy; Goldberg, Lew

2002-12-17

A multi-mode gain fiber is provided which affords substantial improvements in the maximum pulse energy, peak power handling capabilities, average output power, and/or pumping efficiency of fiber amplifier and laser sources while maintaining good beam quality (comparable to that of a conventional single-mode fiber source). These benefits are realized by coiling the multimode gain fiber to induce significant bend loss for all but the lowest-order mode(s).

Lean and Efficient Software: Whole-Program Optimization of Executables

DTIC Science & Technology

2015-09-30

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

Effect of citric acid modification of aspen wood on sorption of copper ion

Treesearch

James D. McSweeny; Roger M. Rowell; Soo Hong Min

2006-01-01

Milled aspen wood was thermochemically modified with citric acid for the purpose of improving the copper (Cu2+) ion sorption capacity of the wood when tested in 24-hour equilibrium batch tests. The wood-citric acid adducts provided additional carboxyl groups to those in the native wood and substantially increased Cu2+ ion uptake of the modified wood compared with that...

Probing and Improving Student's Understanding of Protein a-Helix Structure Using Targeted Assessment and Classroom Interventions in Collaboration with a Faculty Community of Practice

ERIC Educational Resources Information Center

Loertscher, Jennifer; Villafañe, Sachel M.; Lewis, Jennifer E.; Minderhout, Vicky

2014-01-01

The increasing availability of concept inventories and other assessment tools in the molecular life sciences provides instructors with myriad avenues to probe student understanding. For example, although molecular visualization is central to the study of biochemistry, a growing body of evidence suggests that students have substantial limitations…

Transforming the HIM department into a strategic resource.

PubMed

Odorisio, L F; Piescik, J B

1998-05-01

The transformation of a traditional (HIM) health information management department into a "virtual" HIM department can offer an IDS substantial economic advantages, improve patient satisfaction levels, enhance the quality of care, and provide greater accuracy in measuring and demonstrating healthcare outcomes. The HIM department's mission should be aligned with enterprise strategies, and the IDS should invest in technology that enables HIM to respond to enterprisewide information requirements.

Optimally moderated nuclear fission reactor and fuel source therefor

DOEpatents

Ougouag, Abderrafi M [Idaho Falls, ID; Terry, William K [Shelley, ID; Gougar, Hans D [Idaho Falls, ID

2008-07-22

An improved nuclear fission reactor of the continuous fueling type involves determining an asymptotic equilibrium state for the nuclear fission reactor and providing the reactor with a moderator-to-fuel ratio that is optimally moderated for the asymptotic equilibrium state of the nuclear fission reactor; the fuel-to-moderator ratio allowing the nuclear fission reactor to be substantially continuously operated in an optimally moderated state.

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

ERIC Educational Resources Information Center

Hilal, Kholoud T.

2013-01-01

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

Lithography process for patterning HgI2 photonic devices

DOEpatents

Mescher, Mark J.; James, Ralph B.; Hermon, Haim

2004-11-23

A photolithographic process forms patterns on HgI.sub.2 surfaces and defines metal sublimation masks and electrodes to substantially improve device performance by increasing the realizable design space. Techniques for smoothing HgI.sub.2 surfaces and for producing trenches in HgI.sub.2 are provided. A sublimation process is described which produces etched-trench devices with enhanced electron-transport-only behavior.

Membranes having aligned 1-D nanoparticles in a matrix layer for improved fluid separation

DOEpatents

Revanur, Ravindra; Lulevich, Valentin; Roh, Il Juhn; Klare, Jennifer E.; Kim, Sangil; Noy, Aleksandr; Bakajin, Olgica

2015-12-22

Membranes for fluid separation are disclosed. These membranes have a matrix layer sandwiched between an active layer and a porous support layer. The matrix layer includes 1-D nanoparticles that are vertically aligned in a porous polymer matrix, and which substantially extend through the matrix layer. The active layer provides species-specific transport, while the support layer provides mechanical support. A matrix layer of this type has favorable surface morphology for forming the active layer. Furthermore, the pores that form in the matrix layer tend to be smaller and more evenly distributed as a result of the presence of aligned 1-D nanoparticles. Improved performance of separation membranes of this type is attributed to these effects.

Alkaline battery, separator therefore

NASA Technical Reports Server (NTRS)

Schmidt, George F. (Inventor)

1980-01-01

An improved battery separator for alkaline battery cells has low resistance to electrolyte ion transfer and high resistance to electrode ion transfer. The separator is formed by applying an improved coating to an electrolyte absorber. The absorber, preferably, is a flexible, fibrous, and porous substrate that is resistant to strong alkali and oxidation. The coating composition includes an admixture of a polymeric binder, a hydrolyzable polymeric ester and inert fillers. The coating composition is substantially free of reactive fillers and plasticizers commonly employed as porosity promoting agents in separator coatings. When the separator is immersed in electrolyte, the polymeric ester of the film coating reacts with the electrolyte forming a salt and an alcohol. The alcohol goes into solution with the electrolyte while the salt imbibes electrolyte into the coating composition. When the salt is formed, it expands the polymeric chains of the binder to provide a film coating substantially permeable to electrolyte ion transfer but relatively impermeable to electrode ion transfer during use.

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 major employer as a health care services laboratory.

PubMed

Reeve, G R; Pastula, S; Rontal, R

1998-12-01

Health care management within the USA operations of the Ford Motor Company is a substantial and critical enterprise. The company provides health care coverage for a population of 636,000 active employees, retirees and their dependents at a cost of US$1.5 billion annually. The company realizes that effective management of health care resources requires continuous improvement in the services for which the company contracts and in the manner in which these services are provided to employees. In this context, the company's health care management department views the Ford employee population as a living health care sciences laboratory for the design, evaluation and improvement of health care services. The population, available data sources, and their advantages and disadvantages for use in the evaluation of disease and health utilization patterns are discussed in this paper from an epidemiological perspective. Two examples of preliminary evaluations are presented to illustrate use of data from this large employee population for improving care provided to persons with elevated risk of cardiovascular disease.

An integrated outsourcing solution at York Central Hospital.

PubMed

Marr, Jo-Anne; Tam, Richard; Simms, Stephen; Bacchus, Feria

2011-01-01

Canadian hospitals struggle to balance the need to increase and improve operational services and quality with diminishing resources. Many realize that sustaining their organization depends on how well they focus their resources and talents on their core business, clinical care delivery. Outsourcing of non-core, non-clinical support services is a solution for many organizations. Most often, this is put into action one service provider at a time. In 2007, however, York Central Hospital (YCH) implemented Sodexo's integrated Comprehensive Service Solutions (CSS) for all its support service functions. In doing so, YCH achieved significant improvements in patient and staff satisfaction rates, substantial cost savings through improved operational efficiency from process improvements and leveraging technology investments, and increased retail food revenue.

Improved PVDF membrane performance by doping extracellular polymeric substances of activated sludge.

PubMed

Guan, Yan-Fang; Huang, Bao-Cheng; Qian, Chen; Wang, Long-Fei; Yu, Han-Qing

2017-04-15

Polyvinylidene fluoride (PVDF) membrane has been widely applied in water and wastewater treatment because of its high mechanical strength, thermal stability and chemical resistance. However, the hydrophobic nature of PVDF membrane makes it readily fouled, substantially reducing water flux and overall membrane rejection ability. In this work, an in-situ blending modifier, i.e., extracellular polymeric substances (EPS) from activated sludge, was used to enhance the anti-fouling ability of PVDF membrane. Results indicate that the pure water flux of the membrane and its anti-fouling performance were substantially improved by blending 8% EPS into the membrane. By introducing EPS, the membrane hydrophilicity was increased and the cross section morphology was changed when it interacted with polyvinl pyrrolidone, resulting in the formation of large cavities below the finger-like pores. In addition, the fraction of pores with a size of 100-500 nm increased, which was also beneficial to improving membrane performance. Surface thermodynamic calculations indicate the EPS-functionalized membrane had a higher cohesion free energy, implying its good pollutant rejection and anti-fouling ability. This work provides a simple, efficient and cost-effective method to improve membrane performance and also extends the applications of EPS. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ceramic tip cast in valve rocker arm

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

Tashiro, K.

1986-12-09

This patent describes a cast ceramic tip for a rocker arm of an automotive engine, a slipper block having a contoured cam engaging surface extending longitudinally of one face thereof, and having a retainer block formed integrally with the slipper block and extending substantially perpendicular to an opposite face of the slipper block. The retainer block has opposite longitudinally extending faces and opposite laterally extending faces. The improvement described here comprises: radiused fillets extending laterally of the opposite faces of the slipper block, and providing transitions between the opposite face thereof and the opposite laterally extending faces of the retainermore » block; and, retaining channels formed exclusively in the longitudinally extending faces of the retainer block, the laterally extending faces being substantially planar.« less

Adherence to Treatment Guidelines and Therapeutic Regimens: A US Claims-Based Benchmark of a Commercial Population

PubMed Central

Priest, Julie L.; Cook, Christopher L.; Fincham, Jack; Burch, Steven P.

2011-01-01

Abstract The objective of this cross-sectional, retrospective study assessing commercially insured patients was to provide a useful benchmark to US health care payers and decision makers to assess quality of care, medication use and adherence, and health care resource utilization/costs associated with common chronic diseases. Measures of quality of care were suboptimal and substantial numbers of patients were not using any pharmacotherapy considered acceptable according to treatment guidelines. The widespread nature of undertreatment, poor medication adherence, and substantial health care costs highlights deficits and points to the need for comprehensive, multifaceted strategies to improve clinical and economic outcomes for chronic diseases. (Population Health Management 2011;14:33–41) PMID:21142978

High performance liquid chromatographic hydrocarbon group-type analyses of mid-distillates employing fuel-derived fractions as standards

NASA Technical Reports Server (NTRS)

Seng, G. T.; Otterson, D. A.

1983-01-01

Two high performance liquid chromatographic (HPLC) methods have been developed for the determination of saturates, olefins and aromatics in petroleum and shale derived mid-distillate fuels. In one method the fuel to be analyzed is reacted with sulfuric acid, to remove a substantial portion of the aromatics, which provides a reacted fuel fraction for use in group type quantitation. The second involves the removal of a substantial portion of the saturates fraction from the HPLC system to permit the determination of olefin concentrations as low as 0.3 volume percent, and to improve the accuracy and precision of olefins determinations. Each method was evaluated using model compound mixtures and real fuel samples.

The Oncology Care Model: Perspectives From the Centers for Medicare & Medicaid Services and Participating Oncology Practices in Academia and the Community.

PubMed

Kline, Ron; Adelson, Kerin; Kirshner, Jeffrey J; Strawbridge, Larissa M; Devita, Marsha; Sinanis, Naralys; Conway, Patrick H; Basch, Ethan

2017-01-01

Cancer care delivery in the United States is often fragmented and inefficient, imposing substantial burdens on patients. Costs of cancer care are rising more rapidly than other specialties, with substantial regional differences in quality and cost. The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMIS) recently launched the Oncology Care Model (OCM), which uses payment incentives and practice redesign requirements toward the goal of improving quality while controlling costs. As of March 2017, 190 practices were participating, with approximately 3,200 oncologists providing care for approximately 150,000 unique beneficiaries per year (approximately 20% of the Medicare Fee-for-Service population receiving chemotherapy for cancer). This article provides an overview of the program from the CMS perspective, as well as perspectives from two practices implementing OCM: an academic health system (Yale Cancer Center) and a community practice (Hematology Oncology Associates of Central New York). Requirements of OCM, as well as implementation successes, challenges, financial implications, impact on quality, and future visions, are provided from each perspective.

Higher Throughput Calorimetry: Opportunities, Approaches and Challenges

PubMed Central

Recht, Michael I.; Coyle, Joseph E.; Bruce, Richard H.

2010-01-01

Higher throughput thermodynamic measurements can provide value in structure-based drug discovery during fragment screening, hit validation, and lead optimization. Enthalpy can be used to detect and characterize ligand binding, and changes that affect the interaction of protein and ligand can sometimes be detected more readily from changes in the enthalpy of binding than from the corresponding free-energy changes or from protein-ligand structures. Newer, higher throughput calorimeters are being incorporated into the drug discovery process. Improvements in titration calorimeters come from extensions of a mature technology and face limitations in scaling. Conversely, array calorimetry, an emerging technology, shows promise for substantial improvements in throughput and material utilization, but improved sensitivity is needed. PMID:20888754

Retinal image contrast obtained by a model eye with combined correction of chromatic and spherical aberrations

PubMed Central

Ohnuma, Kazuhiko; Kayanuma, Hiroyuki; Lawu, Tjundewo; Negishi, Kazuno; Yamaguchi, Takefumi; Noda, Toru

2011-01-01

Correcting spherical and chromatic aberrations in vitro in human eyes provides substantial visual acuity and contrast sensitivity improvements. We found the same improvement in the retinal images using a model eye with/without correction of longitudinal chromatic aberrations (LCAs) and spherical aberrations (SAs). The model eye included an intraocular lens (IOL) and artificial cornea with human ocular LCAs and average human SAs. The optotypes were illuminated using a D65 light source, and the images were obtained using two-dimensional luminance colorimeter. The contrast improvement from the SA correction was higher than the LCA correction, indicating the benefit of an aspheric achromatic IOL. PMID:21698008

Process oriented guided inquiry learning (POGIL®) marginally effects student achievement measures but substantially increases the odds of passing a course.

PubMed

Walker, Lindsey; Warfa, Abdi-Rizak M

2017-01-01

While the inquiry approach to science teaching has been widely recommended as an epistemic mechanism to promote deep content understanding, there is also increased expectation that process and other transferable skills should be integral part of science pedagogy. To test the hypothesis that coupling process skills to content teaching impacts academic success measures, we meta-analyzed twenty-one studies (n = 21) involving 7876 students that compared Process Oriented Guided Inquiry Learning (POGIL), a pedagogy that provides opportunities for improving process skills during content learning through guided-inquiry activities, to standard lecture conditions. Based on conventional measures of class performance, POGIL had a small effect on achievement outcomes (effect size = 0.29, [95% CI = 0.15-0.43]) but substantially improved the odds of passing a class (odds ratio = 2.02, [95% CI: 1.45-2.83]). That is, participants in the POGIL pedagogy had higher odds of passing a course and roughly performed 0.3 standard deviations higher on achievement measures than participants in standard lectures. In relative risk terms, POGIL reduced the risk of failing a course by 38%. These findings suggest providing opportunities to improve process skills during class instruction does not inhibit content learning but enhances conventional success measures. We compare these findings with those of recent large meta-analysis that examined the effects of global active learning methods on achievement outcomes and course failure rates in science, technology, engineering, and mathematics (STEM) fields.

Process oriented guided inquiry learning (POGIL®) marginally effects student achievement measures but substantially increases the odds of passing a course

PubMed Central

Walker, Lindsey

2017-01-01

While the inquiry approach to science teaching has been widely recommended as an epistemic mechanism to promote deep content understanding, there is also increased expectation that process and other transferable skills should be integral part of science pedagogy. To test the hypothesis that coupling process skills to content teaching impacts academic success measures, we meta-analyzed twenty-one studies (n = 21) involving 7876 students that compared Process Oriented Guided Inquiry Learning (POGIL), a pedagogy that provides opportunities for improving process skills during content learning through guided-inquiry activities, to standard lecture conditions. Based on conventional measures of class performance, POGIL had a small effect on achievement outcomes (effect size = 0.29, [95% CI = 0.15–0.43]) but substantially improved the odds of passing a class (odds ratio = 2.02, [95% CI: 1.45–2.83]). That is, participants in the POGIL pedagogy had higher odds of passing a course and roughly performed 0.3 standard deviations higher on achievement measures than participants in standard lectures. In relative risk terms, POGIL reduced the risk of failing a course by 38%. These findings suggest providing opportunities to improve process skills during class instruction does not inhibit content learning but enhances conventional success measures. We compare these findings with those of recent large meta-analysis that examined the effects of global active learning methods on achievement outcomes and course failure rates in science, technology, engineering, and mathematics (STEM) fields. PMID:29023502

Decentralized energy studies: Compendium of international studies and research

NASA Astrophysics Data System (ADS)

Wallace, C.

1980-03-01

With efficient use of energy, renewable energy sources can supply the majority, if not the totality, of energy supplies in developed nations at real energy prices that double or triple by 2025 (1975 prices). This appears true even in harsh climates with oil dependent industrial economies. Large increases in end-use energy efficiency are cost effective at present prices. Some reports show that cost effective end-use efficiency improvements can reduce energy consumption (per capita, per unit of amenity, or per unit of output) to as much as 90 percent. This was demonstrated by highly disaggregated analyses of end-uses. Such analyses consistently show larger potential for efficiency improvements than can be detected from conventional analyses of more aggregated data. As energy use demands decline due to end use efficiency improvements, energy supply problems subsequently decrease. Lifestyle changes, influenced by social factors, and rising energy prices can substantially reduce demands for energy. Such changes are already discernible in end-use energy studies. When energy efficient capital stock is in place, many end-users of energy will be able to provide a substantial portion of their own energy needs from renewable energy sources that are directly available to them.

The Role of Leisure Engagement for Health Benefits Among Korean Older Women.

PubMed

Kim, Junhyoung; Irwin, Lori; Kim, May; Chin, Seungtae; Kim, Jun

2015-01-01

This qualitative study was designed to examine the benefits of leisure to older Korean women. Using a constructive grounded theory methodology, in this study we identified three categories of benefits from leisure activities: (a) developing social connections, (b) enhancing psychological well-being, and (c) improving physical health. The findings of this study demonstrate that involvement in leisure activities offers substantial physical, psychological, and social benefits for older Korean women. The results also suggest that these benefits can provide an opportunity for older Korean adults to improve their health and well-being, which, in turn, may help promote successful aging.

Apparatus for improving the working time of the XeBr laser

DOEpatents

Sander, Robert K.; Balog, George; Seegmiller, Emma T.

1982-01-01

In XeBr lasers which make use of HBr as the source of bromine, it has been found that the working life of the laser is limited because of dissociation of the HBr in the lasing region to form H.sub.2 and Br.sub.2. Accordingly, apparatus is disclosed for substantially improving the working time of the XeBr laser wherein means are provided for recombining H.sub.2 and Br.sub.2 into HBr and for continuously circulating the gaseous working medium from the lasing region through the recombination region. BACKGROUND OF THE INVENTION

Improving SALT productivity by using the theory of constraints

NASA Astrophysics Data System (ADS)

Coetzee, Johannes C.; Väisänen, Petri; O'Donoghue, Darragh E.; Kotze, Paul; Romero Colmenero, Encarni; Miszalski, Brent; Crawford, Steven M.; Kniazev, Alexei; Depagne, Éric; Rabe, Paul; Hettlage, Christian

2016-07-01

SALT, the Southern African Large Telescope, is a very cost effective 10 m class telescope. The operations cost per refereed science paper is currently approximately $70,000. To achieve this competitive advantage, specific design tradeoffs had to be made leading to technical constraints. On the other hand, the telescope has many advantages, such as being able to rapidly switch between different instruments and observing modes during the night. We provide details of the technical and operational constraints and how they were dealt with, by applying the theory of constraints, to substantially improve the observation throughput during the last semester.

Expected Improvements in VLBI Measurements of the Earth's Orientation

NASA Technical Reports Server (NTRS)

Ma, Chopo

2003-01-01

Measurements of the Earth s orientation since the 1970s using space geodetic techniques have provided a continually expanding and improving data set for studies of the Earth s structure and the distribution of mass and angular momentum. The accuracy of current one-day measurements is better than 100 microarcsec for the motion of the pole with respect to the celestial and terrestrial reference frames and better than 3 microsec for the rotation around the pole. VLBI uniquely provides the three Earth orientation parameters (nutation and UTI) that relate the Earth to the extragalactic celestial reference frame. The accuracy and resolution of the VLBI Earth orientation time series can be expected to improve substantially in the near future because of refinements in the realization of the celestial reference frame, improved modeling of the troposphere and non-linear station motions, larger observing networks, optimized scheduling, deployment of disk-based Mark V recorders, full use of Mark IV capabilities, and e-VLBI. More radical future technical developments will be discussed.

Single-row versus double-row rotator cuff repair: techniques and outcomes.

PubMed

Dines, Joshua S; Bedi, Asheesh; ElAttrache, Neal S; Dines, David M

2010-02-01

Double-row rotator cuff repair techniques incorporate a medial and lateral row of suture anchors in the repair configuration. Biomechanical studies of double-row repair have shown increased load to failure, improved contact areas and pressures, and decreased gap formation at the healing enthesis, findings that have provided impetus for clinical studies comparing single-row with double-row repair. Clinical studies, however, have not yet demonstrated a substantial improvement over single-row repair with regard to either the degree of structural healing or functional outcomes. Although double-row repair may provide an improved mechanical environment for the healing enthesis, several confounding variables have complicated attempts to establish a definitive relationship with improved rates of healing. Appropriately powered rigorous level I studies that directly compare single-row with double-row techniques in matched tear patterns are necessary to further address these questions. These studies are needed to justify the potentially increased implant costs and surgical times associated with double-row rotator cuff repair.

Improved technique for one-way transformation of information

DOEpatents

Cooper, J.A.

1987-05-11

Method and apparatus are provided for one-way transformation of data according to multiplication and/or exponentiation modulo a prime number. An implementation of the invention permits the one way residue transformation, useful in encryption and similar applications, to be implemented by n-bit computers substantially with no increase in difficulty or complexity over a natural transformation thereby, using a modulus which is a power of two. 9 figs.

Numerical and Physical Aspects of Aerodynamic Flows

DTIC Science & Technology

1992-01-15

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

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

DTIC Science & Technology

2000-12-01

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

Histogram equalization with Bayesian estimation for noise robust speech recognition.

PubMed

Suh, Youngjoo; Kim, Hoirin

2018-02-01

The histogram equalization approach is an efficient feature normalization technique for noise robust automatic speech recognition. However, it suffers from performance degradation when some fundamental conditions are not satisfied in the test environment. To remedy these limitations of the original histogram equalization methods, class-based histogram equalization approach has been proposed. Although this approach showed substantial performance improvement under noise environments, it still suffers from performance degradation due to the overfitting problem when test data are insufficient. To address this issue, the proposed histogram equalization technique employs the Bayesian estimation method in the test cumulative distribution function estimation. It was reported in a previous study conducted on the Aurora-4 task that the proposed approach provided substantial performance gains in speech recognition systems based on the acoustic modeling of the Gaussian mixture model-hidden Markov model. In this work, the proposed approach was examined in speech recognition systems with deep neural network-hidden Markov model (DNN-HMM), the current mainstream speech recognition approach where it also showed meaningful performance improvement over the conventional maximum likelihood estimation-based method. The fusion of the proposed features with the mel-frequency cepstral coefficients provided additional performance gains in DNN-HMM systems, which otherwise suffer from performance degradation in the clean test condition.

QUANTIFYING ALTERNATIVE SPLICING FROM PAIRED-END RNA-SEQUENCING DATA.

PubMed

Rossell, David; Stephan-Otto Attolini, Camille; Kroiss, Manuel; Stöcker, Almond

2014-03-01

RNA-sequencing has revolutionized biomedical research and, in particular, our ability to study gene alternative splicing. The problem has important implications for human health, as alternative splicing may be involved in malfunctions at the cellular level and multiple diseases. However, the high-dimensional nature of the data and the existence of experimental biases pose serious data analysis challenges. We find that the standard data summaries used to study alternative splicing are severely limited, as they ignore a substantial amount of valuable information. Current data analysis methods are based on such summaries and are hence sub-optimal. Further, they have limited flexibility in accounting for technical biases. We propose novel data summaries and a Bayesian modeling framework that overcome these limitations and determine biases in a non-parametric, highly flexible manner. These summaries adapt naturally to the rapid improvements in sequencing technology. We provide efficient point estimates and uncertainty assessments. The approach allows to study alternative splicing patterns for individual samples and can also be the basis for downstream analyses. We found a several fold improvement in estimation mean square error compared popular approaches in simulations, and substantially higher consistency between replicates in experimental data. Our findings indicate the need for adjusting the routine summarization and analysis of alternative splicing RNA-seq studies. We provide a software implementation in the R package casper.

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

NASA Technical Reports Server (NTRS)

Ellison, Donald; Conway, Bruce; Englander, Jacob

2015-01-01

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

Exploring the energy benefits of advanced water metering

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

Berger, Michael A.; Hans, Liesel; Piscopo, Kate

Recent improvements to advanced water metering and communications technologies have the potential to improve the management of water resources and utility infrastructure, benefiting both utilities and ratepayers. The highly granular, near-real-time data and opportunity for automated control provided by these advanced systems may yield operational benefits similar to those afforded by similar technologies in the energy sector. While significant progress has been made in quantifying the water-related benefits of these technologies, the research on quantifying the energy benefits of improved water metering is underdeveloped. Some studies have quantified the embedded energy in water in California, however these findings are basedmore » on data more than a decade old, and unanimously assert that more research is needed to further explore how topography, climate, water source, and other factors impact their findings. In this report, we show how water-related advanced metering systems may present a broader and more significant set of energy-related benefits. We review the open literature of water-related advanced metering technologies and their applications, discuss common themes with a series of water and energy experts, and perform a preliminary scoping analysis of advanced water metering deployment and use in California. We find that the open literature provides very little discussion of the energy savings potential of advanced water metering, despite the substantial energy necessary for water’s extraction, conveyance, treatment, distribution, and eventual end use. We also find that water AMI has the potential to provide water-energy co-efficiencies through improved water systems management, with benefits including improved customer education, automated leak detection, water measurement and verification, optimized system operation, and inherent water and energy conservation. Our findings also suggest that the adoption of these technologies in the water sector has been slow, due to structural economic and regulatory barriers. In California, we see examples of deployed advanced metering systems with demonstrated embedded energy savings through water conservation and leak detection. Finally, we also see substantial untapped opportunity in the agricultural sector for enabling electric demand response for both traditional peak shaving and more complex flexible and ancillary services through improved water tracking and farm automation.« less

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

PubMed

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

2014-11-01

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

Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending.

PubMed

Song, Zirui; Rose, Sherri; Chernew, Michael E; Safran, Dana Gelb

2017-01-01

As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations. Project HOPE—The People-to-People Health Foundation, Inc.

Public health campaigns and obesity - a critique.

PubMed

Walls, Helen L; Peeters, Anna; Proietto, Joseph; McNeil, John J

2011-02-27

Controlling obesity has become one of the highest priorities for public health practitioners in developed countries. In the absence of safe, effective and widely accessible high-risk approaches (e.g. drugs and surgery) attention has focussed on community-based approaches and social marketing campaigns as the most appropriate form of intervention. However there is limited evidence in support of substantial effectiveness of such interventions. To date there is little evidence that community-based interventions and social marketing campaigns specifically targeting obesity provide substantial or lasting benefit. Concerns have been raised about potential negative effects created by a focus of these interventions on body shape and size, and of the associated media targeting of obesity. A more appropriate strategy would be to enact high-level policy and legislative changes to alter the obesogenic environments in which we live by providing incentives for healthy eating and increased levels of physical activity. Research is also needed to improve treatments available for individuals already obese.

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

NASA Technical Reports Server (NTRS)

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

1986-01-01

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

Public health campaigns and obesity - a critique

PubMed Central

2011-01-01

Background Controlling obesity has become one of the highest priorities for public health practitioners in developed countries. In the absence of safe, effective and widely accessible high-risk approaches (e.g. drugs and surgery) attention has focussed on community-based approaches and social marketing campaigns as the most appropriate form of intervention. However there is limited evidence in support of substantial effectiveness of such interventions. Discussion To date there is little evidence that community-based interventions and social marketing campaigns specifically targeting obesity provide substantial or lasting benefit. Concerns have been raised about potential negative effects created by a focus of these interventions on body shape and size, and of the associated media targeting of obesity. Summary A more appropriate strategy would be to enact high-level policy and legislative changes to alter the obesogenic environments in which we live by providing incentives for healthy eating and increased levels of physical activity. Research is also needed to improve treatments available for individuals already obese. PMID:21352562

Assessment of health claims, content, and safety of herbal supplements containing Ginkgo biloba

PubMed Central

Fransen, Heidi P.; Pelgrom, Sylvia M.G.J.; Stewart-Knox, Barbara; de Kaste, Dries; Verhagen, Hans

2010-01-01

Background European Regulation 1924/2006 states that all health claims made on foods need to be substantiated scientifically. Objective To apply the PASSCLAIM criteria for the scientific substantiation of health claims on foods to herbal supplements containing Ginkgo biloba. Evaluation of three selected claimed health effects for G. biloba (improvement of blood circulation, improvement of symptoms of old age, and improvement of memory) was achieved through review of publicly available scientific data. A total of 35 human intervention studies were evaluated. Commercially available products claimed to contain mainly G. biloba (N=29) were randomly sampled in the Netherlands and analyzed for their content on ginkgo extract. Also, a toxicological risk assessment was performed. Results The three selected health claims investigated could not be substantiated. This was mainly because of a lack of data from studies in healthy volunteers. In most studies results performed with a 24% standardized G. biloba extract were described. However, our chemical analysis showed that 25 of the 29 sampled products did not contain the required minimum 24% standardized extract. Moreover, in most preparations the content of substances typical for G. biloba did not conform to what was declared on the label. Since toxicity data for G. biloba are very limited, a safety limit could not be established. Conclusions Evidence is lacking for three health claims of herbal products with G. biloba. Neither safety nor efficacy can be guaranteed at the recommended daily dose. The multidisciplinary approach described in this paper provides good insight into issues that are relevant for the evaluation of health claims for herbal food supplements. PMID:20927202

Radiation Damage Workshop

NASA Technical Reports Server (NTRS)

Stella, P. M.

1984-01-01

The availability of data regarding the radiation behavior of GaAs and silicon solar cells is discussed as well as efforts to provide sufficient information. Other materials are considered too immature for reasonable radiation evaluation. The lack of concern over the possible catastrophic radiation degradation in cascade cells is a potentially serious problem. Lithium counterdoping shows potential for removing damage in irradiated P-type material, although initial efficiencies are not comparable to current state of the art. The possibility of refining the lithium doping method to maintain high initial efficiencies and combining it with radiation tolerant structures such as thin BSF cells or vertical junction cells could provide a substantial improvement in EOL efficiencies. Laser annealing of junctions, either those formed ion implantation or diffusion, may not only improve initial cell performance but might also reduce the radiation degradation rate.

Draft genome sequence of chickpea (Cicer arietinum) provides a resource for trait improvement.

PubMed

Varshney, Rajeev K; Song, Chi; Saxena, Rachit K; Azam, Sarwar; Yu, Sheng; Sharpe, Andrew G; Cannon, Steven; Baek, Jongmin; Rosen, Benjamin D; Tar'an, Bunyamin; Millan, Teresa; Zhang, Xudong; Ramsay, Larissa D; Iwata, Aiko; Wang, Ying; Nelson, William; Farmer, Andrew D; Gaur, Pooran M; Soderlund, Carol; Penmetsa, R Varma; Xu, Chunyan; Bharti, Arvind K; He, Weiming; Winter, Peter; Zhao, Shancen; Hane, James K; Carrasquilla-Garcia, Noelia; Condie, Janet A; Upadhyaya, Hari D; Luo, Ming-Cheng; Thudi, Mahendar; Gowda, C L L; Singh, Narendra P; Lichtenzveig, Judith; Gali, Krishna K; Rubio, Josefa; Nadarajan, N; Dolezel, Jaroslav; Bansal, Kailash C; Xu, Xun; Edwards, David; Zhang, Gengyun; Kahl, Guenter; Gil, Juan; Singh, Karam B; Datta, Swapan K; Jackson, Scott A; Wang, Jun; Cook, Douglas R

2013-03-01

Chickpea (Cicer arietinum) is the second most widely grown legume crop after soybean, accounting for a substantial proportion of human dietary nitrogen intake and playing a crucial role in food security in developing countries. We report the ∼738-Mb draft whole genome shotgun sequence of CDC Frontier, a kabuli chickpea variety, which contains an estimated 28,269 genes. Resequencing and analysis of 90 cultivated and wild genotypes from ten countries identifies targets of both breeding-associated genetic sweeps and breeding-associated balancing selection. Candidate genes for disease resistance and agronomic traits are highlighted, including traits that distinguish the two main market classes of cultivated chickpea--desi and kabuli. These data comprise a resource for chickpea improvement through molecular breeding and provide insights into both genome diversity and domestication.

Occupational exposure monitoring data collection, storage, and use among state-based and private workers' compensation insurers.

PubMed

Shockey, Taylor M; Babik, Kelsey R; Wurzelbacher, Steven J; Moore, Libby L; Bisesi, Michael S

2018-06-01

Despite substantial financial and personnel resources being devoted to occupational exposure monitoring (OEM) by employers, workers' compensation insurers, and other organizations, the United States (U.S.) lacks comprehensive occupational exposure databases to use for research and surveillance activities. OEM data are necessary for determining the levels of workers' exposures; compliance with regulations; developing control measures; establishing worker exposure profiles; and improving preventive and responsive exposure surveillance and policy efforts. Workers' compensation insurers as a group may have particular potential for understanding exposures in various industries, especially among small employers. This is the first study to determine how selected state-based and private workers' compensation insurers collect, store, and use OEM data related specifically to air and noise sampling.  Of 50 insurers contacted to participate in this study, 28 completed an online survey. All of the responding private and the majority of state-based insurers offered industrial hygiene (IH) services to policyholders and employed 1 to 3 certified industrial hygienists on average. Many, but not all, insurers used standardized forms for data collection, but the data were not commonly stored in centralized databases. Data were most often used to provide recommendations for improvement to policyholders. Although not representative of all insurers, the survey was completed by insurers that cover a substantial number of employers and workers. The 20 participating state-based insurers on average provided 48% of the workers' compensation insurance benefits in their respective states or provinces. These results provide insight into potential next steps for improving the access to and usability of existing data as well as ways researchers can help organizations improve data collection strategies. This effort represents an opportunity for collaboration among insurers, researchers, and others that can help insurers and employers while advancing the exposure assessment field in the U.S.

Improvement of multiprocessing performance by using optical centralized shared bus

NASA Astrophysics Data System (ADS)

Han, Xuliang; Chen, Ray T.

2004-06-01

With the ever-increasing need to solve larger and more complex problems, multiprocessing is attracting more and more research efforts. One of the challenges facing the multiprocessor designers is to fulfill in an effective manner the communications among the processes running in parallel on multiple multiprocessors. The conventional electrical backplane bus provides narrow bandwidth as restricted by the physical limitations of electrical interconnects. In the electrical domain, in order to operate at high frequency, the backplane topology has been changed from the simple shared bus to the complicated switched medium. However, the switched medium is an indirect network. It cannot support multicast/broadcast as effectively as the shared bus. Besides the additional latency of going through the intermediate switching nodes, signal routing introduces substantial delay and considerable system complexity. Alternatively, optics has been well known for its interconnect capability. Therefore, it has become imperative to investigate how to improve multiprocessing performance by utilizing optical interconnects. From the implementation standpoint, the existing optical technologies still cannot fulfill the intelligent functions that a switch fabric should provide as effectively as their electronic counterparts. Thus, an innovative optical technology that can provide sufficient bandwidth capacity, while at the same time, retaining the essential merits of the shared bus topology, is highly desirable for the multiprocessing performance improvement. In this paper, the optical centralized shared bus is proposed for use in the multiprocessing systems. This novel optical interconnect architecture not only utilizes the beneficial characteristics of optics, but also retains the desirable properties of the shared bus topology. Meanwhile, from the architecture standpoint, it fits well in the centralized shared-memory multiprocessing scheme. Therefore, a smooth migration with substantial multiprocessing performance improvement is expected. To prove the technical feasibility from the architecture standpoint, a conceptual emulation of the centralized shared-memory multiprocessing scheme is demonstrated on a generic PCI subsystem with an optical centralized shared bus.

ELECTROCHEMISTRY AND ON-CELL REFORMATION MODELING FOR SOLID OXIDE FUEL CELL STACKS

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

Recknagle, Kurtis P.; Jarboe, Daniel T.; Johnson, Kenneth I.

2007-01-16

ABSTRACT Providing adequate and efficient cooling schemes for solid-oxide-fuel-cell (SOFC) stacks continues to be a challenge coincident with the development of larger, more powerful stacks. The endothermic steam-methane reformation reaction can provide cooling and improved system efficiency when performed directly on the electrochemically active anode. Rapid kinetics of the endothermic reaction typically causes a localized temperature depression on the anode near the fuel inlet. It is desirable to extend the endothermic effect over more of the cell area and mitigate the associated differences in temperature on the cell to alleviate subsequent thermal stresses. In this study, modeling tools validated formore » the prediction of fuel use, on-cell methane reforming, and the distribution of temperature within SOFC stacks, are employed to provide direction for modifying the catalytic activity of anode materials to control the methane conversion rate. Improvements in thermal management that can be achieved through on-cell reforming is predicted and discussed. Two operating scenarios are considered: one in which the methane fuel is fully pre-reformed, and another in which a substantial percentage of the methane is reformed on-cell. For the latter, a range of catalytic activity is considered and the predicted thermal effects on the cell are presented. Simulations of the cell electrochemical and thermal performance with and without on-cell reforming, including structural analyses, show a substantial decrease in thermal stresses for an on-cell reforming case with slowed methane conversion.« less

Enhancement of mechanical properties of 123 superconductors

DOEpatents

Balachandran, Uthamalingam

1995-01-01

A composition and method of preparing YBa.sub.2 Cu.sub.3 O.sub.7-x superconductor. Addition of tin oxide containing compounds to YBCO superconductors results in substantial improvement of fracture toughness and other mechanical properties without affect on T.sub.c. About 5-20% additions give rise to substantially improved mechanical properties.

78 FR 25501 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Designation of a Longer...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-69450; File No. SR-NASDAQ-2013-031] Self... Member Organization To Attest That ``Substantially All'' Orders Submitted to the Retail Price Improvement... ``substantially all,'' rather than all, orders submitted to the Retail Price Improvement Program qualify as...

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

PubMed

Hanna, Timothy P; Kangolle, Alfred C T

2010-10-13

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

Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application.

PubMed

Hobson, D W; Woller, W; Anderson, L; Guthery, E

1998-10-01

Since the introduction in the 1970s of surgical hand scrub formulations that contain 4% chlorhexidine gluconate (CHG), new surgical scrub formulations that have improved efficacy, persistence, or significantly improved use characteristics have not been forthcoming. In addition, the manufacturer's labeling for popular hand scrub products generally requires scrub times in excess of 6 minutes, whereas current practical needs call for products with substantially shorter scrub times. A new alcohol-based surgical scrub formulation, which has ingredients that provide emollient, surfactant, and antimicrobial persistence characteristics to complement the rapid and broad-spectrum antiseptic qualities of alcohol, has been developed in an effort to address these current practical needs. The relative efficacy of a new alcohol-based surgical scrub formulation that contains ingredients that provide surfactant and antimicrobial persistence characteristics was compared with that of commercial 4% CHG and 7.5% povidone iodine (PVPI) formulations with use of human subjects. Hand antimicrobial count sampling was performed by using standardized "glove juice" methodology. The efficacy and persistence results of the new formulation showed statistically significant improvement over both CHG and PVPI at a substantially lessened scrub time (3 minutes). In addition, use of the new formulation without a scrub brush produced results statistically similar to 3-minute applications with either a brush or a sponge. The new alcohol-based formulation demonstrates promise as a new surgical hand scrub formulation with antimicrobial and use characteristics that are significantly improved over current CHG and PVPI formulations. These studies demonstrate the suitability of this formulation for use as a surgical hand scrub and for brushless application.

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

PubMed

Saligheh, Maryam; McNamara, Beverley; Rooney, Rosanna

2016-06-02

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

Interactions between Flight Dynamics and Propulsion Systems of Air-Breathing Hypersonic Vehicles

DTIC Science & Technology

2013-01-01

coupled with combustor – Combustor, component for subsonic or supersonic combustion – Nozzle , expands flow for high thrust and may provide lift... supersonic solution method that is used for both the inlet and nozzle components. The supersonic model SAMURI is a substantial improvement over previous models...purely supersonic inviscid flow. As a result, the model is also appropriate for other applications, including the nozzle , which is important 19 Figure

Edge seal for a porous gas distribution plate of a fuel cell

DOEpatents

Feigenbaum, Haim; Pudick, Sheldon; Singh, Rajindar

1984-01-01

In an improved seal for a gas distribution plate of a fuel cell, a groove is provided extending along an edge of the plate. A member of resinous material is arranged within the groove and a paste comprising an immobilized acid is arranged surrounding the member and substantially filling the groove. The seal, which is impervious to the gas being distributed, is resistant to deterioration by the electrolyte of the cell.

Comparison of flight results with digital simulation for a digital electronic engine control in an F-15 airplane

NASA Technical Reports Server (NTRS)

Myers, L. P.; Burcham, F. W., Jr.

1983-01-01

Substantial benefits of a full authority digital electronic engine control on an air breathing engine were demonstrated repeatedly in simulation studies, ground engine tests, and engine altitude test facilities. A digital engine electronic control system showed improvements in efficiency, performance, and operation. An additional benefit of full authority digital controls is the capability of detecting and correcting failures and providing engine health diagnostics.

Multipulsed dynamic moire interferometer

DOEpatents

Deason, Vance A.

1991-01-01

An improved dynamic moire interferometer comprised of a lasing medium providing a plurality of beams of coherent light, a multiple q-switch producing multiple trains of 100,000 or more pulses per second, a combining means collimating multiple trains of pulses into substantially a single train and directing beams to specimen gratings affixed to a test material, and a controller, triggering and sequencing the emission of the pulses with the occurrence and recording of a dynamic loading event.

Multiple acousto-optic q-switch

DOEpatents

Deason, Vance A.

1993-01-01

An improved dynamic moire interferometer comprised of a lasing medium providing a plurality of beams of coherent light, a multiple q-switch producing multiple trains of 100,000 or more pulses per second, a combining means collimating multiple trains of pulses into substantially a single train and directing beams to specimen gratings affixed to a test material, and a controller, triggering and sequencing the emission of the pulses with the occurrence and recording of a dynamic loading event.

Multiple acousto-optic q-switch

DOEpatents

Deason, Vance A.

1993-12-07

An improved dynamic moire interferometer comprised of a lasing medium providing a plurality of beams of coherent light, a multiple q-switch producing multiple trains of 100,000 or more pulses per second, a combining means collimating multiple trains of pulses into substantially a single train and directing beams to specimen gratings affixed to a test material, and a controller, triggering and sequencing the emission of the pulses with the occurrence and recording of a dynamic loading event.

Saving Your Students' Skin. Undergraduate Experiments that Probe UV Protection by Sunscreens and Sunglasses

NASA Astrophysics Data System (ADS)

Abney, James R.; Scalettar, Bethe A.

1998-06-01

Recent scientific evidence suggests that chlorofluorocarbons have substantially depleted the ozone layer, the earth's primary filter for ultraviolet radiation. At the same time, medical evidence has accumulated which suggests that exposure to ultraviolet radiation is a major cause of prevalent human health disorders, including skin cancer and cataracts. For these reasons, consumer purchases of sunscreens and sunglasses, which provide protection from ultraviolet radiation, have soared, and manufacturer interest in improving these products has intensified. This article describes absorption spectroscopy experiments that illustrate the mechanism of action of sunscreens and sunglasses and that highlight the differences between different products. The experiments are well suited to incorporation into an undergraduate science laboratory and will expose students to absorption phenomena in a familiar context with substantial environmental and medical relevance.

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

PubMed

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

2006-01-01

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

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

Diabetes quality improvement in Department of Veterans Affairs Ambulatory Care Clinics: a group-randomized clinical trial.

PubMed

Reiber, Gayle E; Au, David; McDonell, Mary; Fihn, Stephan D

2004-05-01

To conduct a group-randomized clinical trial to determine whether regular feedback to primary care providers of synthesized information on patients' health, function, and satisfaction would demonstrate improved outcomes for their patients with diabetes. Patients in General Internal Medicine Clinics Department of Veterans Affairs (VA) Medical Centers were randomized into seven intervention or control firms. Patient self-reported information was collected by mail on general health, diabetes, and up to five other chronic conditions. Patients with diabetes received the Seattle Diabetes Questionnaire, the 36-item Medical Outcomes Study short form (SF-36), and a validated patient satisfaction questionnaire at regular intervals. Data from self-report, clinical, pharmacy, and laboratory sources were synthesized into patient-specific feedback reports that intervention providers received before patients' visits. The timely delivery to primary care providers of state-of-the-art patient-feedback reports that identified patient issues and areas for improvement did not result in significant improvements in patient outcomes between the intervention and control firms. Outcomes in diabetic patients whose providers received synthesized patient data before visits were no better than in those receiving care from control firms. Future studies may benefit from substantial involvement in patients discussing, problem solving, and goal setting in addition to use of timely synthesized patient data.

Combination film/splash fill for overcoming film fouling

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

Phelps, P.M.; Minett, T.O.

1995-02-01

In summary, this large cooling tower user has found the Phelps film/splash Stack-Pack fill design to attain a substantial improvement in capability of their existing crossflow cooling towers, without increasing fan power or tower size. The lack of fouling in the film fill component of this fill design is due to the use of film fill with large (1 inch) spacing between sheets, coupled with effective water treatment as provided by Nalco. This combination of factors provides a proven method for significantly increasing crossflow or counterflow cooling tower capability while minimizing chances of serious fill fouling.

Atmospheric Effects of Subsonic Aircraft: Interim Assessment Report of the Advanced Subsonic Technology Program

NASA Technical Reports Server (NTRS)

Friedl, Randall R. (Editor)

1997-01-01

This first interim assessment of the subsonic assessment (SASS) project attempts to summarize concisely the status of our knowledge concerning the impacts of present and future subsonic aircraft fleets. It also highlights the major areas of scientific uncertainty, through review of existing data bases and model-based sensitivity studies. In view of the need for substantial improvements in both model formulations and experimental databases, this interim assessment cannot provide confident numerical predictions of aviation impacts. However, a number of quantitative estimates are presented, which provide some guidance to policy makers.

Pregnancy and alcohol use: evidence and recommendations for prenatal care.

PubMed

Bailey, Beth A; Sokol, Robert J

2008-06-01

Pregnancy alcohol consumption has been linked to poor birth outcomes and long-term developmental problems. Despite this, a significant number of women drink during pregnancy. Although most prenatal care providers are asking women about alcohol use, validated screening tools are infrequently employed. Research has demonstrated that currently available screening methods and intervention techniques are effective in identifying and reducing pregnancy drinking. Implementing universal screening and appropriate intervention for pregnancy alcohol use should be a priority for prenatal care providers, as these efforts could substantially improve pregnancy, birth, and longer term developmental outcomes for those affected.

Cost and quality trends in direct contracting arrangements.

PubMed

Lyles, Alan; Weiner, Jonathan P; Shore, Andrew D; Christianson, Jon; Solberg, Leif I; Drury, Patricia

2002-01-01

This paper presents the first empirical analysis of a 1997 initiative of the Buyers Health Care Action Group (BHCAG) known as Choice Plus. This initiative entailed direct contracts with provider-controlled delivery systems; annual care system bidding; public reports of consumer satisfaction and quality; uniform benefits; and risk-adjusted payment. After case-mix adjustment, hospital costs decreased, ambulatory care costs rose modestly, and pharmacy costs increased substantially. Process-oriented quality indicators were stable or improved. The BHCAG employer-to-provider direct contracting and consumer choice model appeared to perform reasonably well in containing costs, without measurable adverse effects on quality.

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.

36 CFR 51.55 - What must a concessioner do after substantial completion of the capital improvement?

Code of Federal Regulations, 2010 CFR

2010-07-01

... together with, if requested by the Director, a written certification from a certified public accountant... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false What must a concessioner do after substantial completion of the capital improvement? 51.55 Section 51.55 Parks, Forests, and Public...

Enhancement of mechanical properties of 123 superconductors

DOEpatents

Balachandran, U.

1995-04-25

A composition and method are disclosed of preparing YBa{sub 2}Cu{sub 3}O{sub 7{minus}x} superconductor. Addition of tin oxide containing compounds to YBCO superconductors results in substantial improvement of fracture toughness and other mechanical properties without affect on T{sub c}. About 5-20% additions give rise to substantially improved mechanical properties.

Bringing influenza vaccines into the 21st century

PubMed Central

Settembre, Ethan C; Dormitzer, Philip R; Rappuoli, Rino

2014-01-01

The recent H7N9 influenza outbreak in China highlights the need for influenza vaccine production systems that are robust and can quickly generate substantial quantities of vaccines that target new strains for pandemic and seasonal immunization. Although the influenza vaccine system, a public-private partnership, has been effective in providing vaccines, there are areas for improvement. Technological advances such as mammalian cell culture production and synthetic vaccine seeds provide a means to increase the speed and accuracy of targeting new influenza strains with mass-produced vaccines by dispensing with the need for egg isolation, adaptation, and reassortment of vaccine viruses. New influenza potency assays that no longer require the time-consuming step of generating sheep antisera could further speed vaccine release. Adjuvants that increase the breadth of the elicited immune response and allow dose sparing provide an additional means to increase the number of available vaccine doses. Together these technologies can improve the influenza vaccination system in the near term. In the longer term, disruptive technologies, such as RNA-based flu vaccines and ‘universal’ flu vaccines, offer a promise of a dramatically improved influenza vaccine system. PMID:24378716

Bringing influenza vaccines into the 21st century.

PubMed

Settembre, Ethan C; Dormitzer, Philip R; Rappuoli, Rino

2014-01-01

The recent H7N9 influenza outbreak in China highlights the need for influenza vaccine production systems that are robust and can quickly generate substantial quantities of vaccines that target new strains for pandemic and seasonal immunization. Although the influenza vaccine system, a public-private partnership, has been effective in providing vaccines, there are areas for improvement. Technological advances such as mammalian cell culture production and synthetic vaccine seeds provide a means to increase the speed and accuracy of targeting new influenza strains with mass-produced vaccines by dispensing with the need for egg isolation, adaptation, and reassortment of vaccine viruses. New influenza potency assays that no longer require the time-consuming step of generating sheep antisera could further speed vaccine release. Adjuvants that increase the breadth of the elicited immune response and allow dose sparing provide an additional means to increase the number of available vaccine doses. Together these technologies can improve the influenza vaccination system in the near term. In the longer term, disruptive technologies, such as RNA-based flu vaccines and 'universal' flu vaccines, offer a promise of a dramatically improved influenza vaccine system.

Reducing respiratory motion artifacts in positron emission tomography through retrospective stacking

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

Thorndyke, Brian; Schreibmann, Eduard; Koong, Albert

Respiratory motion artifacts in positron emission tomography (PET) imaging can alter lesion intensity profiles, and result in substantially reduced activity and contrast-to-noise ratios (CNRs). We propose a corrective algorithm, coined 'retrospective stacking' (RS), to restore image quality without requiring additional scan time. Retrospective stacking uses b-spline deformable image registration to combine amplitude-binned PET data along the entire respiratory cycle into a single respiratory end point. We applied the method to a phantom model consisting of a small, hot vial oscillating within a warm background, as well as to {sup 18}FDG-PET images of a pancreatic and a liver patient. Comparisons weremore » made using cross-section visualizations, activity profiles, and CNRs within the region of interest. Retrospective stacking was found to properly restore the lesion location and intensity profile in all cases. In addition, RS provided CNR improvements up to three-fold over gated images, and up to five-fold over ungated data. These phantom and patient studies demonstrate that RS can correct for lesion motion and deformation, while substantially improving tumor visibility and background noise.« less

Human genome project: revolutionizing biology through leveraging technology

NASA Astrophysics Data System (ADS)

Dahl, Carol A.; Strausberg, Robert L.

1996-04-01

The Human Genome Project (HGP) is an international project to develop genetic, physical, and sequence-based maps of the human genome. Since the inception of the HGP it has been clear that substantially improved technology would be required to meet the scientific goals, particularly in order to acquire the complete sequence of the human genome, and that these technologies coupled with the information forthcoming from the project would have a dramatic effect on the way biomedical research is performed in the future. In this paper, we discuss the state-of-the-art for genomic DNA sequencing, technological challenges that remain, and the potential technological paths that could yield substantially improved genomic sequencing technology. The impact of the technology developed from the HGP is broad-reaching and a discussion of other research and medical applications that are leveraging HGP-derived DNA analysis technologies is included. The multidisciplinary approach to the development of new technologies that has been successful for the HGP provides a paradigm for facilitating new genomic approaches toward understanding the biological role of functional elements and systems within the cell, including those encoded within genomic DNA and their molecular products.

Polymer/metal oxide hybrid dielectrics for low voltage field-effect transistors with solution-processed, high-mobility semiconductors

NASA Astrophysics Data System (ADS)

Held, Martin; Schießl, Stefan P.; Miehler, Dominik; Gannott, Florentina; Zaumseil, Jana

2015-08-01

Transistors for future flexible organic light-emitting diode (OLED) display backplanes should operate at low voltages and be able to sustain high currents over long times without degradation. Hence, high capacitance dielectrics with low surface trap densities are required that are compatible with solution-processable high-mobility semiconductors. Here, we combine poly(methyl methacrylate) (PMMA) and atomic layer deposition hafnium oxide (HfOx) into a bilayer hybrid dielectric for field-effect transistors with a donor-acceptor polymer (DPPT-TT) or single-walled carbon nanotubes (SWNTs) as the semiconductor and demonstrate substantially improved device performances for both. The ultra-thin PMMA layer ensures a low density of trap states at the semiconductor-dielectric interface while the metal oxide layer provides high capacitance, low gate leakage and superior barrier properties. Transistors with these thin (≤70 nm), high capacitance (100-300 nF/cm2) hybrid dielectrics enable low operating voltages (<5 V), balanced charge carrier mobilities and low threshold voltages. Moreover, the hybrid layers substantially improve the bias stress stability of the transistors compared to those with pure PMMA and HfOx dielectrics.

Improved Behavior and Neuropsychological Function in Children With ROHHAD After High-Dose Cyclophosphamide

PubMed Central

Rane, Shruti; McReynolds, Lisa J.; Steppan, Diana A.; Chen, Allen R.; Paz-Priel, Ido

2016-01-01

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare, generally progressive, and potentially fatal syndrome of unclear etiology. The syndrome is characterized by normal development followed by a sudden, rapid hyperphagic weight gain beginning during the preschool period, hypothalamic dysfunction, and central hypoventilation, and is often accompanied by personality changes and developmental regression, leading to substantial morbidity and mortality. We describe 2 children who had symptomatic and neuropsychological improvement after high-dose cyclophosphamide treatment. Our experience supports an autoimmune pathogenesis and provides the first neuropsychological profile of patients with rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation. PMID:27313069

Analytical investigation of thermal barrier coatings for advanced power generation combustion turbines

NASA Technical Reports Server (NTRS)

Amos, D. J.

1977-01-01

An analytical evaluation was conducted to determine quantitatively the improvement potential in cycle efficiency and cost of electricity made possible by the introduction of thermal barrier coatings to power generation combustion turbine systems. The thermal barrier system, a metallic bond coat and yttria stabilized zirconia outer layer applied by plasma spray techniques, acts as a heat insulator to provide substantial metal temperature reductions below that of the exposed thermal barrier surface. The study results show the thermal barrier to be a potentially attractive means for improving performance and reducing cost of electricity for the simple, recuperated, and combined cycles evaluated.

Dental Emergencies: Management Strategies That Improve Outcomes [Digest].

PubMed

Pedigo, Ryan Anthony; Zaurova, Milana

2017-06-22

Points & Pearls is a digest of Emergency Medicine Practice . Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment.

System and method for improving performance of a fluid sensor for an internal combustion engine

DOEpatents

Kubinski, David [Canton, MI; Zawacki, Garry [Livonia, MI

2009-03-03

A system and method for improving sensor performance of an on-board vehicle sensor, such as an exhaust gas sensor, while sensing a predetermined substance in a fluid flowing through a pipe include a structure for extending into the pipe and having at least one inlet for receiving fluid flowing through the pipe and at least one outlet generally opposite the at least one inlet, wherein the structure redirects substantially all fluid flowing from the at least one inlet to the sensor to provide a representative sample of the fluid to the sensor before returning the fluid through the at least one outlet.

The Advanced Gamma-ray Imaging System (AGIS): A Nanosecond Time Scale Stereoscopic Array Trigger System.

NASA Astrophysics Data System (ADS)

Krennrich, Frank; Buckley, J.; Byrum, K.; Dawson, J.; Drake, G.; Horan, D.; Krawzcynski, H.; Schroedter, M.

2008-04-01

Imaging atmospheric Cherenkov telescope arrays (VERITAS, HESS) have shown unprecedented background suppression capabilities for reducing cosmic-ray induced air showers, muons and night sky background fluctuations. Next-generation arrays with on the order of 100 telescopes offer larger collection areas, provide the possibility to see the air shower from more view points on the ground, have the potential to improve the sensitivity and give additional background suppression. Here we discuss the design of a fast array trigger system that has the potential to perform a real time image analysis allowing substantially improved background rate suppression at the trigger level.

Flexible multiply towpreg and method of production therefor

NASA Technical Reports Server (NTRS)

Muzzy, John D. (Inventor); Varughese, Babu (Inventor)

1992-01-01

This invention relates to an improved flexible towpreg and a method of production therefor. The improved flexible towpreg comprises a plurality of towpreg plies which comprise reinforcing filaments and matrix forming material; the reinforcing filaments being substantially wetout by the matrix forming material such that the towpreg plies are substantially void-free composite articles, and the towpreg plies having an average thickness less than about 100 microns. The method of production for the improved flexible towpreg comprises the steps of spreading the reinforcing filaments to expose individually substantially all of the reinforcing filaments; coating the reinforcing filaments with the matrix forming material in a manner causing interfacial adhesion of the matrix forming material to the reinforcing filaments; forming the towpreg plies by heating the matrix forming material contacting the reinforcing filaments until the matrix forming material liquefies and coats the reinforcing filaments; and cooling the towpreg plies in a manner such that substantial cohesion between neighboring towpreg plies is prevented until the matrix forming material solidifies.

Flexible multiply towpreg

NASA Technical Reports Server (NTRS)

Muzzy, John D. (Inventor); Varughese, Babu (Inventor)

1992-01-01

This invention relates to an improved flexible towpreg and a method of production therefor. The improved flexible towpreg comprises a plurality of towpreg plies which comprise reinforcing filaments and matrix forming material; the reinforcing filaments being substantially wetout by the matrix forming material such that the towpreg plies are substantially void-free composite articles, and the towpreg plies having an average thickness less than about 100 microns. The method of production for the improved flexible towpreg comprises the steps of spreading the reinforcing filaments to expose individually substantially all of the reinforcing filaments; coating the reinforcing filaments with the matrix forming material in a manner causing interfacial adhesion of the matrix forming material to the reinforcing filaments; forming the towpreg plies by heating the matrix forming material contacting the reinforcing filaments until the matrix forming material liquifies and coats the reinforcing filaments; and cooling the towpreg plies in a manner such that substantial cohesion between neighboring towpreg plies is prevented until the matrix forming material solidifies.

Development of high power VRLA batteries using novel materials and processes

NASA Astrophysics Data System (ADS)

Soria, M. L.; Valenciano, J.; Ojeda, A.; Raybaut, G.; Ihmels, K.; Deiters, J.; Clement, N.; Morales, J.; Sánchez, L.

Nowadays UPS manufacturers demand batteries with very high specific power and relatively low specific energy, because most mains failures can be defined as "microfailures", usually of the order of seconds. Due to this fact, it is not necessary to provide energy but power. Within a 3-year EU funded project, a new AGM valve-regulated lead-acid battery with weight and volume substantially reduced, as well as a substantial improvement in its reliability, is under development. These aspects can provide the achievement of a more efficient, safe and economic energy supply. Battery specific power is practically related to electrode area, so that its increase, and therefore an electrode thickness reduction, appear essential to achieve the project objectives. Furthermore, it is necessary to achieve a similar reduction in the conventional glass microfibre separator. But such thin material should have improved mechanical properties and can make the battery more prone to develop short circuits across the separator. In order to avoid this problem, a new microporous polyethylene membrane has been developed and tested, with excellent mechanical properties, high porosity and low pore size. For these reasons, the final separator configuration includes a combination of both materials, improved non-woven glass microfibre and the polyethylene membrane. Batteries are designed and assembled by Tudor (Exide Technologies) as battery manufacturer and will be tested in real conditions by MGE UPS Systems as end user. Daramic for the membrane and Bernard Dumas for the glass microfibre mat, have developed and supplied the separators, while the Inorganic Chemistry Department of Córdoba University carries out fundamental research studies on very thin electrodes.

Standard work for room entry: Linking lean, hand hygiene, and patient-centeredness.

PubMed

O'Reilly, Kristin; Ruokis, Samantha; Russell, Kristin; Teves, Tim; DiLibero, Justin; Yassa, David; Berry, Hannah; Howell, Michael D

2016-03-01

Healthcare-associated infections are costly and fatal. Substantial front-line, administrative, regulatory, and research efforts have focused on improving hand hygiene. While broad agreement exists that hand hygiene is the most important single approach to infection prevention, compliance with hand hygiene is typically only about 40%(1). Our aim was to develop a standard process for room entry in the intensive care unit that improved compliance with hand hygiene and allowed for maximum efficiency. We recognized that hand hygiene is a single step in a substantially more complicated process of room entry. We applied Lean engineering techniques to develop a standard process that included both physical steps and also standard communication elements from provider to patients and families and created a physical environment to support this. We observed meaningful improvement in the performance of the new standard as well as time savings for clinical providers with each room entry. We also observed an increase in room entries that included verbal communication and an explanation of what the clinician was entering the room to do. The design and implementation of a standardized room entry process and the creation of an environment that supports that new process has resulted in measurable positive outcomes on the medical intensive care unit, including quality, patient experience, efficiency, and staff satisfaction. Designing a process, rather than viewing tasks that need to happen in close proximity in time (either serially or in parallel) as unrelated, simplifies work for staff and results in higher compliance to individual tasks. Copyright © 2015 Elsevier Inc. All rights reserved.

Motion correction for improving the accuracy of dual-energy myocardial perfusion CT imaging

NASA Astrophysics Data System (ADS)

Pack, Jed D.; Yin, Zhye; Xiong, Guanglei; Mittal, Priya; Dunham, Simon; Elmore, Kimberly; Edic, Peter M.; Min, James K.

2016-03-01

Coronary Artery Disease (CAD) is the leading cause of death globally [1]. Modern cardiac computed tomography angiography (CCTA) is highly effective at identifying and assessing coronary blockages associated with CAD. The diagnostic value of this anatomical information can be substantially increased in combination with a non-invasive, low-dose, correlative, quantitative measure of blood supply to the myocardium. While CT perfusion has shown promise of providing such indications of ischemia, artifacts due to motion, beam hardening, and other factors confound clinical findings and can limit quantitative accuracy. In this paper, we investigate the impact of applying a novel motion correction algorithm to correct for motion in the myocardium. This motion compensation algorithm (originally designed to correct for the motion of the coronary arteries in order to improve CCTA images) has been shown to provide substantial improvements in both overall image quality and diagnostic accuracy of CCTA. We have adapted this technique for application beyond the coronary arteries and present an assessment of its impact on image quality and quantitative accuracy within the context of dual-energy CT perfusion imaging. We conclude that motion correction is a promising technique that can help foster the routine clinical use of dual-energy CT perfusion. When combined, the anatomical information of CCTA and the hemodynamic information from dual-energy CT perfusion should facilitate better clinical decisions about which patients would benefit from treatments such as stent placement, drug therapy, or surgery and help other patients avoid the risks and costs associated with unnecessary, invasive, diagnostic coronary angiography procedures.

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

PubMed

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

2015-01-01

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

Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009-2012.

PubMed

Evans-Lacko, Sara; Henderson, Claire; Thornicroft, Graham

2013-04-01

Public stigma against people with mental health problems is damaging to individuals with mental illness and is associated with substantial societal burden. To investigate whether public knowledge, attitudes and behaviour in relation to people with mental health problems have improved among the English population since the inception of the Time To Change programme in 2009. We analysed longitudinal trends in public knowledge, attitudes and behaviour between 2009 and 2012 among a nationally representative sample of English adults. There were improvements in intended behaviour (0.07 standard deviation units, 95% CI 0.01-0.14) and a non-significant trend for improvement in attitudes (P = 0.08) among the English population. There was, however, no significant improvement in knowledge or reported behaviour. The findings provide support for effectiveness of the national Time to Change programme against stigma and discrimination in improving attitudes and intended behaviour, but not knowledge, among the public in England.

Advanced Biasing Experiments on the C-2 Field-Reversed Configuration Device

NASA Astrophysics Data System (ADS)

Thompson, Matthew; Korepanov, Sergey; Garate, Eusebio; Yang, Xiaokang; Gota, Hiroshi; Douglass, Jon; Allfrey, Ian; Valentine, Travis; Uchizono, Nolan; TAE Team

2014-10-01

The C-2 experiment seeks to study the evolution, heating and sustainment effects of neutral beam injection on field-reversed configuration (FRC) plasmas. Recently, substantial improvements in plasma performance were achieved through the application of edge biasing with coaxial plasma guns located in the divertors. Edge biasing provides rotation control that reduces instabilities and E × B shear that improves confinement. Typically, the plasma gun arcs are run at ~ 10 MW for the entire shot duration (~ 5 ms), which will become unsustainable as the plasma duration increases. We have conducted several advanced biasing experiments with reduced-average-power plasma gun operating modes and alternative biasing cathodes in an effort to develop an effective biasing scenario applicable to steady state FRC plasmas. Early results show that several techniques can potentially provide effective, long-duration edge biasing.

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

PubMed

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

2014-12-01

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

Automation, decision support, and expert systems in nephrology.

PubMed

Soman, Sandeep; Zasuwa, Gerard; Yee, Jerry

2008-01-01

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

Solid electrolytes strengthened by metal dispersions

DOEpatents

Lauf, Robert J.; Morgan, Chester S.

1983-01-01

An improvement in solid electrolytes of advanced secondary batteries of the sodium-sulfur, sodium-halogen, and like combinations is achieved by providing said battery with a cermet electrolyte containing a metal dispersion ranging from 0.1 to 10.0 vol. % of a substantially nonreactive metal selected from the group consisting essentially of Pt, Cr, Fe, Co, Ni, Nb, their alloys, and their physical mixtures in the elemental or uncombined state, the remainder of said cermet being an ion-conductive ceramic material.

Solid electrolytes strengthened by metal dispersions

DOEpatents

Lauf, R.J.; Morgan, C.S.

1981-10-05

An improvement in solid electrolytes of advanced secondary batteries of the sodium-sulfur, sodium-halogen, and like combinations is achieved by providing said battery with a cermet electrolyte containing a metal dispersion ranging from 0.1 to 10.0 vol. % of a substantially nonreactive metal selected from the group consisting essentially of Pt, Cr, Fe, Co, Ni, Nb, their alloys, and their physical mixtures in the elemental or uncombined state, the remainder of said cermet being an ion-conductive ceramic material.

Losartan Administration Reduces Fibrosis but Hinders Functional Recovery after Volumetric Muscle Loss Injury

DTIC Science & Technology

2014-09-25

therapy. Pre - viously, losartan has been successfully used to reduce fibrosis and improve both muscle regeneration and function in several models of...efficacy of losartan has not yet been tested in a VML injury model. VML injury involves a substantial loss of muscle tissue that does not regenerate by...fibrosis development after VML injury in the rat tibialis anterior (TA) muscle. METHODS Experimental Design Male Lewis rats with VML were provided access

Extension of a Computer Assisted Decision Support (CADS) Study to Improve Outcomes in Patients with Type 2 DM Treated by Primary Care Providers. Addendum

DTIC Science & Technology

2015-04-01

Type 2 diabetes (7-8). Hypertension is one of the most common co-morbidities associated with DM and substantially contributes to the macrovascular...challenged when attempting to upload their glucose data. Access to the patient portal , Diabetes Mellitus Everywhere (DME) in CDMP required installation of...antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension . Systolic hypertension in

Robust Hand Motion Tracking through Data Fusion of 5DT Data Glove and Nimble VR Kinect Camera Measurements

PubMed Central

Arkenbout, Ewout A.; de Winter, Joost C. F.; Breedveld, Paul

2015-01-01

Vision based interfaces for human computer interaction have gained increasing attention over the past decade. This study presents a data fusion approach of the Nimble VR vision based system, using the Kinect camera, with the contact based 5DT Data Glove. Data fusion was achieved through a Kalman filter. The Nimble VR and filter output were compared using measurements performed on (1) a wooden hand model placed in various static postures and orientations; and (2) three differently sized human hands during active finger flexions. Precision and accuracy of joint angle estimates as a function of hand posture and orientation were determined. Moreover, in light of possible self-occlusions of the fingers in the Kinect camera images, data completeness was assessed. Results showed that the integration of the Data Glove through the Kalman filter provided for the proximal interphalangeal (PIP) joints of the fingers a substantial improvement of 79% in precision, from 2.2 deg to 0.9 deg. Moreover, a moderate improvement of 31% in accuracy (being the mean angular deviation from the true joint angle) was established, from 24 deg to 17 deg. The metacarpophalangeal (MCP) joint was relatively unaffected by the Kalman filter. Moreover, the Data Glove increased data completeness, thus providing a substantial advantage over the sole use of the Nimble VR system. PMID:26694395

Robust Hand Motion Tracking through Data Fusion of 5DT Data Glove and Nimble VR Kinect Camera Measurements.

PubMed

Arkenbout, Ewout A; de Winter, Joost C F; Breedveld, Paul

2015-12-15

Vision based interfaces for human computer interaction have gained increasing attention over the past decade. This study presents a data fusion approach of the Nimble VR vision based system, using the Kinect camera, with the contact based 5DT Data Glove. Data fusion was achieved through a Kalman filter. The Nimble VR and filter output were compared using measurements performed on (1) a wooden hand model placed in various static postures and orientations; and (2) three differently sized human hands during active finger flexions. Precision and accuracy of joint angle estimates as a function of hand posture and orientation were determined. Moreover, in light of possible self-occlusions of the fingers in the Kinect camera images, data completeness was assessed. Results showed that the integration of the Data Glove through the Kalman filter provided for the proximal interphalangeal (PIP) joints of the fingers a substantial improvement of 79% in precision, from 2.2 deg to 0.9 deg. Moreover, a moderate improvement of 31% in accuracy (being the mean angular deviation from the true joint angle) was established, from 24 deg to 17 deg. The metacarpophalangeal (MCP) joint was relatively unaffected by the Kalman filter. Moreover, the Data Glove increased data completeness, thus providing a substantial advantage over the sole use of the Nimble VR system.

Quantum-Enhanced Machine Learning

NASA Astrophysics Data System (ADS)

Dunjko, Vedran; Taylor, Jacob M.; Briegel, Hans J.

2016-09-01

The emerging field of quantum machine learning has the potential to substantially aid in the problems and scope of artificial intelligence. This is only enhanced by recent successes in the field of classical machine learning. In this work we propose an approach for the systematic treatment of machine learning, from the perspective of quantum information. Our approach is general and covers all three main branches of machine learning: supervised, unsupervised, and reinforcement learning. While quantum improvements in supervised and unsupervised learning have been reported, reinforcement learning has received much less attention. Within our approach, we tackle the problem of quantum enhancements in reinforcement learning as well, and propose a systematic scheme for providing improvements. As an example, we show that quadratic improvements in learning efficiency, and exponential improvements in performance over limited time periods, can be obtained for a broad class of learning problems.

Within Session Sequence of Balance and Plyometric Exercises Does Not Affect Training Adaptations with Youth Soccer Athletes

PubMed Central

Chaouachi, Mehdi; Granacher, Urs; Makhlouf, Issam; Hammami, Raouf; Behm, David G; Chaouachi, Anis

2017-01-01

The integration of balance and plyometric training has been shown to provide significant improvements in sprint, jump, agility, and other performance measures in young athletes. It is not known if a specific within session balance and plyometric exercise sequence provides more effective training adaptations. The objective of the present study was to investigate the effects of using a sequence of alternating pairs of exercises versus a block (series) of all balance exercises followed by a block of plyometric exercises on components of physical fitness such as muscle strength, power, speed, agility, and balance. Twenty-six male adolescent soccer players (13.9 ± 0.3 years) participated in an 8-week training program that either alternated individual balance (e.g., exercises on unstable surfaces) and plyometric (e.g., jumps, hops, rebounds) exercises or performed a block of balance exercises prior to a block of plyometric exercises within each training session. Pre- and post-training measures included proxies of strength, power, agility, sprint, and balance such as countermovement jumps, isometric back and knee extension strength, standing long jump, 10 and 30-m sprints, agility, standing stork, and Y-balance tests. Both groups exhibited significant, generally large magnitude (effect sizes) training improvements for all measures with mean performance increases of approximately >30%. There were no significant differences between the training groups over time. The results demonstrate the effectiveness of combining balance and plyometric exercises within a training session on components of physical fitness with young adolescents. The improved performance outcomes were not significantly influenced by the within session exercise sequence. Key points The combination of balance and plyometric exercises can induce significant and substantial training improvements in muscle strength, power, speed, agility, and balance with adolescent youth athletes The within training session sequence of balance and plyometric exercises does not substantially affect these training improvements. PMID:28344461

TH-AB-BRB-04: Quality Assurance for Advanced Digital Linac Implementations

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

Yu, V.

2016-06-15

Current state-of-the art digital C-arm medical linear accelerators are capable of delivering radiation treatments with high level of automation, which affords coordinated motions of gantry, couch, and multileaf collimator (MLC) with dose rate modulations. The new machine capacity has shown the potential to bring substantially improved radiation dosimetry and/or delivery efficiency to many challenging diseases. Combining an integrated beam orientation optimization algorithm with automated machine navigation, markedly improved dose conformity has been achieved using 4ρ therapy. Trajectory modulated radiation therapy (TMAT) can be used to deliver highly conformal dose to partial breast or to carve complex dose distribution for therapymore » involving extended volumes such as total marrow and total lymph node treatment. Dynamic electron arc radiotherapy (DEAR) not only overcomes the deficiencies of conventional electron therapy in dose conformity and homogeneity but also achieves so without patient-specific shields. The combination of MLC and couch tracking provides improved motion management of thoracic and abdominal tumors. A substantial body of work has been done in these technological advances for clinical translation. The proposed symposium will provide a timely review of these exciting opportunities. Learning Objectives: Recognize the potential of using digitally controlled linacs for clinically significant improvements in delivered dose distributions for various treatment sites. Identify existing approaches to treatment planning, optimization and delivery for treatment techniques utilizing the advanced functions of digital linacs and venues for further development and improvement. Understand methods for testing and validating delivery system performance. Identify tools available on current delivery systems for implementation and control for such treatments. Obtain the update in clinical applications, trials and regulatory approval. K. Sheng, NIH U19AI067769, NIH R43CA183390, NIH R01CA188300, Varian Medical Systems V. Yu, Varian Medical Systems, AAPM Summer Undergraduate Fellowship, NSF graduate fellowship S. Nill, Elekta AB. Cancer Research UK under Programme C33589/A19727, NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research.« less

TH-AB-BRB-00: Research Opportunities with Digital Linear Accelerators

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

NONE

2016-06-15

Current state-of-the art digital C-arm medical linear accelerators are capable of delivering radiation treatments with high level of automation, which affords coordinated motions of gantry, couch, and multileaf collimator (MLC) with dose rate modulations. The new machine capacity has shown the potential to bring substantially improved radiation dosimetry and/or delivery efficiency to many challenging diseases. Combining an integrated beam orientation optimization algorithm with automated machine navigation, markedly improved dose conformity has been achieved using 4ρ therapy. Trajectory modulated radiation therapy (TMAT) can be used to deliver highly conformal dose to partial breast or to carve complex dose distribution for therapymore » involving extended volumes such as total marrow and total lymph node treatment. Dynamic electron arc radiotherapy (DEAR) not only overcomes the deficiencies of conventional electron therapy in dose conformity and homogeneity but also achieves so without patient-specific shields. The combination of MLC and couch tracking provides improved motion management of thoracic and abdominal tumors. A substantial body of work has been done in these technological advances for clinical translation. The proposed symposium will provide a timely review of these exciting opportunities. Learning Objectives: Recognize the potential of using digitally controlled linacs for clinically significant improvements in delivered dose distributions for various treatment sites. Identify existing approaches to treatment planning, optimization and delivery for treatment techniques utilizing the advanced functions of digital linacs and venues for further development and improvement. Understand methods for testing and validating delivery system performance. Identify tools available on current delivery systems for implementation and control for such treatments. Obtain the update in clinical applications, trials and regulatory approval. K. Sheng, NIH U19AI067769, NIH R43CA183390, NIH R01CA188300, Varian Medical Systems V. Yu, Varian Medical Systems, AAPM Summer Undergraduate Fellowship, NSF graduate fellowship S. Nill, Elekta AB. Cancer Research UK under Programme C33589/A19727, NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research.« less

Effect of canard position and wing leading-edge flap deflection on wing buffet at transonic speeds

NASA Technical Reports Server (NTRS)

Gloss, B. B.; Henderson, W. P.; Huffman, J. K.

1974-01-01

A generalized wind-tunnel model, with canard and wing planform typical of highly maneuverable aircraft, was tested. The addition of a canard above the wing chord plane, for the configuration with leading-edge flaps undeflected, produced substantially higher total configuration lift coefficients before buffet onset than the configuration with the canard off and leading-edge flaps undeflected. The wing buffet intensity was substantially lower for the canard-wing configuration than the wing-alone configuration. The low-canard configuration generally displayed the poorest buffet characteristics. Deflecting the wing leading-edge flaps substantially improved the wing buffet characteristics for canard-off configurations. The addition of the high canard did not appear to substantially improve the wing buffet characteristics of the wing with leading-edge flaps deflected.

Fossil Energy: Drivers and Challenges.

NASA Astrophysics Data System (ADS)

Friedmann, Julio

2007-04-01

Concerns about rapid economic growth, energy security, and global climate change have created a new landscape for fossil energy exploration, production, and utilization. Since 85% of primary energy supply comes from fossil fuels, and 85% of greenhouse gas emissions come from fossil fuel consumption, new and difficult technical and political challenges confront commercial, governmental, and public stakeholders. As such, concerns over climate change are explicitly weighed against security of international and domestic energy supplies, with economic premiums paid for either or both. Efficiency improvements, fuel conservation, and deployment of nuclear and renewable supplies will help both concerns, but are unlikely to offset growth in the coming decades. As such, new technologies and undertakings must both provide high quality fossil energy with minimal environmental impacts. The largest and most difficult of these undertakings is carbon management, wherein CO2 emissions are sequestered indefinitely at substantial incremental cost. Geological formations provide both high confidence and high capacity for CO2 storage, but present scientific and technical challenges. Oil and gas supply can be partially sustained and replaced through exploitation of unconventional fossil fuels such as tar-sands, methane hydrates, coal-to-liquids, and oil shales. These fuels provide enormous reserves that can be exploited at current costs, but generally require substantial energy to process. In most cases, the energy return on investment (EROI) is dropping, and unconventional fuels are generally more carbon intensive than conventional, presenting additional carbon management challenges. Ultimately, a large and sustained science and technology program akin to the Apollo project will be needed to address these concerns. Unfortunately, real funding in energy research has dropped dramatically (75%) in the past three decades, and novel designs in fission and fusion are not likely to provide any substantial offset in the next 30 years when they are most needed internationally.

Trona-enhanced steam foam oil recovery process

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

Lau, H.C.

1988-03-01

In a process in which steam and steam-foaming surfactant are injected into a subterranean reservoir for displacing a relatively acidic oil toward a production location, which process includes injecting into the reservoir, at least as soon as at least some portion of the steam is injected, (a) a kind and amount of water soluble, alkaline material effective for ion-exchanging multivalent ions from the reservoir rocks and precipitating compounds containing those ions and for causing the aqueous liquid phase of the injected fluid to form soaps of substantially all of the petroleum acids in the reservoir oil, and (b) at leastmore » one surfactant arranged for foaming the steam and providing a preformed cosurfactant material capable of increasing the salinity requirement of an aqueous surfactant system in which soaps derived from the reservoir oil comprise a primary surfactant, an improvement is described comprising: using as the water soluble alkaline material, a material consisting essentially of a substantially equal molar mixture of alkali metal carbonates and bicarbonates which is, or is substantially equivalent to, trona.« less

Thermionic gas switch

DOEpatents

Hatch, G.L.; Brummond, W.A.; Barrus, D.M.

1984-04-05

The present invention is directed to an improved temperature responsive thermionic gas switch utilizing a hollow cathode and a folded emitter surface area. The folded emitter surface area of the thermionic switch substantially increases the on/off ratio by changing the conduction surface area involved in the two modes thereof. The improved switch of this invention provides an on/off ratio of 450:1 compared to the 10:1 ratio of the prior known thermionic switch, while providing for adjusting the on current. In the improved switch of this invention the conduction area is made small in the off mode, while in the on mode the conduction area is made large. This is achieved by utilizing a folded hollow cathode configuration and utilizing a folded emitter surface area, and by making the dimensions of the folds small enough so that a space charge will develop in the convolutions of the folds and suppress unignited current, thus limiting the current carrying surface in the off mode.

Thermal modelling using discrete vasculature for thermal therapy: a review

PubMed Central

Kok, H.P.; Gellermann, J.; van den Berg, C.A.T.; Stauffer, P.R.; Hand, J.W.; Crezee, J.

2013-01-01

Reliable temperature information during clinical hyperthermia and thermal ablation is essential for adequate treatment control, but conventional temperature measurements do not provide 3D temperature information. Treatment planning is a very useful tool to improve treatment quality and substantial progress has been made over the last decade. Thermal modelling is a very important and challenging aspect of hyperthermia treatment planning. Various thermal models have been developed for this purpose, with varying complexity. Since blood perfusion is such an important factor in thermal redistribution of energy in in vivo tissue, thermal simulations are most accurately performed by modelling discrete vasculature. This review describes the progress in thermal modelling with discrete vasculature for the purpose of hyperthermia treatment planning and thermal ablation. There has been significant progress in thermal modelling with discrete vasculature. Recent developments have made real-time simulations possible, which can provide feedback during treatment for improved therapy. Future clinical application of thermal modelling with discrete vasculature in hyperthermia treatment planning is expected to further improve treatment quality. PMID:23738700

Maternal health in Gujarat, India: a case study.

PubMed

Mavalankar, Dileep V; Vora, Kranti S; Ramani, K V; Raman, Parvathy; Sharma, Bharati; Upadhyaya, Mudita

2009-04-01

Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.

Improved detector for the measurement of gamma radiation

NASA Astrophysics Data System (ADS)

Zelt, F. B.

1985-07-01

The present invention lies in the field of gamma ray spectrometry of geologic deposits and other materials, such as building materials (cement, asphalt, etc.) More specifically, the invention is an improved device for the gamma ray spetcrometery of gelogical deposits as a tool for petroleum exploration, geologic research and monitoring of radio-active materials such as in uranium mill tailings and the like. Improvement consists in enlarging the area of the receptor face and without any necessarily substantial increase in the volume of the receptor crystal over the current cylindrical shapes. The invention also provides, as a corollary of the increase in area receptor crystal face, a reduction in the weight of the amount of material necessary to provide effective shielding of the crystal from atmospheric radiation and radiation from deposits not under examination. The area of the receptor crystal face is increased by forming the crystal as a truncated cone with the shielding shaped as a hollow frustrum of a cone. A photomultiplier device is secured to the smaller face of the crystal. The improved detector shape can also be used in scintillometers which measure total gamma radiation.

Research Contributing to Improvements in Controlling Florida's Mosquitoes and Mosquito-borne Diseases.

PubMed

Tabachnick, Walter J

2016-09-28

Research on mosquitoes and mosquito-borne diseases has contributed to improvements in providing effective, efficient, and environmentally proper mosquito control. Florida has benefitted from several research accomplishments that have increased the state's mosquito control capabilities. Research with Florida's mosquitoes has resulted in the development of ecologically sound management of mosquito impoundments on Florida's east coast. This strategy, called Rotational Impoundment Management (RIM), has improved the ability to target the delivery of pesticides and has helped to reduce non-target effects and environmental damage. Research has led to the development of an arbovirus surveillance system which includes sentinel chicken surveillance, real time use of environmental contributing factors like meteorology and hydrology to target mosquito control, as well as public health efforts to mitigate disease outbreaks to areas with risk of disease. These research driven improvements have provided substantial benefits to all of Florida. More research is needed to meet the future challenges to reduce emerging pathogens like Zika virus and the consequences of environmental changes like global climate change that are likely to influence the effects of mosquito-borne pathogens on human health and well-being.

The rare earth element (REE) lanthanum (La) induces hormesis in plants.

PubMed

Agathokleous, Evgenios; Kitao, Mitsutoshi; Calabrese, Edward J

2018-07-01

Lanthanum is a rare earth element (REE) which has been extensively studied due to its wide application in numerous fields with a potential accumulation in the environment. It has long been known for its potential to stimulate plant growth within a hormetic-biphasic dose response framework. This article provides evidence from a series of high resolution studies published within the last two decades demonstrating a substantial and significant occurrence of lanthanum-induced hormesis in plants. These findings suggest that hormetic responses should be built into the study design of hazard assessment study protocols and included in the risk assessment process. Hormesis also offers the opportunity to substantially improve cost benefit estimates for environmental contaminants, which have the potential to induce beneficial/desirable effects at low doses. Copyright © 2018 Elsevier Ltd. All rights reserved.

Compacted graphite iron: Cast iron makes a comeback

NASA Astrophysics Data System (ADS)

Dawson, S.

1994-08-01

Although compacted graphite iron has been known for more than four decades, the absence of a reliable mass-production technique has resulted in relatively little effort to exploit its operational benefits. However, a proven on-line process control technology developed by SinterCast allows for series production of complex components in high-quality CGI. The improved mechanical properties of compacted graphite iron relative to conventional gray iron allow for substantial weight reduction in gasoline and diesel engines or substantial increases in horsepower, or an optimal combination of both. Concurrent with these primary benefits, CGI also provides significant emissions and fuel efficiency benefits allowing automakers to meet legislated performance standards. The operational and environmental benefits of compacted graphite iron together with its low cost and recyclability reinforce cast iron as a prime engineering material for the future.

Functional materials for energy-efficient buildings

NASA Astrophysics Data System (ADS)

Ebert, H.-P.

2015-08-01

The substantial improving of the energy efficiency is essential to meet the ambitious energy goals of the EU. About 40% of the European energy consumption belongs to the building sector. Therefore the reduction of the energy demand of the existing building stock is one of the key measures to deliver a substantial contribution to reduce CO2-emissions of our society. Buildings of the future have to be efficient in respect to energy consumption for construction and operation. Current research activities are focused on the development of functional materials with outstanding thermal and optical properties to provide, for example, slim thermally superinsulated facades, highly integrated heat storage systems or adaptive building components. In this context it is important to consider buildings as entities which fulfill energy and comfort claims as well as aesthetic aspects of a sustainable architecture.

The JPL telerobotic Manipulator Control and Mechanization (MCM) subsystem

NASA Technical Reports Server (NTRS)

Hayati, Samad; Lee, Thomas S.; Tso, Kam; Backes, Paul; Kan, Edwin; Lloyd, J.

1989-01-01

The Manipulator Control and Mechanization (MCM) subsystem of the telerobot system provides the real-time control of the robot manipulators in autonomous and teleoperated modes and real time input/output for a variety of sensors and actuators. Substantial hardware and software are included in this subsystem which interfaces in the hierarchy of the telerobot system with the other subsystems. The other subsystems are: run time control, task planning and reasoning, sensing and perception, and operator control subsystem. The architecture of the MCM subsystem, its capabilities, and details of various hardware and software elements are described. Important improvements in the MCM subsystem over the first version are: dual arm coordinated trajectory generation and control, addition of integrated teleoperation, shared control capability, replacement of the ultimate controllers with motor controllers, and substantial increase in real time processing capability.

Removing very low-performing therapists: A simulation of performance-based retention in psychotherapy

PubMed Central

Imel, Zac E.; Sheng, Elisa; Baldwin, Scott A.; Atkins, David C.

2016-01-01

Therapists can impact the likelihood a given patient will benefit from psychotherapy. However, therapists are rarely held accountable for their patients' outcomes. As a result, low performing providers likely continue to practice alongside providers with high response rates. In the current study, we conducted a Monte Carlo simulation to illustrate a thought experiment—what happens to patient outcomes if therapists with the worst outcomes were removed from practice? We drew initial samples of 50 therapists from three simulated populations of 1,000 therapists with a mean patient response rate of 50% and different effect sizes for therapist variability in outcomes. We simulated 30 patient outcomes for each therapist, with outcome defined as response to treatment versus no response. We removed therapists with response rates in the bottom 5% and replaced them with a random sample of therapists from the population. Over 10 years, the difference in responses between the lowest and highest performing therapists was substantial (between 697 and 997 additional responses to treatment). After repeatedly removing the lowest performing providers 40 times (simulating a 10 year time span), response rates increased substantially. The cumulative number of patient responses (i.e., summing the total number of responses across 10 years) increased by 4266, 6404, and 9307 when therapists accounted for 5%, 10%, or 20% of the patient outcome variance, respectively. These findings indicate that performance-based retention of therapists could improve the quality of psychotherapy in health systems by improving the average response rate and decreasing the probability that a patient will be treated by a therapist who has little chance of helping. PMID:26301424

77 FR 34887 - Substantial Business Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

... Substantial Business Activities AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed... regarding whether a foreign corporation has substantial business activities in a foreign country. These... provide guidance regarding whether a foreign corporation has substantial business activities in a foreign...

Safety in the operating theatre--a transition to systems-based care.

PubMed

Weiser, Thomas G; Porter, Michael P; Maier, Ronald V

2013-03-01

All surgeons want the best, safest care for their patients, but providing this requires the complex coordination of multiple disciplines to ensure that all elements of care are timely, appropriate, and well organized. Quality-improvement initiatives are beginning to lead to improvements in the quality of care and coordination amongst teams in the operating room. As the population ages and patients present with more complex disease pathology, the demands for efficient systematization will increase. Although evidence suggests that postoperative mortality rates are declining, there is substantial room for improvement. Multiple quality metrics are used as surrogates for safe care, but surgical teams--including surgeons, anaesthetists, and nurses--must think beyond these simple interventions if they are to effectively communicate and coordinate in the face of increasing demands.

Graduate students' teaching experiences improve their methodological research skills.

PubMed

Feldon, David F; Peugh, James; Timmerman, Briana E; Maher, Michelle A; Hurst, Melissa; Strickland, Denise; Gilmore, Joanna A; Stiegelmeyer, Cindy

2011-08-19

Science, technology, engineering, and mathematics (STEM) graduate students are often encouraged to maximize their engagement with supervised research and minimize teaching obligations. However, the process of teaching students engaged in inquiry provides practice in the application of important research skills. Using a performance rubric, we compared the quality of methodological skills demonstrated in written research proposals for two groups of early career graduate students (those with both teaching and research responsibilities and those with only research responsibilities) at the beginning and end of an academic year. After statistically controlling for preexisting differences between groups, students who both taught and conducted research demonstrate significantly greater improvement in their abilities to generate testable hypotheses and design valid experiments. These results indicate that teaching experience can contribute substantially to the improvement of essential research skills.

Improving assessment and modelling of climate change impacts on global terrestrial biodiversity.

PubMed

McMahon, Sean M; Harrison, Sandy P; Armbruster, W Scott; Bartlein, Patrick J; Beale, Colin M; Edwards, Mary E; Kattge, Jens; Midgley, Guy; Morin, Xavier; Prentice, I Colin

2011-05-01

Understanding how species and ecosystems respond to climate change has become a major focus of ecology and conservation biology. Modelling approaches provide important tools for making future projections, but current models of the climate-biosphere interface remain overly simplistic, undermining the credibility of projections. We identify five ways in which substantial advances could be made in the next few years: (i) improving the accessibility and efficiency of biodiversity monitoring data, (ii) quantifying the main determinants of the sensitivity of species to climate change, (iii) incorporating community dynamics into projections of biodiversity responses, (iv) accounting for the influence of evolutionary processes on the response of species to climate change, and (v) improving the biophysical rule sets that define functional groupings of species in global models. Published by Elsevier Ltd.

Improving health care, Part 4: Concepts for improving any clinical process.

PubMed

Batalden, P B; Mohr, J J; Nelson, E C; Plume, S K

1996-10-01

One promising method for streamlining the generation of "good ideas" is to formulate what are sometimes called change concepts-general notions or approaches to change found useful in developing specific ideas for changes that lead to improvement. For example, in current efforts to reduce health care costs by discounting provider charges, the underlying generic concept is "reducing health care costs," and the specific idea is "discounting provider charges." Short-term gains in health care cost reduction can occur by pursuing discounts. After some time, however, limits to such reduction in costs are experienced. Persevering and continuing to travel down the "discounting provider charges" path is less likely to produce further substantial improvement than returning to the basic concept of "reducing health care costs." An interdisciplinary team aiming to reduce costs while improving quality of care for patients in need of hip joint replacement generated ideas for changing "what's done (process) to get better results." After team members wrote down their improvement ideas, they deduced the underlying change concepts and used them to generate even more ideas for improvement. Such change concepts include reordering the sequence of steps (preadmission physical therapy "certification"), eliminating failures at hand-offs between steps (transfer of information from physician's office to hospital), and eliminating a step (epidural pain control). Learning about making change, encouraging change, managing the change within and across organizations, and learning from the changes tested will characterize the sustainable, thriving health systems of the future.

The Veterans Administration Library Network: VALNET.

PubMed Central

van Vuren, D D

1982-01-01

Given substantial federal budget cuts and ever-increasing quantities of print and nonprint material, Veterans Administration (VA) Library Services have pooled their resources in a network to improve the scope and efficiency of the services they provide. The VA Library Network, VALNET, composed of 176 libraries, serves health care facilities throughout the continental United States and Puerto Rico. This paper outlines VALNET's organization and the range of individual VA Library Services. It also describes centrally provided services and resource-sharing tools being developed by the VA, as well as significant sharing arrangement among VA Library Services and between the VA and non-VA libraries. PMID:7052164

Introduction to the mining of clinical data.

PubMed

Harrison, James H

2008-03-01

The increasing volume of medical data online, including laboratory data, represents a substantial resource that can provide a foundation for improved understanding of disease presentation, response to therapy, and health care delivery processes. Data mining supports these goals by providing a set of techniques designed to discover similarities and relationships between data elements in large data sets. Currently, medical data have several characteristics that increase the difficulty of applying these techniques, although there have been notable medical data mining successes. Future developments in integrated medical data repositories, standardized data representation, and guidelines for the appropriate research use of medical data will decrease the barriers to mining projects.

Secure E-mailing Between Physicians and Patients

PubMed Central

Garrido, Terhilda; Meng, Di; Wang, Jian J.; Palen, Ted E.; Kanter, Michael H.

2014-01-01

Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization. PMID:24887522

Tuned intake air inlet for a rotary engine

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

Corbett, W.D.; Sheaffer, B.L.

This patent describes, in a rotary internal combustion engine, an improved assembly for providing a balanced flow of combustion air to the fuel supply inlet. It comprises: a plenum chamber attached to the engine block, the plenum chamber including an air inlet adapted to receive air from the cooling air exit passage and an air outlet for the discharge of air; and an outlet conduit connecting the air outlet and the fuel supply inlet. The conduit disposed to partially surround the plenum chamber to provide a conduit length substantially greater than the distance from the cooling air exit passage totmore » he fuel supply inlet.« less

The Shape of Io from Galileo Limb Measurements

USGS Publications Warehouse

Thomas, P.C.; Davies, M.E.; Colvin, T.R.; Oberst, J.; Schuster, P.; Neukum, G.; Carr, M.H.; McEwen, A.; Schubert, G.; Belton, M.J.S.

1998-01-01

Galileo CCD images of the limb of Io provide improved data for determining the shape of this synchronously rotating satellite. The best ellipsoidal fit is within 0.3 km of the best equilibrium fit of 1829.7, 1819.2, 1815.8 km. The shape is consistent with substantial mass concentration in a core and with gravity measurements from tracking of the Galileo spacecraft. The surface of Io is largely plains and isolated peaks, with little long-wavelength topography over 1 km in amplitude. ?? 1998 Academic Press.

Burgers approximation for two-dimensional flow past an ellipse

NASA Technical Reports Server (NTRS)

Dorrepaal, J. M.

1982-01-01

A motivation is given for studying Burgers flow and a solution technique is outlined which works equally well for Oseen or Burgers flow past a circular cylinder. The separation behind the cylinder, the drag experienced by the cylinder, and asymptotic behavior far from the cylinder are described. It is shown that the predictions of Burgers flow near the cylinder provide a substantial improvement over those of Oseen flow. Finally, the equations of motion for Burgers flow past an ellipse are formulated and solved.

Side-welded fast response sheathed thermocouple

DOEpatents

Carr, K.R.

A method of fabricating the measuring junction of a grounded-junction sheathed thermocouple to obtain fast time response and good thermal cycling performance is provided. Slots are tooled or machined into the sheath wall at the measuring junction, the thermocouple wires are laser-welded into the slots. A thin metal closure cap is then laser-welded over the end of the sheath. Compared to a conventional grounded-junction thermocouple, the response time is 4 to 5 times faster and the thermal shock and cycling capabilities are substantially improved.

Method of chaotic mixing and improved stirred tank reactors

DOEpatents

Muzzio, F.J.; Lamberto, D.J.

1999-07-13

The invention provides a method and apparatus for efficiently achieving a homogeneous mixture of fluid components by introducing said components having a Reynolds number of between about [le]1 to about 500 into a vessel and continuously perturbing the mixing flow by altering the flow speed and mixing time until homogeneity is reached. This method prevents the components from aggregating into non-homogeneous segregated regions within said vessel during mixing and substantially reduces the time the admixed components reach homogeneity. 19 figs.

Advanced propulsion for LEO-Moon transport. 3: Transportation model. M.S. Thesis - California Univ.

NASA Technical Reports Server (NTRS)

Henley, Mark W.

1992-01-01

A simplified computational model of low Earth orbit-Moon transportation system has been developed to provide insight into the benefits of new transportation technologies. A reference transportation infrastructure, based upon near-term technology developments, is used as a departure point for assessing other, more advanced alternatives. Comparison of the benefits of technology application, measured in terms of a mass payback ratio, suggests that several of the advanced technology alternatives could substantially improve the efficiency of low Earth orbit-Moon transportation.

Clinical operations management in radiology.

PubMed

Ondategui-Parra, Silvia; Gill, Ileana E; Bhagwat, Jui G; Intrieri, Lisa A; Gogate, Adheet; Zou, Kelly H; Nathanson, Eric; Seltzer, Steven E; Ros, Pablo R

2004-09-01

Providing radiology services is a complex and technically demanding enterprise in which the application of operations management (OM) tools can play a substantial role in process management and improvement. This paper considers the benefits of an OM process in a radiology setting. Available techniques and concepts of OM are addressed, along with gains and benefits that can be derived from these processes. A reference framework for the radiology processes is described, distinguishing two phases in the initial assessment of a unit: the diagnostic phase and the redesign phase.

Definitions of Frequency and Timing Terms, Satellite Navigation and Timing Systems, and the Behavior and Analyses of Precision Crystal and Atomic Frequency Standards and their Characteristics

DTIC Science & Technology

2009-05-01

time transfer techniques has largely been due to the improvement in frequency standards. In this document, an effort was made to provide substantial...of RCC Document 214-94, contains definitions of frequency and timing terms, time transfer techniques and analysis, and behavior of crystal and atomic...Characteristics, May 2009 viii TTG Telecommunications and Timing Group TWSTFT Two-Way Satellite Time and Frequency Transfer U.S. United States USNO

Side-welded fast response sheathed thermocouple

DOEpatents

Carr, Kenneth R.

1981-01-01

A method of fabricating the measuring junction of a grounded-junction sheathed thermocouple to obtain fast time response and good thermal cycling performance is provided. Slots are tooled or machined into the sheath wall at the measuring junction, the thermocouple wires are laser-welded into the slots. A thin metal closure cap is then laser-welded over the end of the sheath. Compared to a conventional grounded-junction thermocouple, the response time is 4-5 times faster and the thermal shock and cycling capabilities are substantially improved.

ONE SHAKE GATE FORMER

DOEpatents

Kalibjian, R.; Perez-Mendez, V.

1957-08-20

An improved circuit for forming square pulses having substantially short and precise durations is described. The gate forming circuit incorporates a secondary emission R. F. pentode adapted to receive input trigger pulses amd having a positive feedback loop comnected from the dynode to the control grid to maintain conduction in response to trigger pulses. A short circuited pulse delay line is employed to precisely control the conducting time of the tube and a circuit for squelching spurious oscillations is provided in the feedback loop.

Method of chaotic mixing and improved stirred tank reactors

DOEpatents

Muzzio, Fernando J.; Lamberto, David J.

1999-01-01

The invention provides a method and apparatus for efficiently achieving a homogeneous mixture of fluid components by introducing said components having a Reynolds number of between about .ltoreq.1 to about 500 into a vessel and continuously perturbing the mixing flow by altering the flow speed and mixing time until homogeniety is reached. This method prevents the components from aggregating into non-homogeneous segregated regions within said vessel during mixing and substantially reduces the time the admixed components reach homogeneity.

Multiloop Functional Renormalization Group That Sums Up All Parquet Diagrams

NASA Astrophysics Data System (ADS)

Kugler, Fabian B.; von Delft, Jan

2018-02-01

We present a multiloop flow equation for the four-point vertex in the functional renormalization group (FRG) framework. The multiloop flow consists of successive one-loop calculations and sums up all parquet diagrams to arbitrary order. This provides substantial improvement of FRG computations for the four-point vertex and, consequently, the self-energy. Using the x-ray-edge singularity as an example, we show that solving the multiloop FRG flow is equivalent to solving the (first-order) parquet equations and illustrate this with numerical results.

Benefits of experience. Treating coronary artery disease.

PubMed

Hemenway, D; Sherman, H; Mudge, G H; Flatley, M; Lindsey, N M; Goldman, L

1986-02-01

The authors examined the issue of learning by doing in terms of both the cost and outcome of treating coronary artery disease at one hospital between 1977 and 1981. Over time, the quality of outcome improved for both medical and surgical patients. During this time of cost-plus reimbursement, there was less conclusive evidence of concurrent technical efficiency gains. These findings are consistent with the hypothesis that the benefits of experience can be substantial but they do not just happen: they require proper provider motivation.

Adding Value to Total Joint Arthroplasty Care in an Academic Environment: The Utah Experience.

PubMed

Pelt, Christopher E; Anderson, Mike B; Erickson, Jill A; Gililland, Jeremy M; Peters, Christopher L

2018-06-01

Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models. The changes that occurred at our institution are described. Real-time data and knowledgeable personnel working behind the scenes, while physicians provide clinical care, help move clinical pathway redesigns. Engaged physicians are essential to the successful implementation of value creation and care pathway redesign that can lead to improvements in value. An investment of money and resources toward added infrastructure and personnel is often needed to realize large-scale improvements. Alignment of providers, payers, and hospital administration, including by means of gainsharing programs, can lead to improvements. Although significant care pathway redesign efforts may realize substantial initial cost savings, savings may be asymptotic in nature, which calls into question the likely sustainability of programs that incentivize or penalize payments based on historical targets. Copyright © 2018 Elsevier Inc. All rights reserved.

The Importance of Implementation Strategy in Scaling Up Xpert MTB/RIF for Diagnosis of Tuberculosis in the Indian Health-Care System: A Transmission Model

PubMed Central

Salje, Henrik; Andrews, Jason R.; Deo, Sarang; Satyanarayana, Srinath; Sun, Amanda Y.; Pai, Madhukar; Dowdy, David W.

2014-01-01

Background India has announced a goal of universal access to quality tuberculosis (TB) diagnosis and treatment. A number of novel diagnostics could help meet this important goal. The rollout of one such diagnostic, Xpert MTB/RIF (Xpert) is being considered, but if Xpert is used mainly for people with HIV or high risk of multidrug-resistant TB (MDR-TB) in the public sector, population-level impact may be limited. Methods and Findings We developed a model of TB transmission, care-seeking behavior, and diagnostic/treatment practices in India and explored the impact of six different rollout strategies. Providing Xpert to 40% of public-sector patients with HIV or prior TB treatment (similar to current national strategy) reduced TB incidence by 0.2% (95% uncertainty range [UR]: −1.4%, 1.7%) and MDR-TB incidence by 2.4% (95% UR: −5.2%, 9.1%) relative to existing practice but required 2,500 additional MDR-TB treatments and 60 four-module GeneXpert systems at maximum capacity. Further including 20% of unselected symptomatic individuals in the public sector required 700 systems and reduced incidence by 2.1% (95% UR: 0.5%, 3.9%); a similar approach involving qualified private providers (providers who have received at least some training in allopathic or non-allopathic medicine) reduced incidence by 6.0% (95% UR: 3.9%, 7.9%) with similar resource outlay, but only if high treatment success was assured. Engaging 20% of all private-sector providers (qualified and informal [providers with no formal medical training]) had the greatest impact (14.1% reduction, 95% UR: 10.6%, 16.9%), but required >2,200 systems and reliable treatment referral. Improving referrals from informal providers for smear-based diagnosis in the public sector (without Xpert rollout) had substantially greater impact (6.3% reduction) than Xpert scale-up within the public sector. These findings are subject to substantial uncertainty regarding private-sector treatment patterns, patient care-seeking behavior, symptoms, and infectiousness over time; these uncertainties should be addressed by future research. Conclusions The impact of new diagnostics for TB control in India depends on implementation within the complex, fragmented health-care system. Transformative strategies will require private/informal-sector engagement, adequate referral systems, improved treatment quality, and substantial resources. Please see later in the article for the Editors' Summary PMID:25025235

Improved Behavior and Neuropsychological Function in Children With ROHHAD After High-Dose Cyclophosphamide.

PubMed

Jacobson, Lisa A; Rane, Shruti; McReynolds, Lisa J; Steppan, Diana A; Chen, Allen R; Paz-Priel, Ido

2016-07-01

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare, generally progressive, and potentially fatal syndrome of unclear etiology. The syndrome is characterized by normal development followed by a sudden, rapid hyperphagic weight gain beginning during the preschool period, hypothalamic dysfunction, and central hypoventilation, and is often accompanied by personality changes and developmental regression, leading to substantial morbidity and mortality. We describe 2 children who had symptomatic and neuropsychological improvement after high-dose cyclophosphamide treatment. Our experience supports an autoimmune pathogenesis and provides the first neuropsychological profile of patients with rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation. Copyright © 2016 by the American Academy of Pediatrics.

Enhanced Molecular Sieve CO2 Removal Evaluation

NASA Technical Reports Server (NTRS)

Rose, Susan; ElSherif, Dina; MacKnight, Allen

1996-01-01

The objective of this research is to quantitatively characterize the performance of two major types of molecular sieves for two-bed regenerative carbon dioxide removal at the conditions compatible with both a spacesuit and station application. One sorbent is a zeolite-based molecular sieve that has been substantially improved over the materials used in Skylab. The second sorbent is a recently developed carbon-based molecular sieve. Both molecular sieves offer the potential of high payoff for future manned missions by reducing system complexity, weight (including consumables), and power consumption in comparison with competing concepts. The research reported here provides the technical data required to improve CO2 removal systems for regenerative life support systems for future IVA and EVA missions.

Counterflow absorber for an absorption refrigeration system

DOEpatents

Reimann, Robert C.

1984-01-01

An air-cooled, vertical tube absorber for an absorption refrigeration system is disclosed. Strong absorbent solution is supplied to the top of the absorber and refrigerant vapor is supplied to the bottom of the absorber to create a direct counterflow of refrigerant vapor and absorbent solution in the absorber. The refrigeration system is designed so that the volume flow rate of refrigerant vapor in the tubes of the absorber is sufficient to create a substantially direct counterflow along the entire length of each tube in the absorber. This provides several advantages for the absorber such as higher efficiency and improved heat transfer characteristics, and allows improved purging of non-condensibles from the absorber.

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

PubMed

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

2008-06-01

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

Tradeoffs between income, air pollution and life expectancy: Brief report on the US experience, 1980-2000.

PubMed

Pope, C Arden; Ezzati, Majid; Dockery, Douglas W

2015-10-01

During the period of 1980-2000, the US obtained substantial reductions in air pollution and improvements in life expectancy (LE). Multiple factors contributed to improved health. This report explores and illustrates trade-offs between income, air pollution, and LE. Both improved air quality and income growth contributed to LE gains - without evidence of substantial negative tradeoffs between air pollution and income. Cleaner air may be considered an "economic good" with contributions to health, wellbeing, and human capital. Copyright © 2015 Elsevier Inc. All rights reserved.

Progress and challenges of the rural cooperative medical scheme in China

PubMed Central

Xu, Ke

2014-01-01

Abstract Problem During China’s transition to a market economy in the 1980s and 1990s, the rural population faced substantial barriers to accessing health care and encountered heavier financial burdens than urban residents in paying for necessary health services. Approach In 2003, China started to implement a rural cooperative medical scheme (RCMS), mainly through government subsidies. The scheme operates at the county level and offers a modest benefit package. Local setting In spite of rapid economic growth since the early 1980s, income disparities in China have increased, particularly between rural and urban populations. In response, the government has put greater emphasis on social development, including health system development. Examples are the prioritization of improved access to health services and the reduction of the burden of payment for necessary services. Relevant changes After 10 years of implementation, the RCMS now provides coverage to the entire rural population and has substantially improved access to health care. Yet despite a drop in out-of-pocket payments as a proportion of total health expenditure, paying for necessary services continues to cause financial hardship for many rural residents. Lessons learnt In its first decade, the RCMS made progress through political mobilization, government subsidies, the readiness of the health-care delivery system, and the availability of a monitoring and evaluation system. Further improving the RCMS will require a focus on cost containment, quality improvement and making the scheme portable. PMID:24940019

Understanding glass formation and ion transport in polymeric ionic liquids using computer simulations

NASA Astrophysics Data System (ADS)

Patra, Tarak; Yang, Junhong; Cheng, Yiz; Simmons, David

Polymeric ionic liquids (PILs) are very promising materials to enable more environmentally stable high density energy storage devices. Realization of PILs providing high environmental and mechanical stability while maximizing ion conductivity would be accelerated by an improved molecular level understanding of their structure and dynamics. Extensive evidence suggests that both mechanical properties and ion conductivity in anhydrous PILs are intimately related to the PIL's glass formation behavior. This represents a major challenge to the rational design of these materials, given that the basic nature of glass formation and its connection to molecular properties remains a substantial open question in polymer and condensed matter physics. Here we describe coarse-grained and atomistic molecular dynamics simulations probing the relationship between PIL architecture and interactions, glass formation behavior, and ion transport characteristics. These studies provide guidance towards the design of PILs with improved stability and ion conductivity for future energy applications.

The Impact of Improved Oral Health on the Utilization of Dental Services.

PubMed

Eklund, Stephen A

2017-08-01

Since the mid-20th century, there has been a remarkable decline in dental caries in the United States. The effects of that caries decline have now been demonstrated well into the adult population. These improvements in oral health are resulting in substantial declines in the reparative and restorative dental services being provided to the affected individuals, who comprise a growing part of the population. Because of fewer compromised teeth, extractions and their sequelae also are declining. Much of the recall and periodontal maintenance care can be provided by allied dental personnel. As the older age cohorts, who were children before the caries decline occurred, become an ever-smaller part of the population, the number of patients an individual dentist can treat in a year is likely to increase. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

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

PubMed Central

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

2011-01-01

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

High-performance thermoelectric nanocomposites from nanocrystal building blocks

PubMed Central

Ibáñez, Maria; Luo, Zhishan; Genç, Aziz; Piveteau, Laura; Ortega, Silvia; Cadavid, Doris; Dobrozhan, Oleksandr; Liu, Yu; Nachtegaal, Maarten; Zebarjadi, Mona; Arbiol, Jordi; Kovalenko, Maksym V.; Cabot, Andreu

2016-01-01

The efficient conversion between thermal and electrical energy by means of durable, silent and scalable solid-state thermoelectric devices has been a long standing goal. While nanocrystalline materials have already led to substantially higher thermoelectric efficiencies, further improvements are expected to arise from precise chemical engineering of nanoscale building blocks and interfaces. Here we present a simple and versatile bottom–up strategy based on the assembly of colloidal nanocrystals to produce consolidated yet nanostructured thermoelectric materials. In the case study on the PbS–Ag system, Ag nanodomains not only contribute to block phonon propagation, but also provide electrons to the PbS host semiconductor and reduce the PbS intergrain energy barriers for charge transport. Thus, PbS–Ag nanocomposites exhibit reduced thermal conductivities and higher charge carrier concentrations and mobilities than PbS nanomaterial. Such improvements of the material transport properties provide thermoelectric figures of merit up to 1.7 at 850 K. PMID:26948987

High-performance thermoelectric nanocomposites from nanocrystal building blocks.

PubMed

Ibáñez, Maria; Luo, Zhishan; Genç, Aziz; Piveteau, Laura; Ortega, Silvia; Cadavid, Doris; Dobrozhan, Oleksandr; Liu, Yu; Nachtegaal, Maarten; Zebarjadi, Mona; Arbiol, Jordi; Kovalenko, Maksym V; Cabot, Andreu

2016-03-07

The efficient conversion between thermal and electrical energy by means of durable, silent and scalable solid-state thermoelectric devices has been a long standing goal. While nanocrystalline materials have already led to substantially higher thermoelectric efficiencies, further improvements are expected to arise from precise chemical engineering of nanoscale building blocks and interfaces. Here we present a simple and versatile bottom-up strategy based on the assembly of colloidal nanocrystals to produce consolidated yet nanostructured thermoelectric materials. In the case study on the PbS-Ag system, Ag nanodomains not only contribute to block phonon propagation, but also provide electrons to the PbS host semiconductor and reduce the PbS intergrain energy barriers for charge transport. Thus, PbS-Ag nanocomposites exhibit reduced thermal conductivities and higher charge carrier concentrations and mobilities than PbS nanomaterial. Such improvements of the material transport properties provide thermoelectric figures of merit up to 1.7 at 850 K.

Passenger aircraft cabin air quality: trends, effects, societal costs, proposals.

PubMed

Hocking, M B

2000-08-01

As aircraft operators have sought to substantially reduce propulsion fuel cost by flying at higher altitudes, the energy cost of providing adequate outside air for ventilation has increased. This has lead to a significant decrease in the amount of outside air provided to the passenger cabin, partly compensated for by recirculation of filtered cabin air. The purpose of this review paper is to assemble the available measured air quality data and some calculated estimates of the air quality for aircraft passenger cabins to highlight the trend of the last 25 years. The influence of filter efficiencies on air quality, and a few medically documented and anecdotal cases of illness transmission aboard aircraft are discussed. Cost information has been collected from the perspective of both the airlines and passengers. Suggestions for air quality improvement are given which should help to result in a net, multistakeholder savings and improved passenger comfort.

Visualising reacting single atoms under controlled conditions: Advances in atomic resolution in situ Environmental (Scanning) Transmission Electron Microscopy (E(S)TEM)

NASA Astrophysics Data System (ADS)

Boyes, Edward D.; Gai, Pratibha L.

2014-02-01

Advances in atomic resolution Environmental (Scanning) Transmission Electron Microscopy (E(S)TEM) for probing gas-solid catalyst reactions in situ at the atomic level under controlled reaction conditions of gas environment and temperature are described. The recent development of the ESTEM extends the capability of the ETEM by providing the direct visualisation of single atoms and the atomic structure of selected solid state heterogeneous catalysts in their working states in real-time. Atomic resolution E(S)TEM provides a deeper understanding of the dynamic atomic processes at the surface of solids and their mechanisms of operation. The benefits of atomic resolution-E(S)TEM to science and technology include new knowledge leading to improved technological processes with substantial economic benefits, improved healthcare, reductions in energy needs and the management of environmental waste generation. xml:lang="fr"

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

PubMed

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

2004-01-01

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

Cosmic ray antiprotons at high energies

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

Winkler, Martin Wolfgang, E-mail: martin.winkler@su.se

2017-02-01

Cosmic ray antiprotons provide a powerful tool to probe dark matter annihilations in our galaxy. The sensitivity of this important channel is, however, diluted by sizable uncertainties in the secondary antiproton background. In this work, we improve the calculation of secondary antiproton production with a particular focus on the high energy regime. We employ the most recent collider data and identify a substantial increase of antiproton cross sections with energy. This increase is driven by the violation of Feynman scaling as well as by an enhanced strange hyperon production. The updated antiproton production cross sections are made publicly available formore » independent use in cosmic ray studies. In addition, we provide the correlation matrix of cross section uncertainties for the AMS-02 experiment. At high energies, the new cross sections improve the compatibility of the AMS-02 data with a pure secondary origin of antiprotons in cosmic rays.« less

Insulin analogues with improved absorption characteristics.

PubMed

Brange, J; Hansen, J F; Langkjaer, L; Markussen, J; Ribel, U; Sørensen, A R

1992-01-01

The insulin preparations available today are not ideal for therapy as s.c. injection does not provide a physiological insulin profile. With the aim to improve the absorption properties recombinant DNA technology has been utilized to design novel insulin molecules with changed physico-chemical characteristics and hence altered subcutaneous absorption kinetics. Soluble, long-acting human insulin analogues in which the isoelectric point has been increased from 5.4 to approx. 7 are absorbed very slowly, providing a more constant basal insulin delivery with lower day-to-day variation than present protracted preparations. In addition they have better storage stability. Rapid-acting human insulin analogues with largely reduced self-association are absorbed substantially faster from subcutaneous tissue than current regular insulin and thus are better suited for bolus injection. The absorption kinetics of these analogues have been able to explain the mechanism behind the dose effect on insulin absorption rate.

The benefits of improved national elevation data

USGS Publications Warehouse

Snyder, Gregory I.

2013-01-01

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

NASTRAN internal improvements for 1992 release

NASA Technical Reports Server (NTRS)

Chan, Gordon C.

1992-01-01

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

Historical background and design evolution of the transonic aircraft technology supercritical wing

NASA Technical Reports Server (NTRS)

Ayers, T. G.; Hallissy, J. B.

1981-01-01

Two dimensional wind tunnel test results obtained for supercritical airfoils indicated that substantial improvements in aircraft performance at high subsonic speeds could be achieved by shaping the airfoil to improve the supercritical flow above the upper surface. Significant increases in the drag divergence Mach number, the maximum lift coefficient for buffer onset, and the Mach number for buffet onset at a given lift coefficient were demonstrated for the supercritical airfoil, as compared with a NACA 6 series airfoil of comparable thickness. These trends were corroborated by results from three dimensional wind tunnel and flight tests. Because these indicated extensions of the buffet boundaries could provide significant improvements in the maneuverability of a fighter airplane, an exploratory wind tunnel investigation was initiated which demonstrated that significant aerodynamic improvements could be achieved from the direct substitution of a supercritical airfoil on a variable wing sweep multimission airplane model.

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

PubMed

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

2016-07-01

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

Improved specificity of TALE-based genome editing using an expanded RVD repertoire.

PubMed

Miller, Jeffrey C; Zhang, Lei; Xia, Danny F; Campo, John J; Ankoudinova, Irina V; Guschin, Dmitry Y; Babiarz, Joshua E; Meng, Xiangdong; Hinkley, Sarah J; Lam, Stephen C; Paschon, David E; Vincent, Anna I; Dulay, Gladys P; Barlow, Kyle A; Shivak, David A; Leung, Elo; Kim, Jinwon D; Amora, Rainier; Urnov, Fyodor D; Gregory, Philip D; Rebar, Edward J

2015-05-01

Transcription activator-like effector (TALE) proteins have gained broad appeal as a platform for targeted DNA recognition, largely owing to their simple rules for design. These rules relate the base specified by a single TALE repeat to the identity of two key residues (the repeat variable diresidue, or RVD) and enable design for new sequence targets via modular shuffling of these units. A key limitation of these rules is that their simplicity precludes options for improving designs that are insufficiently active or specific. Here we address this limitation by developing an expanded set of RVDs and applying them to improve the performance of previously described TALEs. As an extreme example, total conversion of a TALE nuclease to new RVDs substantially reduced off-target cleavage in cellular studies. By providing new RVDs and design strategies, these studies establish options for developing improved TALEs for broader application across medicine and biotechnology.

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

PubMed

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

2016-01-01

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

A randomized comparison of online- and telephone-based care management with internet training alone in adult patients with poorly controlled type 2 diabetes.

PubMed

McMahon, Graham T; Fonda, Stephanie J; Gomes, Helen E; Alexis, George; Conlin, Paul R

2012-11-01

Care management may improve the quality of diabetes care by enhancing contact between high-risk patients and their providers. This prospective, longitudinal, randomized trial sought to investigate whether telephone or online care management improves diabetes-related outcomes over time compared with usual care supplemented with Internet access and training. One hundred fifty-one adult subjects with type 2 diabetes mellitus and an elevated hemoglobin A1c (A1c) level (≥8.5%) were randomly assigned to online care management (n=51), telephone-based care management (n=51), or Web training (n=49) groups. Online and telephone participants interacted with a care manager through a diabetes education and care management Web site and by telephone, respectively. The Web training group was provided with online diabetes self-management resources but no care management support. The primary outcome measure was A1c measured every 3 months for a year. A1c declined significantly and substantially in all groups over 12 months. A1c declined linearly at a rate of 0.32% (P<0.0001) per quarter for the online group, 0.36% (P<0.0001) for the telephone group, and 0.41% for the Web training group (P<0.0001). The rate of change over time did not differ significantly among groups. The groups converged at 12 months with average absolute A1c difference of -1.5%. The number of interactions with care providers was not significantly associated with the change in A1c. Blood pressure, weight, lipid levels, and diabetes distress did not differ among groups over time. Online, telephone-based care management, and Web training for diabetes patients with elevated A1c were each associated with a substantial improvement in A1c over a 1-year period. Internet access and training alone may be as effective as care management in patients with poorly controlled diabetes.

Liposome-chaperoned cell-free synthesis for the design of proteoliposomes: Implications for therapeutic delivery.

PubMed

Lu, Mei; Zhao, Xiaoyun; Xing, Haonan; Xun, Zhe; Yang, Tianzhi; Cai, Cuifang; Wang, Dongkai; Ding, Pingtian

2018-04-03

Cell-free (CF) protein synthesis has emerged as a powerful technique platform for efficient protein production in vitro. Liposomes have been widely studied as therapeutic carriers due to their biocompatibility, biodegradability, low toxicity, flexible surface manipulation, easy preparation, and higher cargo encapsulation capability. However, rapid immune clearance, insufficient targeting capacity, and poor cytoplasmic delivery efficiency substantially restrict their clinical application. The incorporation of functional membrane proteins (MPs) or peptides allows the transfer of biological properties to liposomes and imparts them with improved circulation, increased targeting, and efficient intracellular delivery. Liposome-chaperoned CF synthesis enables production of proteoliposomes in one-step reaction, which not only substantially simplifies the production procedure but also keeps protein functionality intact. Building off these observations, proteoliposomes with integrated MPs represent an excellent candidate for therapeutic delivery. In this review, we describe recent advances in CF synthesis with emphasis on detailing key factors for improving CF expression efficiency. Furthermore, we provide insights into strategies for rational design of proteoliposomal nanodelivery systems via CF synthesis. Liposome-chaperoned CF synthesis has emerged as a powerful approach for the design of recombinant proteoliposomes in one-step reaction. The incorporation of bioactive MPs or peptides into liposomes via CF synthesis can facilitate the development of proteoliposomal nanodelivery systems with improved circulation, increased targeting, and enhanced cellular delivery capacity. Moreover, by adapting lessons learned from natural delivery vehicles, novel bio-inspired proteoliposomes with enhanced delivery properties could be produced in CF systems. In this review, we first give an overview of CF synthesis with focus on enhancing protein expression in liposome-chaperoned CF systems. Furthermore, we intend to provide insight into harnessing CF-synthesized proteoliposomes for efficient therapeutic delivery. Copyright © 2018. Published by Elsevier Ltd.

Treatment of Lung Cancer in Medically Compromised Patients.

PubMed

Crawford, Jeffrey; Wheatley-Price, Paul; Feliciano, Josephine Louella

2016-01-01

Outcomes for patients with lung cancer have been improved substantially through the integration of surgery, radiation, and systemic therapy for patients with early-stage disease. Meanwhile, advances in our understanding of molecular mechanisms have substantially advanced our treatment of patients with advanced lung cancer through the introduction of targeted therapies, immune approaches, improvements in chemotherapy, and better supportive care. However, the majority of these advances have occurred among patients with good functional status, normal organ function, and with the social and economic support systems to be able to benefit most from these treatments. The aim of this article is to bring greater attention to management of lung cancer in patients who are medically compromised, which remains a major barrier to care delivery. Impaired performance status is associated with poor outcomes and correlates with the high prevalence of cachexia among patients with advanced lung cancer. CT imaging is emerging as a research tool to quantify muscle loss in patients with cancer, and new therapeutics are on the horizon that may provide important adjunctive therapy in the future. The benefits of cancer therapy for patients with organ failure are poorly understood because of their exclusion from clinical trials. The availability of targeted therapy and immunotherapy may provide alternatives that may be easier to deliver in this population, but clinical trials of these new agents in this population are vital. Patients with lower socioeconomic status are disproportionately affected by lung cancer because of higher rates of tobacco addiction and the impact of socioeconomic status on delay in diagnosis, treatment, and outcomes. For all patients who are medically compromised with lung cancer, multidisciplinary approaches are particularly needed to evaluate these patients and to incorporate rapidly changing therapeutics to improve outcomes.

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.

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.

26 CFR 1.7874-3T - Substantial business activities (temporary).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 13 2013-04-01 2013-04-01 false Substantial business activities (temporary). 1... Substantial business activities (temporary). (a) Scope. This section provides rules regarding whether a foreign corporation has substantial business activities in the relevant foreign country when compared to...

47 CFR 95.831 - Service requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... that it provides substantial service within the service area. Substantial service is defined as a service that is sound, favorable, and substantially above a level of service which might minimally warrant...

Contactor/filter improvements

DOEpatents

Stelman, D.

1988-06-30

A contactor/filter arrangement for removing particulate contaminants from a gaseous stream is described. The filter includes a housing having a substantially vertically oriented granular material retention member with upstream and downstream faces, a substantially vertically oriented microporous gas filter element, wherein the retention member and the filter element are spaced apart to provide a zone for the passage of granular material therethrough. A gaseous stream containing particulate contaminants passes through the gas inlet means as well as through the upstream face of the granular material retention member, passing through the retention member, the body of granular material, the microporous gas filter element, exiting out of the gas outlet means. A cover screen isolates the filter element from contact with the moving granular bed. In one embodiment, the granular material is comprised of porous alumina impregnated with CuO, with the cover screen cleaned by the action of the moving granular material as well as by backflow pressure pulses. 6 figs.

Robust Combining of Disparate Classifiers Through Order Statistics

NASA Technical Reports Server (NTRS)

Tumer, Kagan; Ghosh, Joydeep

2001-01-01

Integrating the outputs of multiple classifiers via combiners or meta-learners has led to substantial improvements in several difficult pattern recognition problems. In this article we investigate a family of combiners based on order statistics, for robust handling of situations where there are large discrepancies in performance of individual classifiers. Based on a mathematical modeling of how the decision boundaries are affected by order statistic combiners, we derive expressions for the reductions in error expected when simple output combination methods based on the the median, the maximum and in general, the ith order statistic, are used. Furthermore, we analyze the trim and spread combiners, both based on linear combinations of the ordered classifier outputs, and show that in the presence of uneven classifier performance, they often provide substantial gains over both linear and simple order statistics combiners. Experimental results on both real world data and standard public domain data sets corroborate these findings.

The role of myocardial viability in contemporary cardiac practice.

PubMed

Jamiel, Abdelrahman; Ebid, Mohamad; Ahmed, Amjad M; Ahmed, Dalia; Al-Mallah, Mouaz H

2017-07-01

Ischemic heart disease (IHD) remains the single most common cause of death worldwide. Ischemic cardiomyopathy is a major sequel of coronary artery disease. The economic health burden of IHD is substantial. In patients with old myocardial infarction (OMI), the extent of viable myocardium (VM) directly affects the short- and long-term outcome. There is a considerable collection of observational data showing substantial improvement in patients with significant left ventricular dysfunction when the need for revascularization is guided by preoperative assessment of viability and hibernation. However, a major challenge for present cardiovascular imaging is to identify better ways to assess viable but inadequately perfused myocardium and thus optimize selection of patients for coronary revascularization. Several non-invasive techniques have been developed to detect signs of viability. Hence, our aim is to provide the reader a state-of-the art review for the assessment of myocardial viability.

Advanced space solar dynamic receivers

NASA Technical Reports Server (NTRS)

Strumpf, Hal J.; Coombs, Murray G.; Lacy, Dovie E.

1988-01-01

A study has been conducted to generate and evaluate advanced solar heat receiver concepts suitable for orbital application with Brayton and Stirling engine cycles in the 7-kW size range. The generated receiver designs have thermal storage capability (to enable power production during the substantial eclipse period which accompanies typical orbits) and are lighter and smaller than state-of-the-art systems, such as the Brayton solar receiver being designed and developed by AiResearch for the NASA Space Station. Two receiver concepts have been developed in detail: a packed bed receiver and a heat pipe receiver. The packed bed receiver is appropriate for a Brayton engine; the heat pipe receiver is applicable for either a Brayton or Stirling engine. The thermal storage for both concepts is provided by the melting and freezing of a salt. Both receiver concepts offer substantial improvements in size and weight compared to baseline receivers.

Machine-Learning Based Co-adaptive Calibration: A Perspective to Fight BCI Illiteracy

NASA Astrophysics Data System (ADS)

Vidaurre, Carmen; Sannelli, Claudia; Müller, Klaus-Robert; Blankertz, Benjamin

"BCI illiteracy" is one of the biggest problems and challenges in BCI research. It means that BCI control cannot be achieved by a non-negligible number of subjects (estimated 20% to 25%). There are two main causes for BCI illiteracy in BCI users: either no SMR idle rhythm is observed over motor areas, or this idle rhythm is not attenuated during motor imagery, resulting in a classification performance lower than 70% (criterion level) already for offline calibration data. In a previous work of the same authors, the concept of machine learning based co-adaptive calibration was introduced. This new type of calibration provided substantially improved performance for a variety of users. Here, we use a similar approach and investigate to what extent co-adapting learning enables substantial BCI control for completely novice users and those who suffered from BCI illiteracy before.

Photostability can be significantly modulated by molecular packing in glasses

DOE Data Explorer

Ediger, Mark [University of Wisconsin-Madison; de Pablo, Juan [University of Chicago; Anthony, Lucas [University of Chicago; Qiu, Yue [University of Chicago

2016-04-10

While previous work has demonstrated that molecular packing in organic crystals can strongly influence photochemical stability, efforts to tune photostability in amorphous materials have shown much smaller effects. Here we show that physical vapor deposition can substantially improve the photostability of organic glasses. Disperse Orange 37 (DO37), an azobenzene derivative, is studied as a model system. Photostability is assessed through changes in the density and molecular orientation of glassy thin films during light irradiation. By optimizing the substrate temperature used for deposition, we can increase photostability by a factor of 50 relative to the liquid-cooled glass. Photostability correlates with glass density, with density increases of up to 1.3%. Coarse-grained molecular simulations, which mimic glass preparation and the photoisomerization reaction, also indicate that glasses with higher density have substantially increased photostability. These results provide insights that may assist in the design of organic photovoltaics and light emission devices with longer lifetimes.

Widespread Nanoparticle-Assay Interference: Implications for Nanotoxicity Testing

PubMed Central

Ong, Kimberly J.; MacCormack, Tyson J.; Clark, Rhett J.; Ede, James D.; Ortega, Van A.; Felix, Lindsey C.; Dang, Michael K. M.; Ma, Guibin; Fenniri, Hicham; Veinot, Jonathan G. C.; Goss, Greg G.

2014-01-01

The evaluation of engineered nanomaterial safety has been hindered by conflicting reports demonstrating differential degrees of toxicity with the same nanoparticles. The unique properties of these materials increase the likelihood that they will interfere with analytical techniques, which may contribute to this phenomenon. We tested the potential for: 1) nanoparticle intrinsic fluorescence/absorbance, 2) interactions between nanoparticles and assay components, and 3) the effects of adding both nanoparticles and analytes to an assay, to interfere with the accurate assessment of toxicity. Silicon, cadmium selenide, titanium dioxide, and helical rosette nanotubes each affected at least one of the six assays tested, resulting in either substantial over- or under-estimations of toxicity. Simulation of realistic assay conditions revealed that interference could not be predicted solely by interactions between nanoparticles and assay components. Moreover, the nature and degree of interference cannot be predicted solely based on our current understanding of nanomaterial behaviour. A literature survey indicated that ca. 95% of papers from 2010 using biochemical techniques to assess nanotoxicity did not account for potential interference of nanoparticles, and this number had not substantially improved in 2012. We provide guidance on avoiding and/or controlling for such interference to improve the accuracy of nanotoxicity assessments. PMID:24618833

How rural land use management facilitates drought risk adaptation in a changing climate - A case study in arid northern China.

PubMed

Lei, Yongdeng; Zhang, Hailin; Chen, Fu; Zhang, Linbo

2016-04-15

Under a warming climate, frequent drought and water scarcity in northern China have severely disrupted agricultural production and posed a substantial threat to farmers' livelihoods. Based on first-hand data collected through in-depth interviews with local managers and farmer households, this study evaluated the effectiveness of rural land use management in mitigating drought risk, ensuring food security and improving farmers' livelihoods. Our findings indicate that a) reforestation on low-yield cropland not only can improve the eco-environment but can also prominently mitigate the production risk to local farmers; b) replacing the traditional border irrigation with sprinkler irrigation has substantially curbed agricultural water usage and increased the per unit of output; and c) in recent years, instead of planting water-intensive grain crops, local farmers cultivated more forage crops to raise animals, which greatly diversified their income sources and reduced the drought risk of agricultural production. By performing an empirical case study in drought-prone Inner Mongolia, this study provides decision-makers with insights into how to strategically adapt to drought risk and reduce rural poverty within the broader context of climate change. Copyright © 2016 Elsevier B.V. All rights reserved.

New and future heat pump technologies

NASA Astrophysics Data System (ADS)

Creswick, F. A.

It is not possible to say for sure what future heat pumps will look like, but there are some interesting possibilities. In the next five years, we are likely to see US heat pumps with two kinds of innovations: capacity modulation and charge control. Capacity modulation will be accomplished by variable-speed compressor motors. The objective of charge control is to keep the refrigerant charge in the system where it belongs for best performance; there are probably many ways to accomplish this. Charge control will improve efficiency and durability; capacity modulation will further improve efficiency and comfort. The Stirling cycle heat pump has several interesting advantages, but it is farther out in time. At present, we don't know how to make it as efficient as the conventional vapor-compression heat pump. Electric utility people should be aware that major advances are being made in gas-fired heat pumps which could provide strong competition in the future. However, even a gas-fired heat pump has a substantial auxiliary electric power requirement. The resources needed to develop advanced heat pumps are substantial and foreign competition will be intense. It will be important for utilities, manufacturers, and the federal government to work in close cooperation.

Polymer/metal oxide hybrid dielectrics for low voltage field-effect transistors with solution-processed, high-mobility semiconductors

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

Held, Martin; Schießl, Stefan P.; Gannott, Florentina

Transistors for future flexible organic light-emitting diode (OLED) display backplanes should operate at low voltages and be able to sustain high currents over long times without degradation. Hence, high capacitance dielectrics with low surface trap densities are required that are compatible with solution-processable high-mobility semiconductors. Here, we combine poly(methyl methacrylate) (PMMA) and atomic layer deposition hafnium oxide (HfO{sub x}) into a bilayer hybrid dielectric for field-effect transistors with a donor-acceptor polymer (DPPT-TT) or single-walled carbon nanotubes (SWNTs) as the semiconductor and demonstrate substantially improved device performances for both. The ultra-thin PMMA layer ensures a low density of trap states atmore » the semiconductor-dielectric interface while the metal oxide layer provides high capacitance, low gate leakage and superior barrier properties. Transistors with these thin (≤70 nm), high capacitance (100–300 nF/cm{sup 2}) hybrid dielectrics enable low operating voltages (<5 V), balanced charge carrier mobilities and low threshold voltages. Moreover, the hybrid layers substantially improve the bias stress stability of the transistors compared to those with pure PMMA and HfO{sub x} dielectrics.« less

24 CFR 907.7 - Remedies for substantial default.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Remedies for substantial default... URBAN DEVELOPMENT SUBSTANTIAL DEFAULT BY A PUBLIC HOUSING AGENCY § 907.7 Remedies for substantial... staff; or (3) Provide assistance deemed necessary, in the discretion of HUD, to remedy emergency...

Constructing Carbon Fiber Motion-Detection Loops for Simultaneous EEG–fMRI

PubMed Central

Abbott, David F.; Masterton, Richard A. J.; Archer, John S.; Fleming, Steven W.; Warren, Aaron E. L.; Jackson, Graeme D.

2015-01-01

One of the most significant impediments to high-quality EEG recorded in an MRI scanner is subject motion. Availability of motion artifact sensors can substantially improve the quality of the recorded EEG. In the study of epilepsy, it can also dramatically increase the confidence that one has in discriminating true epileptiform activity from artifact. This is due both to the reduction in artifact and the ability to visually inspect the motion sensor signals when reading the EEG, revealing whether or not head motion is present. We have previously described the use of carbon fiber loops for detecting and correcting artifact in EEG acquired simultaneously with MRI. The loops, attached to the subject’s head, are electrically insulated from the scalp. They provide a simple and direct measure of specific artifact that is contaminating the EEG, including both subject motion and residual artifact arising from magnetic field gradients applied during MRI. Our previous implementation was used together with a custom-built EEG–fMRI system that differs substantially from current commercially available EEG–fMRI systems. The present technical note extends this work, describing in more detail how to construct the carbon fiber motion-detection loops, and how to interface them with a commercially available simultaneous EEG–fMRI system. We hope that the information provided may help those wishing to utilize a motion-detection/correction solution to improve the quality of EEG recorded within an MRI scanner. PMID:25601852

Timely disclosure of progress in long-term cancer survival: the boomerang method substantially improved estimates in a comparative study.

PubMed

Brenner, Hermann; Jansen, Lina

2016-02-01

Monitoring cancer survival is a key task of cancer registries, but timely disclosure of progress in long-term survival remains a challenge. We introduce and evaluate a novel method, denoted "boomerang method," for deriving more up-to-date estimates of long-term survival. We applied three established methods (cohort, complete, and period analysis) and the boomerang method to derive up-to-date 10-year relative survival of patients diagnosed with common solid cancers and hematological malignancies in the United States. Using the Surveillance, Epidemiology and End Results 9 database, we compared the most up-to-date age-specific estimates that might have been obtained with the database including patients diagnosed up to 2001 with 10-year survival later observed for patients diagnosed in 1997-2001. For cancers with little or no increase in survival over time, the various estimates of 10-year relative survival potentially available by the end of 2001 were generally rather similar. For malignancies with strongly increasing survival over time, including breast and prostate cancer and all hematological malignancies, the boomerang method provided estimates that were closest to later observed 10-year relative survival in 23 of the 34 groups assessed. The boomerang method can substantially improve up-to-dateness of long-term cancer survival estimates in times of ongoing improvement in prognosis. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed Central

2010-01-01

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

Online database for documenting clinical pathology resident education.

PubMed

Hoofnagle, Andrew N; Chou, David; Astion, Michael L

2007-01-01

Training of clinical pathologists is evolving and must now address the 6 core competencies described by the Accreditation Council for Graduate Medical Education (ACGME), which include patient care. A substantial portion of the patient care performed by the clinical pathology resident takes place while the resident is on call for the laboratory, a practice that provides the resident with clinical experience and assists the laboratory in providing quality service to clinicians in the hospital and surrounding community. Documenting the educational value of these on-call experiences and providing evidence of competence is difficult for residency directors. An online database of these calls, entered by residents and reviewed by faculty, would provide a mechanism for documenting and improving the education of clinical pathology residents. With Microsoft Access we developed an online database that uses active server pages and secure sockets layer encryption to document calls to the clinical pathology resident. Using the data collected, we evaluated the efficacy of 3 interventions aimed at improving resident education. The database facilitated the documentation of more than 4 700 calls in the first 21 months it was online, provided archived resident-generated data to assist in serving clients, and demonstrated that 2 interventions aimed at improving resident education were successful. We have developed a secure online database, accessible from any computer with Internet access, that can be used to easily document clinical pathology resident education and competency.

Stratospheric Aerosol--Observations, Processes, and Impact on Climate

NASA Technical Reports Server (NTRS)

Kresmer, Stefanie; Thomason, Larry W.; von Hobe, Marc; Hermann, Markus; Deshler, Terry; Timmreck, Claudia; Toohey, Matthew; Stenke, Andrea; Schwarz, Joshua P.; Weigel, Ralf;

Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the area of blood glucose and insulin concentrations.

PubMed

Martini, Daniela; Biasini, Beatrice; Zavaroni, Ivana; Bedogni, Giorgio; Musci, Marilena; Pruneti, Carlo; Passeri, Giovanni; Ventura, Marco; Galli, Daniela; Mirandola, Prisco; Vitale, Marco; Dei Cas, Alessandra; Bonadonna, Riccardo C; Del Rio, Daniele

2018-04-01

Most requests for authorization to bear health claims under Articles 13(5) and 14 related to blood glucose and insulin concentration/regulation presented to the European Food Safety Authority (EFSA) receive a negative opinion. Reasons for such decisions are mainly ascribable to poor substantiation of the claimed effects. In this scenario, a project was carried out aiming at critically analysing the outcome variables (OVs) and methods of measurement (MMs) to be used to substantiate health claims, with the final purpose to improve the quality of applications provided by stakeholders to EFSA. This manuscript provides a position statement of the experts involved in the project, reporting the results of an investigation aimed to collect, collate and critically analyse the information relevant to claimed effects (CEs), OVs and MMs related to blood glucose and insulin levels and homoeostasis compliant with Regulation 1924/2006. The critical analysis of OVs and MMs was performed with the aid of the pertinent scientific literature and was aimed at defining their appropriateness (alone or in combination with others) to support a specific CE. The results can be used to properly select OVs and MMs in a randomized controlled trial, for an effective substantiation of the claims, using the reference method(s) whenever available. Moreover, results can help EFSA in updating the guidance for the scientific requirements of health claims.

Patient satisfaction as a predictor of return-to-provider behavior: analysis and assessment of financial implications.

PubMed

Garman, Andrew N; Garcia, Joanne; Hargreaves, Marcia

2004-01-01

Although customer loyalty is frequently cited as a benefit of patient satisfaction, an empirical link between the two has not, to our knowledge, ever been statistically established in a hospital setting. The goal of the present study was to evaluate the relationship between self-reported patient satisfaction measures and subsequent return to the provider for care at a large academic medical center. Data from all adult medical patients responding to a patient satisfaction survey distributed by a large midwestern academic medical center during fiscal year 1997 (n = 1485) were analyzed. Response patterns were examined as they related to whether patients returned to the provider during the subsequent 2-year period. Analyses suggested that return-to-provider was associated with only a minority of the satisfaction items (approx. 11%). All items showing a significant relationship measured perceptions of how well physicians and nurses attended to, and provided information to, patients and their families. Although the size of these relationships was generally small, the estimated financial implications are substantial. Other implications of these findings for planning effective service improvement initiatives as well as improving patient survey design are discussed.

Maternal Health in Gujarat, India: A Case Study

PubMed Central

Vora, Kranti S.; Ramani, K.V.; Raman, Parvathy; Sharma, Bharati; Upadhyaya, Mudita

2009-01-01

Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness. PMID:19489418

Research Contributing to Improvements in Controlling Florida’s Mosquitoes and Mosquito-Borne Diseases

PubMed Central

Tabachnick, Walter J.

2016-01-01

Research on mosquitoes and mosquito-borne diseases has contributed to improvements in providing effective, efficient, and environmentally proper mosquito control. Florida has benefitted from several research accomplishments that have increased the state’s mosquito control capabilities. Research with Florida’s mosquitoes has resulted in the development of ecologically sound management of mosquito impoundments on Florida’s east coast. This strategy, called Rotational Impoundment Management (RIM), has improved the ability to target the delivery of pesticides and has helped to reduce non-target effects and environmental damage. Research has led to the development of an arbovirus surveillance system which includes sentinel chicken surveillance, real time use of environmental contributing factors like meteorology and hydrology to target mosquito control, as well as public health efforts to mitigate disease outbreaks to areas with risk of disease. These research driven improvements have provided substantial benefits to all of Florida. More research is needed to meet the future challenges to reduce emerging pathogens like Zika virus and the consequences of environmental changes like global climate change that are likely to influence the effects of mosquito-borne pathogens on human health and well-being. PMID:27690112

Comparing Binaural Pre-processing Strategies II: Speech Intelligibility of Bilateral Cochlear Implant Users.

PubMed

Baumgärtel, Regina M; Hu, Hongmei; Krawczyk-Becker, Martin; Marquardt, Daniel; Herzke, Tobias; Coleman, Graham; Adiloğlu, Kamil; Bomke, Katrin; Plotz, Karsten; Gerkmann, Timo; Doclo, Simon; Kollmeier, Birger; Hohmann, Volker; Dietz, Mathias

2015-12-30

Several binaural audio signal enhancement algorithms were evaluated with respect to their potential to improve speech intelligibility in noise for users of bilateral cochlear implants (CIs). 50% speech reception thresholds (SRT50) were assessed using an adaptive procedure in three distinct, realistic noise scenarios. All scenarios were highly nonstationary, complex, and included a significant amount of reverberation. Other aspects, such as the perfectly frontal target position, were idealized laboratory settings, allowing the algorithms to perform better than in corresponding real-world conditions. Eight bilaterally implanted CI users, wearing devices from three manufacturers, participated in the study. In all noise conditions, a substantial improvement in SRT50 compared to the unprocessed signal was observed for most of the algorithms tested, with the largest improvements generally provided by binaural minimum variance distortionless response (MVDR) beamforming algorithms. The largest overall improvement in speech intelligibility was achieved by an adaptive binaural MVDR in a spatially separated, single competing talker noise scenario. A no-pre-processing condition and adaptive differential microphones without a binaural link served as the two baseline conditions. SRT50 improvements provided by the binaural MVDR beamformers surpassed the performance of the adaptive differential microphones in most cases. Speech intelligibility improvements predicted by instrumental measures were shown to account for some but not all aspects of the perceptually obtained SRT50 improvements measured in bilaterally implanted CI users. © The Author(s) 2015.

Comparing Binaural Pre-processing Strategies II

PubMed Central

Hu, Hongmei; Krawczyk-Becker, Martin; Marquardt, Daniel; Herzke, Tobias; Coleman, Graham; Adiloğlu, Kamil; Bomke, Katrin; Plotz, Karsten; Gerkmann, Timo; Doclo, Simon; Kollmeier, Birger; Hohmann, Volker; Dietz, Mathias

2015-01-01

Several binaural audio signal enhancement algorithms were evaluated with respect to their potential to improve speech intelligibility in noise for users of bilateral cochlear implants (CIs). 50% speech reception thresholds (SRT50) were assessed using an adaptive procedure in three distinct, realistic noise scenarios. All scenarios were highly nonstationary, complex, and included a significant amount of reverberation. Other aspects, such as the perfectly frontal target position, were idealized laboratory settings, allowing the algorithms to perform better than in corresponding real-world conditions. Eight bilaterally implanted CI users, wearing devices from three manufacturers, participated in the study. In all noise conditions, a substantial improvement in SRT50 compared to the unprocessed signal was observed for most of the algorithms tested, with the largest improvements generally provided by binaural minimum variance distortionless response (MVDR) beamforming algorithms. The largest overall improvement in speech intelligibility was achieved by an adaptive binaural MVDR in a spatially separated, single competing talker noise scenario. A no-pre-processing condition and adaptive differential microphones without a binaural link served as the two baseline conditions. SRT50 improvements provided by the binaural MVDR beamformers surpassed the performance of the adaptive differential microphones in most cases. Speech intelligibility improvements predicted by instrumental measures were shown to account for some but not all aspects of the perceptually obtained SRT50 improvements measured in bilaterally implanted CI users. PMID:26721921

Caregivers as money managers for adults with severe mental illness: how treatment providers can help.

PubMed

Elbogen, Eric B; Wilder, Christine; Swartz, Marvin S; Swanson, Jeffrey W

2008-01-01

To review the prevalence, benefits, and problems associated with families who, either informally or formally as representative payees, manage money for adults with severe mental illness. Based on empirical research and clinical cases, suggestions are offered for minimizing downsides and capitalizing upon benefits of family money management. The findings and case vignettes demonstrate four specific strategies for treatment providers: facilitating collaboration, increasing knowledge about disability funds, improving money-management skills, and developing plans for financial decision-making. By following these recommendations and becoming aware of whether their clients had family money managers, clinicians can promote independent functioning and family support for a substantial number of people with severe mental illness.

Secure e-mailing between physicians and patients: transformational change in ambulatory care.

PubMed

Garrido, Terhilda; Meng, Di; Wang, Jian J; Palen, Ted E; Kanter, Michael H

2014-01-01

Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization.

Final Report, 2011-2014. Forecasting Carbon Storage as Eastern Forests Age. Joining Experimental and Modeling Approaches at the UMBS AmeriFlux Site

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

Curtis, Peter; Bohrer, Gil; Gough, Christopher

2015-03-12

At the University of Michigan Biological Station (UMBS) AmeriFlux sites (US-UMB and US-UMd), long-term C cycling measurements and a novel ecosystem-scale experiment are revealing physical, biological, and ecological mechanisms driving long-term trajectories of C cycling, providing new data for improving modeling forecasts of C storage in eastern forests. Our findings provide support for previously untested hypotheses that stand-level structural and biological properties constrain long-term trajectories of C storage, and that remotely sensed canopy structural parameters can substantially improve model forecasts of forest C storage. Through the Forest Accelerated Succession ExperimenT (FASET), we are directly testing the hypothesis that forest Cmore » storage will increase due to increasing structural and biological complexity of the emerging tree communities. Support from this project, 2011-2014, enabled us to incorporate novel physical and ecological mechanisms into ecological, meteorological, and hydrological models to improve forecasts of future forest C storage in response to disturbance, succession, and current and long-term climate variation« less

Perceptions of a medical microbiology service: a survey of laboratory users.

PubMed Central

Morgan, M S

1995-01-01

AIM--To ascertain the perception of laboratory users regarding the quality of the medical microbiology services in a district general hospital. METHODS--Detailed questionnaires were circulated to all clinicians in the locality, with headings covering the quality of medical advice provided, the availability of information on specimen collection, format of request forms, specimen transport arrangements, turnaround times, the quality and need for interpretative advice, and the overall impression of the quality of the services provided. RESULTS--Two hundred and thirty five replies were received, giving a response rate of 69%. Transportation of specimens and communication of reports were identified as priority areas for improvement. The overall quality of the service was perceived as satisfactory, although areas were identified where substantial improvements could be made, some at little or no cost to the laboratory. CONCLUSIONS--The survey focused clinicians' attention on the service, raised the profile of the laboratory, and resulted in improved communications and a better understanding of customer needs. Overall, the exercise was felt to be extremely useful, and worthwhile repeating to gauge the effect of the changes instituted as a result. PMID:8537489

Salvage reconstruction of failed interposition arthroplasty at the base of the thumb.

PubMed

Braun, Richard M; Rechnic, Mark; Shah, Kalpit N

2012-12-01

We present an operative procedure designed to revise a failed arthroplasty at the base of the thumb. This report describes a reliable operation that corrects residual instability and malignment which results in thumbs that are weak and painful despite a previous procedure. The operation has also been used as a primary procedure for arthritis of the trapeziometacarpal joint where instability and subluxation was a major component of the problem requiring joint reconstruction. The unique features of this procedure include a reinforced double-thickness tendon graft, a unique tendon anchor, and a fascia lata allograft spacer. Significant functional improvement is anticipated when joint reconstruction provides increased proximal stability. Pinch and grip measurements improve. Pain scores also diminish after the operation. Hand function and patient satisfaction can be substantially improved with revision arthroplasty when the initial operation has failed to provide a thumb that is mobile, stable, and pain free. The technical features of the procedure address reduction of malignment, restoring of anatomic balance, and secure fixation of the proximal apex of the thumb metacarpal which restores thumb reduction position and digital balance.

Assimilation of Satellite to Improve Cloud Simulation in Wrf Model

NASA Astrophysics Data System (ADS)

Park, Y. H.; Pour Biazar, A.; McNider, R. T.

2012-12-01

A simple approach has been introduced to improve cloud simulation spatially and temporally in a meteorological model. The first step for this approach is to use Geostationary Operational Environmental Satellite (GOES) observations to identify clouds and estimate the clouds structure. Then by comparing GOES observations to model cloud field, we identify areas in which model has under-predicted or over-predicted clouds. Next, by introducing subsidence in areas with over-prediction and lifting in areas with under-prediction, erroneous clouds are removed and new clouds are formed. The technique estimates a vertical velocity needed for the cloud correction and then uses a one dimensional variation schemes (1D_Var) to calculate the horizontal divergence components and the consequent horizontal wind components needed to sustain such vertical velocity. Finally, the new horizontal winds are provided as a nudging field to the model. This nudging provides the dynamical support needed to create/clear clouds in a sustainable manner. The technique was implemented and tested in the Weather Research and Forecast (WRF) Model and resulted in substantial improvement in model simulated clouds. Some of the results are presented here.

Ocean heat content estimation from in situ observations at the National Centers for Environmental Information: Improvements and Uncertainties

NASA Astrophysics Data System (ADS)

Boyer, T.; Locarnini, R. A.; Mishonov, A. V.; Reagan, J. R.; Seidov, D.; Zweng, M.; Levitus, S.

2017-12-01

Ocean heat uptake is the major factor in sequestering the Earth's Energy Imbalance (EEI). Since 2000, the National Centers for Environmental Information (NCEI) have been estimating historical ocean heat content (OHC) changes back to the 1950s, as well as monitoring recent OHC. Over these years, through worldwide community efforts, methods of calculating OHC have substantially improved. Similarly, estimation of the uncertainty of ocean heat content calculations provide new insight into how well EEI estimates can be constrained using in situ measurements and models. The changing ocean observing system, especially with the near-global year-round coverage afforded by Argo, has also allowed more confidence in regional and global OHC estimates and provided a benchmark for better understanding of historical OHC changes. NCEI is incorporating knowledge gained through these global efforts into the basic methods, instrument bias corrections, uncertainty measurements, and temporal and spatial resolution capabilities of historic OHC change estimation and recent monitoring. The nature of these improvements and their consequences for estimation of OHC in relation to the EEI will be discussed.

Estimating Evapotranspiration with Land Data Assimilation Systems

NASA Technical Reports Server (NTRS)

Peters-Lidard, C. D.; Kumar, S. V.; Mocko, D. M.; Tian, Y.

2011-01-01

Advancements in both land surface models (LSM) and land surface data assimilation, especially over the last decade, have substantially advanced the ability of land data assimilation systems (LDAS) to estimate evapotranspiration (ET). This article provides a historical perspective on international LSM intercomparison efforts and the development of LDAS systems, both of which have improved LSM ET skill. In addition, an assessment of ET estimates for current LDAS systems is provided along with current research that demonstrates improvement in LSM ET estimates due to assimilating satellite-based soil moisture products. Using the Ensemble Kalman Filter in the Land Information System, we assimilate both NASA and Land Parameter Retrieval Model (LPRM) soil moisture products into the Noah LSM Version 3.2 with the North American LDAS phase 2 (NLDAS-2) forcing to mimic the NLDAS-2 configuration. Through comparisons with two global reference ET products, one based on interpolated flux tower data and one from a new satellite ET algorithm, over the NLDAS2 domain, we demonstrate improvement in ET estimates only when assimilating the LPRM soil moisture product.

Hybrid Environmental Control System Integrated Modeling Trade Study Analysis for Commercial Aviation

NASA Astrophysics Data System (ADS)

Parrilla, Javier

Current industry trends demonstrate aircraft electrification will be part of future platforms in order to achieve higher levels of efficiency in various vehicle level sub-systems. However electrification requires a substantial change in aircraft design that is not suitable for re-winged or re-engined applications as some aircraft manufacturers are opting for today. Thermal limits arise as engine cores progressively get smaller and hotter to improve overall engine efficiency, while legacy systems still demand a substantial amount of pneumatic, hydraulic and electric power extraction. The environmental control system (ECS) provides pressurization, ventilation and air conditioning in commercial aircraft, making it the main heat sink for all aircraft loads with exception of the engine. To mitigate the architecture thermal limits in an efficient manner, the form in which the ECS interacts with the engine will have to be enhanced as to reduce the overall energy consumed and achieve an energy optimized solution. This study examines a tradeoff analysis of an electric ECS by use of a fully integrated Numerical Propulsion Simulation System (NPSS) model that is capable of studying the interaction between the ECS and the engine cycle deck. It was found that a peak solution lays in a hybrid ECS where it utilizes the correct balance between a traditional pneumatic and a fully electric system. This intermediate architecture offers a substantial improvement in aircraft fuel consumptions due to a reduced amount of waste heat and customer bleed in exchange for partial electrification of the air-conditions pack which is a viable option for re-winged applications.

Consumer food handling in the home: a review of food safety studies.

PubMed

Redmond, Elizabeth C; Griffith, Christopher J

2003-01-01

Epidemiological data from Europe, North America, Australia, and New Zealand indicate that a substantial proportion of foodborne disease is attributable to improper food preparation practices in consumers' homes. International concern about consumer food safety has prompted considerable research to evaluate domestic food-handling practices. The majority of consumer food safety studies in the last decade have been conducted in the United Kingdom and Northern Ireland (48%) and in the United States (42%). Surveys (questionnaires and interviews), the most frequent means of data collection, were used in 75% of the reviewed studies. Focus groups and observational studies have also been used. One consumer food safety study examined the relationship between pathogenic microbial contamination from raw chicken and observed food-handling behaviors, and the results of this study indicated extensive Campylobacter cross-contamination during food preparation sessions. Limited information about consumers' attitudes and intentions with regard to safe food-handling behaviors has been obtained, although a substantial amount of information about consumer knowledge and self-reported practices is available. Observation studies suggest that substantial numbers of consumers frequently implement unsafe food-handling practices. Knowledge, attitudes, intentions, and self-reported practices did not correspond to observed behaviors, suggesting that observational studies provide a more realistic indication of the food hygiene actions actually used in domestic food preparation. An improvement in consumer food-handling behavior is likely to reduce the risk and incidence of foodborne disease. The need for the development and implementation of food safety education strategies to improve specific food safety behaviors is reviewed in this paper.

Venous thromboembolism in medical outpatients - a cross-sectional survey of risk assessment and prophylaxis.

PubMed

Lawall, Holger; Matthiessen, Andreas; Hohmann, Volker; Bramlage, Peter; Haas, Sylvia; Schellong, Sebastian

2011-01-01

The degree of thromboprophylaxis in medical outpatients is low despite a substantial risk for venous thromboembolism (VTE). This may be attributable to difficulties in assessing risk. Assessment tools like the Haas' scorecard aid in determining the need for thromboprophylaxis. We aimed at evaluating how the use of this tool may aid physicians in appropriately using anticoagulants. This was an epidemiological, cross-sectional survey of acute medically ill patients with limited mobility treated by general practitioners and internists. Risk assessment for VTE by the treating physician was compared to calculated risk. Of 8,123 patients evaluated between August 2006 and April 2008, 7,271 fulfilled the in- and exclusion criteria. Mean age was 69.4 ± 13.6 years, and 45.2% were male. Of these 82.8% were high risk based on their acute medical condition, 37.9% based on their underlying chronic condition. Immobilisation, heart failure, pneumonia, age, obesity, and major varicosis were the most frequently encountered risk factors. The agreement between the Haas' scorecard and physician indicated risk was high. At least 94.1% of patients with high risk received adequate anticoagulation mostly as low molecular weight heparins for a mean duration of 15.1 ± 30.5 days. There is a substantial risk for VTE in medical outpatients. Using a simple structured scorecard resulted in an overall appropriate risk assessment and high degree of anticoagulation. The scorecard may provide a tool to improve the overall awareness for VTE risk in medical outpatients, substantially improving the degree of prophylaxis in a patient population with largely underestimated risk.

Estimating energy expenditure from heart rate in older adults: a case for calibration.

PubMed

Schrack, Jennifer A; Zipunnikov, Vadim; Goldsmith, Jeff; Bandeen-Roche, Karen; Crainiceanu, Ciprian M; Ferrucci, Luigi

2014-01-01

Accurate measurement of free-living energy expenditure is vital to understanding changes in energy metabolism with aging. The efficacy of heart rate as a surrogate for energy expenditure is rooted in the assumption of a linear function between heart rate and energy expenditure, but its validity and reliability in older adults remains unclear. To assess the validity and reliability of the linear function between heart rate and energy expenditure in older adults using different levels of calibration. Heart rate and energy expenditure were assessed across five levels of exertion in 290 adults participating in the Baltimore Longitudinal Study of Aging. Correlation and random effects regression analyses assessed the linearity of the relationship between heart rate and energy expenditure and cross-validation models assessed predictive performance. Heart rate and energy expenditure were highly correlated (r=0.98) and linear regardless of age or sex. Intra-person variability was low but inter-person variability was high, with substantial heterogeneity of the random intercept (s.d. =0.372) despite similar slopes. Cross-validation models indicated individual calibration data substantially improves accuracy predictions of energy expenditure from heart rate, reducing the potential for considerable measurement bias. Although using five calibration measures provided the greatest reduction in the standard deviation of prediction errors (1.08 kcals/min), substantial improvement was also noted with two (0.75 kcals/min). These findings indicate standard regression equations may be used to make population-level inferences when estimating energy expenditure from heart rate in older adults but caution should be exercised when making inferences at the individual level without proper calibration.

Grating angle magnification enhanced angular sensor and scanner

NASA Technical Reports Server (NTRS)

Sun, Ke-Xun (Inventor); Byer, Robert L. (Inventor)

2009-01-01

An angular magnification effect of diffraction is exploited to provide improved sensing and scanning. This effect is most pronounced for a normal or near-normal incidence angle in combination with a grazing diffraction angle, so such configurations are preferred. Angular sensitivity can be further enhanced because the width of the diffracted beam can be substantially less than the width of the incident beam. Normal incidence configurations with two symmetric diffracted beams are preferred, since rotation and vertical displacement can be readily distinguished. Increased sensitivity to vertical displacement can be provided by incorporating an interferometer into the measurement system. Quad cell detectors can be employed to provide sensitivity to rotation about the grating surface normal. A 2-D grating can be employed to provide sensitivity to angular displacements in two different planes (e.g., pitch and yaw). Combined systems can provide sensitivity to vertical displacement and to all three angular degrees of freedom.

Actual and desired information provision after a stroke.

PubMed

Wachters-Kaufmann, Cresje; Schuling, Jan; The, Hauw; Meyboom-de Jong, Betty

2005-02-01

Stroke patients and caregivers have a substantial information need. The study investigates how information was actually provided to stroke patients and caregivers and how they prefer to be informed. The GP, neurologist and physiotherapist are both the actual and desired information providers. The actual and desired information correspond in terms of content, frequency, and method of presentation. However, patients and caregivers prefer to receive information within 24 h and to be informed about, and be given, relevant written information. The information given by the various professional stroke care-providers could be better co-ordinated. The role of the GP as an information provider lagged quite a long way behind. Recommendations for the provision of an improved information system is given. Most of the subjects are relatively young male patients with few disabilities and healthy caregivers. More attention should be paid to encouraging patients and caregivers to actively seek information to supplement the information given by professional stroke care-providers.

Process for coal liquefaction employing selective coal feed

DOEpatents

Hoover, David S.; Givens, Edwin N.

1983-01-01

An improved coal liquefaction process is provided whereby coal conversion is improved and yields of pentane soluble liquefaction products are increased. In this process, selected feed coal is pulverized and slurried with a process derived solvent, passed through a preheater and one or more dissolvers in the presence of hydrogen-rich gases at elevated temperatures and pressures, following which solids, including mineral ash and unconverted coal macerals, are separated from the condensed reactor effluent. The selected feed coals comprise washed coals having a substantial amount of mineral matter, preferably from about 25-75%, by weight, based upon run-of-mine coal, removed with at least 1.0% by weight of pyritic sulfur remaining and exhibiting vitrinite reflectance of less than about 0.70%.

How changes to the Medicare Benefits Schedule could improve the practice of cardiology and save taxpayer money.

PubMed

Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya

2015-09-21

Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money.

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

PubMed Central

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

2012-01-01

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

Migrant Home Attendants: Regulation and Practice in 7 Countries

PubMed Central

Garms-Homolová, Vjenka; Bentwich, Miriam

2013-01-01

We compared regulation and working and living conditions of foreign home attendants in 7 countries (Canada, Germany, Israel, Singapore, Spain, United Kingdom, United States). We conducted a literature search in the PSYCinfo, MEDLINE, and Google Scholar databases for 2002 to 2012. We found substantial between-country differences in the legal status of migrant caregivers and regulations regarding working and living conditions and drew 3 conclusions. Improving regulations will likely improve not only the well-being of foreign home attendants but also the care they provide. Countries in which many foreign home attendants work without specific legal entry programs should rethink their policies. Finally, requiring an employer’s recommendation to obtain permanent residency may constrain foreign workers from registering complaints or leaving suboptimal employment situations. PMID:24134377

Simultaneous retrieval of atmospheric CO2 and light path modification from space-based spectroscopic observations of greenhouse gases: methodology and application to GOSAT measurements over TCCON sites.

PubMed

Oshchepkov, Sergey; Bril, Andrey; Yokota, Tatsuya; Yoshida, Yukio; Blumenstock, Thomas; Deutscher, Nicholas M; Dohe, Susanne; Macatangay, Ronald; Morino, Isamu; Notholt, Justus; Rettinger, Markus; Petri, Christof; Schneider, Matthias; Sussman, Ralf; Uchino, Osamu; Velazco, Voltaire; Wunch, Debra; Belikov, Dmitry

2013-02-20

This paper presents an improved photon path length probability density function method that permits simultaneous retrievals of column-average greenhouse gas mole fractions and light path modifications through the atmosphere when processing high-resolution radiance spectra acquired from space. We primarily describe the methodology and retrieval setup and then apply them to the processing of spectra measured by the Greenhouse gases Observing SATellite (GOSAT). We have demonstrated substantial improvements of the data processing with simultaneous carbon dioxide and light path retrievals and reasonable agreement of the satellite-based retrievals against ground-based Fourier transform spectrometer measurements provided by the Total Carbon Column Observing Network (TCCON).

Method and apparatus for controlling pitch and flap angles of a wind turbine

DOEpatents

Deering, Kenneth J [Seattle, WA; Wohlwend, Keith P [Issaquah, WA

2009-05-12

A wind turbine with improved response to wind conditions is provided. Blade flap angle motion is accompanied by a change in pitch angle by an amount defining a pitch/flap coupling ratio. The coupling ratio is non-constant as a function of a flap angle and is preferably a substantially continuous, non-linear function of flap angle. The non-constant coupling ratio can be provided by mechanical systems such as a series of linkages or by configuring electronic or other control systems and/or angle sensors. A link with a movable proximal end advantageously is part of the mechanical system. The system can provide relatively large coupling ratios and relatively large rates of coupling ratio changes especially for near-feather pitches and low flap angles.

Read/write head having a GMR sensor biased by permanent magnets located between the GMR and the pole shields

DOEpatents

Yuan, Samuel W.; Rottmayer, Robert Earl; Carey, Matthew J.

1999-01-01

A compact read/write head having a biased giant magnetoresistive sensor. Permanent magnet films are placed adjacent to the giant magnetoresistive sensor operating in the current-perpendicular-to the-plane (Cpp) mode and spaced with respect to the sensor by conducting films. These permanent magnet films provide a magnetic bias. The bias field is substantial and fairly uniform across sensor height. Biasing of the giant magnetoresistive sensor provides distinguishable response to the rising and falling edges of a recorded pulse on an adjacent recording medium, improves the linearity of the response, and helps to reduce noise. This read/write head is much simpler to fabricate and pattern and provides an enhanced uniformity of the bias field throughout the sensor.

Use of Web-based training for quality improvement between a field immunohistochemistry laboratory in Nigeria and its United States-based partner institution.

PubMed

Oluwasola, Abideen O; Malaka, David; Khramtsov, Andrey Ilyich; Ikpatt, Offiong Francis; Odetunde, Abayomi; Adeyanju, Oyinlolu Olorunsogo; Sveen, Walmy Elisabeth; Falusi, Adeyinka Gloria; Huo, Dezheng; Olopade, Olufunmilayo Ibironke

2013-12-01

The importance of hormone receptor status in assigning treatment and the potential use of human epidermal growth factor receptor 2 (HER2)-targeted therapy have made it beneficial for laboratories to improve detection techniques. Because interlaboratory variability in immunohistochemistry (IHC) tests may also affect studies of breast cancer subtypes in different countries, we undertook a Web-based quality improvement training and a comparative study of accuracy of immunohistochemical tests of breast cancer biomarkers between a well-established laboratory in the United States (University of Chicago) and a field laboratory in Ibadan, Nigeria. Two hundred and thirty-two breast tumor blocks were evaluated for estrogen receptors (ERs), progesterone receptors (PRs), and HER2 status at both laboratories using tissue microarray technique. Initially, concordance analysis revealed κ scores of 0.42 (moderate agreement) for ER, 0.41 (moderate agreement) for PR, and 0.39 (fair agreement) for HER2 between the 2 laboratories. Antigen retrieval techniques and scoring methods were identified as important reasons for discrepancy. Web-based conferences using Web conferencing tools such as Skype and WebEx were then held periodically to discuss IHC staining protocols and standard scoring systems and to resolve discrepant cases. After quality assurance and training, the agreement improved to 0.64 (substantial agreement) for ER, 0.60 (moderate agreement) for PR, and 0.75 (substantial agreement) for HER2. We found Web-based conferences and digital microscopy useful and cost-effective tools for quality assurance of IHC, consultation, and collaboration between distant laboratories. Quality improvement exercises in testing of tumor biomarkers will reduce misclassification in epidemiologic studies of breast cancer subtypes and provide much needed capacity building in resource-poor countries. © 2013.

A systems approach to improving rural care in Ethiopia.

PubMed

Bradley, Elizabeth H; Byam, Patrick; Alpern, Rachelle; Thompson, Jennifer W; Zerihun, Abraham; Abebe, Yigeremu; Abeb, Yigeremu; Curry, Leslie A

2012-01-01

Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. Effective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with government offices that oversee front-line providers, and committed community leadership to succeed.

Three-grid accelerator system for an ion propulsion engine

NASA Technical Reports Server (NTRS)

Brophy, John R. (Inventor)

1994-01-01

An apparatus is presented for an ion engine comprising a three-grid accelerator system with the decelerator grid biased negative of the beam plasma. This arrangement substantially reduces the charge-exchange ion current reaching the accelerator grid at high tank pressures, which minimizes erosion of the accelerator grid due to charge exchange ion sputtering, known to be the major accelerator grid wear mechanism. An improved method for life testing ion engines is also provided using the disclosed apparatus. In addition, the invention can also be applied in materials processing.

Blood Pressure Control

NASA Technical Reports Server (NTRS)

1992-01-01

Engineering Development Lab., Inc.'s E-2000 Neck Baro Reflex System was developed for cardiovascular studies of astronauts. It is regularly used on Space Shuttle Missions, and a parallel version has been developed as a research tool to facilitate studies of blood pressure reflex controls in patients with congestive heart failure, diabetes, etc. An advanced version, the PPC-1000, was developed in 1991, and the technology has been refined substantially. The PPC provides an accurate means of generating pressure for a broad array of laboratory applications. An improved version, the E2010 Barosystem, is anticipated.

Biomass fuels update. TVAs biomass fuels program

NASA Astrophysics Data System (ADS)

1982-02-01

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

Method Of Making Closed End Ceramic Fuel Cell Tubes

DOEpatents

Borglum, Brian P.

2002-04-30

A method of manufacturing closed end ceramic fuel cell tubes with improved properties and higher manufacturing yield is disclosed. The method involves bonding an unfired cap to a hollow unfired tube to form a compound joint. The assembly is then fired to net shape without subsequent machining. The resultant closed end tube is superior in that it provides a leak-tight seal and its porosity is substantially identical to that of the tube wall. The higher manufacturing yield associated with the present method decreases overall fuel cell cost significantly.

Enhancing intensity and refractive index sensing capability with infrared plasmonic perfect absorbers.

PubMed

Cheng, Fei; Yang, Xiaodong; Gao, Jie

2014-06-01

An infrared refractive index sensor based on plasmonic perfect absorbers for glucose concentration sensing is experimentally demonstrated. Utilizing substantial absorption contrast between a perfect absorber (∼98% at normal incidence) and a non-perfect absorber upon the refractive index change, a maximum value of figure of merit (FOM^*) about 55 and a bulk wavelength sensitivity about 590  nm/RIU are achieved. The demonstrated sensing platform provides great potential in improving the performance of plasmonic refractive index sensors and developing future surface enhanced infrared spectroscopy.

Artificial intelligence and deep learning - Radiology's next frontier?

PubMed

Mayo, Ray Cody; Leung, Jessica

Tracing the use of computers in the radiology department from administrative functions through image acquisition, storage, and reporting, to early attempts at improved diagnosis, we begin to imagine possible new frontiers for their use in exam interpretation. Given their initially slow but ultimately substantial progress in the noninterpretive areas, we are left desiring and even expecting more in the interpretation realm. New technological advances may provide the next wave of progress and radiologists should be early adopters. Several potential applications are discussed and hopefully will serve to inspire future progress. Published by Elsevier Inc.

Massage therapy for patients with metastatic cancer: a pilot randomized controlled trial.

PubMed

Toth, Maria; Marcantonio, Edward R; Davis, Roger B; Walton, Tracy; Kahn, Janet R; Phillips, Russell S

2013-07-01

The study objectives were to determine the feasibility and effects of providing therapeutic massage at home for patients with metastatic cancer. This was a randomized controlled trial. Patients were enrolled at Oncology Clinics at a large urban academic medical center; massage therapy was provided in patients' homes. Subjects were patients with metastatic cancer. There were three interventions: massage therapy, no-touch intervention, and usual care. Primary outcomes were pain, anxiety, and alertness; secondary outcomes were quality of life and sleep. In this study, it was possible to provide interventions for all patients at home by professional massage therapists. The mean number of massage therapy sessions per patient was 2.8. A significant improvement was found in the quality of life of the patients who received massage therapy after 1-week follow-up, which was not observed in either the No Touch control or the Usual Care control groups, but the difference was not sustained at 1 month. There were trends toward improvement in pain and sleep of the patients after therapeutic massage but not in patients in the control groups. There were no serious adverse events related to the interventions. The study results showed that it is feasible to provide therapeutic massage at home for patients with advanced cancer, and to randomize patients to a no-touch intervention. Providing therapeutic massage improves the quality of life at the end of life for patients and may be associated with further beneficial effects, such as improvement in pain and sleep quality. Larger randomized controlled trials are needed to substantiate these findings.

TH-AB-BRB-01: Trajectory Modulated Arc Therapy: Application to Partial Breast Irradiation

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

Hristov, D.

2016-06-15

Current state-of-the art digital C-arm medical linear accelerators are capable of delivering radiation treatments with high level of automation, which affords coordinated motions of gantry, couch, and multileaf collimator (MLC) with dose rate modulations. The new machine capacity has shown the potential to bring substantially improved radiation dosimetry and/or delivery efficiency to many challenging diseases. Combining an integrated beam orientation optimization algorithm with automated machine navigation, markedly improved dose conformity has been achieved using 4ρ therapy. Trajectory modulated radiation therapy (TMAT) can be used to deliver highly conformal dose to partial breast or to carve complex dose distribution for therapymore » involving extended volumes such as total marrow and total lymph node treatment. Dynamic electron arc radiotherapy (DEAR) not only overcomes the deficiencies of conventional electron therapy in dose conformity and homogeneity but also achieves so without patient-specific shields. The combination of MLC and couch tracking provides improved motion management of thoracic and abdominal tumors. A substantial body of work has been done in these technological advances for clinical translation. The proposed symposium will provide a timely review of these exciting opportunities. Learning Objectives: Recognize the potential of using digitally controlled linacs for clinically significant improvements in delivered dose distributions for various treatment sites. Identify existing approaches to treatment planning, optimization and delivery for treatment techniques utilizing the advanced functions of digital linacs and venues for further development and improvement. Understand methods for testing and validating delivery system performance. Identify tools available on current delivery systems for implementation and control for such treatments. Obtain the update in clinical applications, trials and regulatory approval. K. Sheng, NIH U19AI067769, NIH R43CA183390, NIH R01CA188300, Varian Medical Systems V. Yu, Varian Medical Systems, AAPM Summer Undergraduate Fellowship, NSF graduate fellowship S. Nill, Elekta AB. Cancer Research UK under Programme C33589/A19727, NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research.« less

The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes.

PubMed

Barto, Beth; Bartlett, Jessica Dym; Von Ende, Adam; Bodian, Ruth; Noroña, Carmen Rosa; Griffin, Jessica; Fraser, Jenifer Goldman; Kinniburgh, Kristine; Spinazzola, Joseph; Montagna, Crystaltina; Todd, Marybeth

2018-05-05

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery. Copyright © 2018 Elsevier Ltd. All rights reserved.

Improving the quality of EHR recording in primary care: a data quality feedback tool.

PubMed

van der Bij, Sjoukje; Khan, Nasra; Ten Veen, Petra; de Bakker, Dinny H; Verheij, Robert A

2017-01-01

Electronic health record (EHR) data are used to exchange information among health care providers. For this purpose, the quality of the data is essential. We developed a data quality feedback tool that evaluates differences in EHR data quality among practices and software packages as part of a larger intervention. The tool was applied in 92 practices in the Netherlands using different software packages. Practices received data quality feedback in 2010 and 2012. We observed large differences in the quality of recording. For example, the percentage of episodes of care that had a meaningful diagnostic code ranged from 30% to 100%. Differences were highly related to the software package. A year after the first measurement, the quality of recording had improved significantly and differences decreased, with 67% of the physicians indicating that they had actively changed their recording habits based on the results of the first measurement. About 80% found the feedback helpful in pinpointing recording problems. One of the software vendors made changes in functionality as a result of the feedback. Our EHR data quality feedback tool is capable of highlighting differences among practices and software packages. As such, it also stimulates improvements. As substantial variability in recording is related to the software package, our study strengthens the evidence that data quality can be improved substantially by standardizing the functionalities of EHR software packages. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Benefits and Sustainability of a Learning Collaborative for Implementation of Treat to Target in Rheumatoid Arthritis: Results of the TRACTION Trial Phase II.

PubMed

Solomon, Daniel H; Lu, Bing; Yu, Zhi; Corrigan, Cassandra; Harrold, Leslie R; Smolen, Josef S; Fraenkel, Liana; Katz, Jeffrey N; Losina, Elena

2018-01-05

We conducted a two-phase randomized controlled trial of a Learning Collaborative (LC) to facilitate implementation of treat to target (TTT) to manage rheumatoid arthritis (RA). We found substantial improvement in implementation of TTT in Phase I. Herein, we report on a second 9 months (Phase II) where we examined maintenance of response in Phase I and predictors of greater improvement in TTT adherence. We recruited 11 rheumatology sites and randomized them to either receive the LC during Phase I or to a wait-list control group that received the LC intervention during Phase II. The outcome was change in TTT implementation score (0 to 100, 100 is best) from pre- to post-intervention. TTT implementation score is defined as a percent of components documented in visit notes. Analyses examined: 1) the extent that the Phase I intervention teams sustained improvement in TTT; and, 2) predictors of TTT improvement. The analysis included 636 RA patients. At baseline, mean TTT implementation score was 11% in Phase I intervention sites and 13% in Phase II sites. After the intervention, TTT implementation score improved to 57% in the Phase I intervention sites and to 58% in the Phase II sites. Intervention sites from Phase I sustained the improvement during the Phase II (52%). Predictors of greater TTT improvement included only having rheumatologist providers at the site, academic affiliation of the site, fewer providers per site, and the rheumatologist provider being a trainee. Improvement in TTT remained relatively stable over a post-intervention period. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

ECM turnover-stimulated gene delivery through collagen-mimetic peptide-plasmid integration in collagen.

PubMed

Urello, Morgan A; Kiick, Kristi L; Sullivan, Millicent O

2017-10-15

Gene therapies have great potential in regenerative medicine; however, clinical translation has been inhibited by low stability and limited transfection efficiencies. Herein, we incorporate collagen-mimetic peptide (CMP)-linked polyplexes in collagen scaffolds to increase DNA stability by up to 400% and enable tailorable in vivo transgene expression at 100-fold higher levels and 10-fold longer time periods. These improvements were directly linked to a sustained interaction between collagen and polyplexes that persisted during cellular remodeling, polyplex uptake, and intracellular trafficking. Specifically, incorporation of CMPs into polyethylenimine (PEI) polyplexes preserved serum-exposed polyplex-collagen activity over a period of 14days, with 4 orders-of-magnitude more intact DNA present in CMP-modified polyplex-collagen relative to unmodified polyplex-collagen after a 10day incubation under cell culture conditions. CMP-modification also altered endocytic uptake, as indicated by gene silencing studies showing a nearly 50% decrease in transgene expression in response to caveolin-1 silencing in modified samples versus only 30% in unmodified samples. Furthermore, cellular internalization studies demonstrated that polyplex-collagen association persisted within cells in CMP polyplexes, but not in unmodified polyplexes, suggesting that CMP linkage to collagen regulates intracellular transport. Moreover, experiments in an in vivo repair model showed that CMP modification enabled tailoring of transgene expression from 4 to 25days over a range of concentrations. Overall, these findings demonstrate that CMP decoration provides substantial improvements in gene retention, altered release kinetics, improved serum-stability, and improved gene activity in vivo. This versatile technique has great potential for multiple applications in regenerative medicine. In this work, we demonstrate a novel approach for stably integrating DNA into collagen scaffolds to exploit the natural process of collagen remodelling for high efficiency non-viral gene delivery. The incorporation of CMPs into DNA polyplexes, coupled with the innate affinity between CMPs and collagen, not only permitted improved control over polyplex retention and release, but also provided a series of substantial and highly unique benefits via the stable and persistent linkage between CMP-polyplexes and collagen fragments. Specifically, CMP-modification of polyplexes was demonstrated to (i) control release for nearly a month, (ii) improve vector stability under physiological-like conditions, and (iii) provide ligands able to efficiently transfer genes via endocytic collagen pathways. These unique properties overcome key barriers inhibiting non-viral gene therapy. Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Increasing the Cryogenic Toughness of Steels

NASA Technical Reports Server (NTRS)

Rush, H. F.

1986-01-01

Grain-refining heat treatments increase toughness without substantial strength loss. Five alloys selected for study, all at or near technological limit. Results showed clearly grain sizes of these alloys refined by such heat treatments and grain refinement results in large improvement in toughness without substantial loss in strength. Best improvements seen in HP-9-4-20 Steel, at low-strength end of technological limit, and in Maraging 200, at high-strength end. These alloys, in grain refined condition, considered for model applications in high-Reynolds-number cryogenic wind tunnels.

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2013 CFR

2013-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2014 CFR

2014-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2011 CFR

2011-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2012 CFR

2012-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2010 CFR

2010-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

Structural barriers in the context of opiate substitution treatment in Germany - a survey among physicians in primary care

PubMed Central

2013-01-01

Background Opiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST. Methods An anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively. Results The response rate was 25,5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future. Conclusion Despite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration. PMID:23875627

Self-calibrated multiple-echo acquisition with radial trajectories using the conjugate gradient method (SMART-CG).

PubMed

Jung, Youngkyoo; Samsonov, Alexey A; Bydder, Mark; Block, Walter F

2011-04-01

To remove phase inconsistencies between multiple echoes, an algorithm using a radial acquisition to provide inherent phase and magnitude information for self correction was developed. The information also allows simultaneous support for parallel imaging for multiple coil acquisitions. Without a separate field map acquisition, a phase estimate from each echo in multiple echo train was generated. When using a multiple channel coil, magnitude and phase estimates from each echo provide in vivo coil sensitivities. An algorithm based on the conjugate gradient method uses these estimates to simultaneously remove phase inconsistencies between echoes, and in the case of multiple coil acquisition, simultaneously provides parallel imaging benefits. The algorithm is demonstrated on single channel, multiple channel, and undersampled data. Substantial image quality improvements were demonstrated. Signal dropouts were completely removed and undersampling artifacts were well suppressed. The suggested algorithm is able to remove phase cancellation and undersampling artifacts simultaneously and to improve image quality of multiecho radial imaging, the important technique for fast three-dimensional MRI data acquisition. Copyright © 2011 Wiley-Liss, Inc.

Self-calibrated Multiple-echo Acquisition with Radial Trajectories using the Conjugate Gradient Method (SMART-CG)

PubMed Central

Jung, Youngkyoo; Samsonov, Alexey A; Bydder, Mark; Block, Walter F.

2011-01-01

Purpose To remove phase inconsistencies between multiple echoes, an algorithm using a radial acquisition to provide inherent phase and magnitude information for self correction was developed. The information also allows simultaneous support for parallel imaging for multiple coil acquisitions. Materials and Methods Without a separate field map acquisition, a phase estimate from each echo in multiple echo train was generated. When using a multiple channel coil, magnitude and phase estimates from each echo provide in-vivo coil sensitivities. An algorithm based on the conjugate gradient method uses these estimates to simultaneously remove phase inconsistencies between echoes, and in the case of multiple coil acquisition, simultaneously provides parallel imaging benefits. The algorithm is demonstrated on single channel, multiple channel, and undersampled data. Results Substantial image quality improvements were demonstrated. Signal dropouts were completely removed and undersampling artifacts were well suppressed. Conclusion The suggested algorithm is able to remove phase cancellation and undersampling artifacts simultaneously and to improve image quality of multiecho radial imaging, the important technique for fast 3D MRI data acquisition. PMID:21448967

Study on real-time force feedback for a master-slave interventional surgical robotic system.

PubMed

Guo, Shuxiang; Wang, Yuan; Xiao, Nan; Li, Youxiang; Jiang, Yuhua

2018-04-13

In robot-assisted catheterization, haptic feedback is important, but is currently lacking. In addition, conventional interventional surgical robotic systems typically employ a master-slave architecture with an open-loop force feedback, which results in inaccurate control. We develop herein a novel real-time master-slave (RTMS) interventional surgical robotic system with a closed-loop force feedback that allows a surgeon to sense the true force during remote operation, provide adequate haptic feedback, and improve control accuracy in robot-assisted catheterization. As part of this system, we also design a unique master control handle that measures the true force felt by a surgeon, providing the basis for the closed-loop control of the entire system. We use theoretical and empirical methods to demonstrate that the proposed RTMS system provides a surgeon (using the master control handle) with a more accurate and realistic force sensation, which subsequently improves the precision of the master-slave manipulation. The experimental results show a substantial increase in the control accuracy of the force feedback and an increase in operational efficiency during surgery.

Assessing administrative costs of mental health and substance abuse services.

PubMed

Broyles, Robert W; Narine, Lutchmie; Robertson, Madeline J

2004-05-01

Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.

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

Jeffery, D.J.

This report considers a wide range of possible methods for improving the route guidance information available to drivers, and for saving up to L600M per year of national resource costs which are effectively wasted by drivers who fail to select optimum routes for unfamiliar journeys. The methods considered include improvements to maps and roadsigns, both of which could prove highly cost effective although they would leave some 80 per cent of the wastage unrecovered. A substantial proportion of this remaining wastage might be avoided with a Viewdata route planning and guidance scheme which could be achieved at relatively low costmore » to public funds, or with automatic systems. Of a range of automatic electronic guidance systems considered the most cost effective solution would be provided by a system which used buried loops to provide a two-way communication link between a roadside and a vehicle unit. Such a scheme would necessarily involve a considerable investment from public funds, but would offer the greatest potential for further development and, in particular, could provide the basis of a comprehensive traffic control tool.« less

75 FR 27504 - Substantial Product Hazard List: Hand-Held Hair Dryers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

...The Consumer Product Safety Improvement Act of 2008 (``CPSIA''), authorizes the United States Consumer Product Safety Commission (``Commission'') to specify, by rule, for any consumer product or class of consumer products, characteristics whose existence or absence shall be deemed a substantial product hazard under certain circumstances. In this document, the Commission is proposing a rule to determine that any hand-held hair dryer without integral immersion protection presents a substantial product hazard.

Quantifying the sources of variability in equine faecal egg counts: implications for improving the utility of the method.

PubMed

Denwood, M J; Love, S; Innocent, G T; Matthews, L; McKendrick, I J; Hillary, N; Smith, A; Reid, S W J

2012-08-13

The faecal egg count (FEC) is the most widely used means of quantifying the nematode burden of horses, and is frequently used in clinical practice to inform treatment and prevention. The statistical process underlying the FEC is complex, comprising a Poisson counting error process for each sample, compounded with an underlying continuous distribution of means between samples. Being able to quantify the sources of variability contributing to this distribution of means is a necessary step towards providing estimates of statistical power for future FEC and FECRT studies, and may help to improve the usefulness of the FEC technique by identifying and minimising unwanted sources of variability. Obtaining such estimates require a hierarchical statistical model coupled with repeated FEC observations from a single animal over a short period of time. Here, we use this approach to provide the first comparative estimate of multiple sources of within-horse FEC variability. The results demonstrate that a substantial proportion of the observed variation in FEC between horses occurs as a result of variation in FEC within an animal, with the major sources being aggregation of eggs within faeces and variation in egg concentration between faecal piles. The McMaster procedure itself is associated with a comparatively small coefficient of variation, and is therefore highly repeatable when a sufficiently large number of eggs are observed to reduce the error associated with the counting process. We conclude that the variation between samples taken from the same animal is substantial, but can be reduced through the use of larger homogenised faecal samples. Estimates are provided for the coefficient of variation (cv) associated with each within animal source of variability in observed FEC, allowing the usefulness of individual FEC to be quantified, and providing a basis for future FEC and FECRT studies. Copyright © 2012 Elsevier B.V. All rights reserved.

Future of the PCI Readmission Metric.

PubMed

Wasfy, Jason H; Yeh, Robert W

2016-03-01

Between 2013 and 2014, the Centers for Medicare and Medicaid Services and the National Cardiovascular Data Registry publically reported risk-adjusted 30-day readmission rates after percutaneous coronary intervention (PCI) as a pilot project. A key strength of this public reporting effort included risk adjustment with clinical rather than administrative data. Furthermore, because readmission after PCI is common, expensive, and preventable, this metric has substantial potential to improve quality and value in American cardiology care. Despite this, concerns about the metric exist. For example, few PCI readmissions are caused by procedural complications, limiting the extent to which improved procedural technique can reduce readmissions. Also, similar to other readmission measures, PCI readmission is associated with socioeconomic status and race. Accordingly, the metric may unfairly penalize hospitals that care for underserved patients. Perhaps in the context of these limitations, Centers for Medicare and Medicaid Services has not yet included PCI readmission among metrics that determine Medicare financial penalties. Nevertheless, provider organizations may still wish to focus on this metric to improve value for cardiology patients. PCI readmission is associated with low-risk chest discomfort and patient anxiety. Therefore, patient education, improved triage mechanisms, and improved care coordination offer opportunities to minimize PCI readmissions. Because PCI readmission is common and costly, reducing PCI readmission offers provider organizations a compelling target to improve the quality of care, and also performance in contracts involve shared financial risk. © 2016 American Heart Association, Inc.

30 CFR 700.5 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... substantial physical harm to persons, property, or the environment and to which persons or improvements on... substantially the quality of the environment, prevent or damage the beneficial use of land or water resources.... Reclamation activity means the reclamation, abatement, control, or prevention of adverse effects of past...

30 CFR 700.5 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... substantial physical harm to persons, property, or the environment and to which persons or improvements on... substantially the quality of the environment, prevent or damage the beneficial use of land or water resources.... Reclamation activity means the reclamation, abatement, control, or prevention of adverse effects of past...

Global Tsunami Warning System Development Since 2004

NASA Astrophysics Data System (ADS)

Weinstein, S.; Becker, N. C.; Wang, D.; Fryer, G. J.; McCreery, C.; Hirshorn, B. F.

2014-12-01

The 9.1 Mw Great Sumatra Earthquake of Dec. 26, 2004, generated the most destructive tsunami in history killing 227,000 people along Indian Ocean coastlines and was recorded by sea-level instruments world-wide. This tragedy showed the Indian Ocean needed a tsunami warning system to prevent another tragedy on this scale. The Great Sumatra Earthquake also highlighted the need for tsunami warning systems in other ocean basins. Instruments for recording earthquakes and sea-level data useful for tsunami monitoring did not exist outside of the Pacific Ocean in 2004. Seismometers were few in number, and even fewer were high-quality long period broadband instruments. Nor was much of their data made available to the US tsunami warning centers (TWCs). In 2004 the US TWCs relied exclusively on instrumentation provided and maintained by IRIS and the USGS for areas outside of the Pacific.Since 2004, the US TWCs and their partners have made substantial improvements to seismic and sea-level monitoring networks with the addition of new and better instruments, densification of existing networks, better communications infrastructure, and improved data sharing among tsunami warning centers. In particular, the number of sea-level stations transmitting data in near real-time and the amount of seismic data available to the tsunami warning centers has more than tripled. The DART network that consisted of a half-dozen Pacific stations in 2004 now totals nearly 60 stations worldwide. Earthquake and tsunami science has progressed as well. It took nearly three weeks to obtain the first reliable estimates of the 2004 Sumatra Earthquake's magnitude. Today, thanks to improved seismic networks and modern computing power, TWCs use the W-phase seismic moment method to determine accurate earthquake magnitudes and focal mechanisms for great earthquakes within 25 minutes. TWC scientists have also leveraged these modern computers to generate tsunami forecasts in a matter of minutes.Progress towards a global tsunami warning system has been substantial and today fully-functioning TWCs protect most of the world's coastlines. These improvements have also led to a substantial reduction of time required by the TWCs to detect, locate, and assess the tsunami threat from earthquakes occurring worldwide.

E-prescription as a tool for improving services and the financial viability of healthcare systems: the case of the Greek national e-prescription system.

PubMed

Pangalos, G; Sfyroeras, V; Pagkalos, I

2014-01-01

E-prescription systems can help improve patient service, safety and quality of care. They can also help achieve better compliance for the patients and better alignment with the guidelines for the practitioners. The recently implemented national e-prescription system in Greece already covers approximately 85% of all prescriptions prescribed in Greece today (approximately 5.5 million per month). The system has not only contributed already in significant changes towards improving services and better monitoring and planning of public health, but also substantially helped to contain unnecessary expenditure related to medication use and improve transparency and administrative control. Such issues have gained increasing importance not only for Greece but also for many other national healthcare systems that have to cope with the continuous rise of medication expenditure. Our implementation has, therefore, shown that besides their importance for improving services, national e-prescription systems can also provide a valuable tool for better utilisation of resources and for containing unnecessary healthcare costs, thus contributing to the improvement of the financial stability and viability of the overall healthcare system.

Stigma Reduction Training Improves Healthcare Provider Attitudes Toward, and Experiences of, Young Marginalized People in Bangladesh.

PubMed

Geibel, Scott; Hossain, Sharif M I; Pulerwitz, Julie; Sultana, Nargis; Hossain, Tarik; Roy, Shongkour; Burnett-Zieman, Brady; Stackpool-Moore, Lucy; Friedland, Barbara A; Yasmin, Reena; Sadiq, Najmus; Yam, Eileen

2017-02-01

Working with health providers to reduce HIV stigma in the healthcare setting is an important strategy to improve service utilization and quality of care, especially for young people who are sexually active before marriage, are sexual minorities, or who sell sex. A stigma reduction training program for health providers in Bangladesh was evaluated. A cohort of 300 healthcare providers were given a self-administered questionnaire, then attended a 2-day HIV and sexual and reproductive health and rights training (including a 90-minute session on stigma issues). Six months later, the cohort repeated the survey and participated in a 1-day supplemental training on stigma, which included reflection on personal values and negative impacts of stigma. A third survey was administered 6 months later. A cross-sectional survey of clients age 15-24 years was implemented before and after the second stigma training to assess client satisfaction with services. Provider agreement that people living with HIV should be ashamed of themselves decreased substantially (35.3%-19.7%-16.3%; p < .001), as did agreement that sexually active young people (50.3%-36.0%-21.7%; p < .001) and men who have sex with men (49.3%-38.0%-24.0%; p < .001) engage in "immoral behavior." Young clients reported improvement in overall satisfaction with services after the stigma trainings (63.5%-97.6%; p < .001). This study indicates that a targeted stigma reduction intervention can rapidly improve provider attitudes and increase service satisfaction among young people. More funding to scale up these interventions is needed. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

76 FR 69330 - Proposed Collection; Comment Request for Regulation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... collection requirements related to substantiation and reporting requirements for cash and noncash charitable...: Substantiation and Reporting Requirements for Cash and Noncash Charitable Contribution Deductions. OMB Number... provide guidance concerning substantiation and reporting requirements for cash and noncash charitable...

Vinblastine 20' Amides: Synthetic Analogues That Maintain or Improve Potency and Simultaneously Overcome Pgp-Derived Efflux and Resistance.

PubMed

Lukesh, John C; Carney, Daniel W; Dong, Huijun; Cross, R Matthew; Shukla, Vyom; Duncan, Katharine K; Yang, Shouliang; Brody, Daniel M; Brütsch, Manuela M; Radakovic, Aleksandar; Boger, Dale L

2017-09-14

A series of 180 vinblastine 20' amides were prepared in three steps from commercially available starting materials, systematically exploring a typically inaccessible site in the molecule enlisting a powerful functionalization strategy. Clear structure-activity relationships and a structural model were developed in the studies which provided many such 20' amides that exhibit substantial and some even remarkable enhancements in potency, many that exhibit further improvements in activity against a Pgp overexpressing resistant cancer cell line, and an important subset of the vinblastine analogues that display little or no differential in activity against a matched pair of vinblastine sensitive and resistant (Pgp overexpressing) cell lines. The improvements in potency directly correlated with target tubulin binding affinity, and the reduction in differential functional activity against the sensitive and Pgp overexpressing resistant cell lines was found to correlate directly with an impact on Pgp-derived efflux.

Dose Adjustment for Normal Eating: A Role for the Expert Patient?

PubMed Central

2014-01-01

The Dose Adjustment for Normal Eating (DAFNE) programme of intensive insulin therapy for type 1 diabetes provides a structured educational intervention to improve glycemic control, reduce hypoglycemia and improve quality of life. Enhancement of self-management skills is a key element of DAFNE and patients acquire detailed skills in insulin dose adjustment. Following DAFNE training, patients report improved confidence in their ability to manage their own insulin dosing, but generally still seek and require the assistance of health professionals when making substantial changes to their insulin regimens. Some DAFNE trained patients may be able to assist their peers in aspects of diabetes management within a group environment, but widespread introduction of the expert patient/peer educator role in the self-management of type 1 diabetes, in particular related to insulin dose management, would require formal and detailed evaluation, preferably in randomized controlled clinical trials, before being introduced into routine clinical practice. PMID:24851201

Test Activities in the Langley Transonic Dynamics Tunnel and a Summary of Recent Facility Improvements

NASA Technical Reports Server (NTRS)

Cole, Stanley R.; Johnson, R. Keith; Piatak, David J.; Florance, Jennifer P.; Rivera, Jose A., Jr.

2003-01-01

The Langley Transonic Dynamics Tunnel (TDT) has provided a unique capability for aeroelastic testing for over forty years. The facility has a rich history of significant contributions to the design of many United States commercial transports, military aircraft, launch vehicles, and spacecraft. The facility has many features that contribute to its uniqueness for aeroelasticity testing, perhaps the most important feature being the use of a heavy gas test medium to achieve higher test densities compared to testing in air. Higher test medium densities substantially improve model-building requirements and therefore simplify the fabrication process for building aeroelastically scaled wind tunnel models. This paper describes TDT capabilities that make it particularly suited for aeroelasticity testing. The paper also discusses the nature of recent test activities in the TDT, including summaries of several specific tests. Finally, the paper documents recent facility improvement projects and the continuous statistical quality assessment effort for the TDT.

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

PubMed

Murman, D L

2001-01-01

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

Development of an Inhaled Dry-Powder Formulation of Tobramycin Using PulmoSphere™ Technology

PubMed Central

Weers, Jeffry; Heuerding, Silvia

2011-01-01

Abstract At present, the only approved inhaled antipseudomonal antibiotics for chronic pulmonary infections in patients with cystic fibrosis (CF) are nebulized solutions. However, prolonged administration and cleaning times, high administration frequency, and cumbersome delivery technologies with nebulizers add to the high treatment burden in this patient population. PulmoSphere™ technology is an emulsion-based spray-drying process that enables the production of light porous particle, dry-powder formulations, which exhibit improved flow and dispersion from passive dry powder inhalers. This review explores the fundamental characteristics of PulmoSphere technology, focusing on the development of a dry powder formulation of tobramycin for the treatment of chronic pulmonary Pseudomonas aeruginosa (Pa) infection in CF patients. This dry powder formulation provides substantially improved intrapulmonary deposition efficiency, faster delivery, and more convenient administration over nebulized formulations. The availability of more efficient and convenient treatment options may improve treatment compliance, and thereby therapeutic outcomes in CF. PMID:21395432

Management of melanoma brain metastases in the era of targeted therapy.

PubMed

Shapiro, Daniela Gonsalves; Samlowski, Wolfram E

2011-01-01

Disseminated metastatic disease, including brain metastases, is commonly encountered in malignant melanoma. The classical treatment approach for melanoma brain metastases has been neurosurgical resection followed by whole brain radiotherapy. Traditionally, if lesions were either too numerous or surgical intervention would cause substantial neurologic deficits, patients were either treated with whole brain radiotherapy or referred to hospice and supportive care. Chemotherapy has not proven effective in treating brain metastases. Improvements in surgery, radiosurgery, and new drug discoveries have provided a wider range of treatment options. Additionally, recently discovered mutations in the melanoma genome have led to the development of "targeted therapy." These vastly improved options are resulting in novel treatment paradigms for approaching melanoma brain metastases in patients with and without systemic metastatic disease. It is therefore likely that improved survival can currently be achieved in at least a subset of melanoma patients with brain metastases.

Procedural techniques in sacral nerve modulation.

PubMed

Williams, Elizabeth R; Siegel, Steven W

2010-12-01

Sacral neuromodulation involves a staged process, including a screening trial and delayed formal implantation for those with substantial improvement. The advent of the tined lead has revolutionized the technology, allowing for a minimally invasive outpatient procedure to be performed under intravenous sedation. With the addition of fluoroscopy to the bilateral percutaneous nerve evaluation, there has been marked improvement in the placement of these temporary leads. Thus, the screening evaluation is now a better reflection of possible permanent improvement. Both methods of screening have advantages and disadvantages. Selection of a particular procedure should be tailored to individual patient characteristics. Subsequent implantation of the internal pulse generator (IPG) or explantation of an unsuccessful staged lead is straightforward outpatient procedure, providing minimal additional risk for the patient. Future refinement to the procedure may involve the introduction of a rechargeable battery, eliminating the need for IPG replacement at the end of the battery life.

A model for evaluating academic research centers: Case study of the Asian/Pacific Islander Youth Violence Prevention Center.

PubMed

Nishimura, Stephanie T; Hishinuma, Earl S; Goebert, Deborah A; Onoye, Jane M M; Sugimoto-Matsuda, Jeanelle J

2018-02-01

To provide one model for evaluating academic research centers, given their vital role in addressing public health issues. A theoretical framework is described for a comprehensive evaluation plan for research centers. This framework is applied to one specific center by describing the center's Logic Model and Evaluation Plan, including a sample of the center's activities. Formative and summative evaluation information is summarized. In addition, a summary of outcomes is provided: improved practice and policy; reduction of risk factors and increase in protective factors; reduction of interpersonal youth violence in the community; and national prototype for prevention of interpersonal youth violence. Research centers are important mechanisms to advance science and improve people's quality of life. Because of their more infrastructure-intensive and comprehensive approach, they also require substantial resources for success, and thus, also require careful accountability. It is therefore important to comprehensively evaluate these centers. As provided herein, a more systematic and structured approach utilizing logic models, an evaluation plan, and successful processes can provide research centers with a functionally useful method in their evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Reactivity of sulfide-containing silane toward boehmite and in situ modified rubber/boehmite composites by the silane

NASA Astrophysics Data System (ADS)

Lin, Tengfei; Zhu, Lixin; Chen, Weiwei; Wu, Siwu; Guo, Baochun; Jia, Demin

2013-09-01

The silanization reaction between boehmite (BM) nanoplatelets and bis-[3-(triethoxysilyl)-propyl]-tetrasulfide (TESPT) was characterized in detail. Via such modification process, the grafted sulfide moieties on the BM endow reactivity toward rubber and substantially improved hydrophobicity for BM. Accordingly, TESPT was employed as in situ modifier for the nitrile rubber (NBR)/BM compounds to improve the mechanical properties of the reinforced vulcanizates. The effects of BM content and in situ modification on the mechanical properties, curing characteristics and morphology were investigated. BM was found to be effective in improving the mechanical performance of NBR vulcanizates. The NBR/BM composites could be further strengthened by the incorporation of TESPT. The interfacial adhesion of NBR/BM composites was obviously improved by the addition of TESPT. The substantially improved mechanical performance was correlated to the interfacial reaction and the improved dispersion of BM in rubber matrix.

Enhancing Communication in Adults with Dementia and Age-Related Hearing Loss

PubMed Central

Mamo, Sara K.; Oh, Esther; Lin, Frank R.

2017-01-01

For many adults with dementia, age-related hearing loss is undiagnosed and/or untreated. Untreated hearing loss can exacerbate common dementia-related behavioral symptoms, such as depression, apathy, agitation. Despite the potential benefits to the individual and the family, pursuing and adopting hearing aids for persons with dementia presents with many challenges. As such, this group of vulnerable older adults is well suited for alternative approaches that adopt an interventional audiology framework. This article reviews alternative hearing care models that we have tested when working with older adults with cognitive impairments. We have found that some individuals show improvements in dementia-related problem behaviors and/or in measures of social engagement after brief aural rehabilitation interventions that provide non-custom amplification. We have developed simple training materials to help family and professional caregivers use communication strategies and non-custom amplification. Providing services that can be integrated into the person's broader dementia care has the potential to improve communication and quality of life for individuals and families. There are opportunities in this population to provide basic, simple strategies and make substantial improvements as long as we adopt approaches that bring the services to the people, instead of bringing the people to us in the audiology clinic. PMID:28522892

Heat regenerative external combustion engine

NASA Astrophysics Data System (ADS)

Duva, Anthony W.

1993-03-01

It is an object of the invention to provide an external combustion expander-type engine having improved efficiency. It is another object of the invention to provide an external combustion engine in which afterburning in the exhaust channel is substantially prevented. Yet another object of the invention is to provide an external combustion engine which is less noisy than an external combustion engine of conventional design. These and other objects of the invention will become more apparent from the following description. The above objects of the invention are realized by providing a heat regenerative external combustion engine. The heat regenerative external combustion engine of the invention comprises a combustion chamber for combusting a monopropellant fuel in order to form an energized gas. The energized gas is then passed through a rotary valve to a cylinder having a reciprocating piston disposed therein. The gas is spent in moving the piston, thereby driving a drive shaft.

7 CFR 1710.112 - Loan feasibility.

Code of Federal Regulations, 2011 CFR

2011-01-01

... other energy sources to prevent substantial load loss while providing satisfactory service to its consumers. (4) Risks of possible loss of substantial loads from large consumers or from load concentrations in particular industries will not substantially impair loan feasibility. (5) Risks of loss of...

7 CFR 1710.112 - Loan feasibility.

Code of Federal Regulations, 2012 CFR

2012-01-01

... other energy sources to prevent substantial load loss while providing satisfactory service to its consumers. (4) Risks of possible loss of substantial loads from large consumers or from load concentrations in particular industries will not substantially impair loan feasibility. (5) Risks of loss of...

7 CFR 1710.112 - Loan feasibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... other energy sources to prevent substantial load loss while providing satisfactory service to its consumers. (4) Risks of possible loss of substantial loads from large consumers or from load concentrations in particular industries will not substantially impair loan feasibility. (5) Risks of loss of...

7 CFR 1710.112 - Loan feasibility.

Code of Federal Regulations, 2013 CFR

2013-01-01

... other energy sources to prevent substantial load loss while providing satisfactory service to its consumers. (4) Risks of possible loss of substantial loads from large consumers or from load concentrations in particular industries will not substantially impair loan feasibility. (5) Risks of loss of...

7 CFR 1710.112 - Loan feasibility.

Code of Federal Regulations, 2014 CFR

2014-01-01

... other energy sources to prevent substantial load loss while providing satisfactory service to its consumers. (4) Risks of possible loss of substantial loads from large consumers or from load concentrations in particular industries will not substantially impair loan feasibility. (5) Risks of loss of...

[Technical advancements in cochlear implants : State of the art].

PubMed

Büchner, A; Gärtner, L

2017-04-01

Twenty years ago, cochlear implants (CI) were indicated only in cases of profound hearing loss or complete deafness. While from today's perspective the technology was clumsy and provided patients with only limited speech comprehension in quiet scenarios, successive advances in CI technology and the consequent substantial hearing improvements over time have since then resulted in continuous relaxation of indication criteria toward residual hearing. While achievements in implant and processor electronics have been one key factor for the ever-improving hearing performance, development of electro-acoustic CI systems-together with atraumatic implantation concepts-has led to enormous improvements in patients with low-frequency residual hearing. Manufactures have designed special processors with integrated hearing aid components for this patient group, which are capable of conveying acoustic and electric stimulation. A further milestone in improvement of hearing in challenging listening environments was the adoption of signal enhancement algorithms and assistive listening devices from the hearing aid industry. This article gives an overview of the current state of the art in the abovementioned areas of CI technology.

Improving Medication Adherence in Cardiometabolic Disease

PubMed Central

Ferdinand, Keith C.; Senatore, Fortunato Fred; Clayton-Jeter, Helene; Cryer, Dennis R.; Lewin, John C.; Nasser, Samar A.; Fiuzat, Mona; Califf, Robert M.

2017-01-01

Medication nonadherence, a major problem in cardiovascular disease (CVD), contributes yearly to approximately 125,000 preventable deaths, which is partly attributable to only about one-half of CVD patients consistently taking prescribed life-saving medications. Current interest has focused on how labeling and education influence adherence. This paper summarizes the scope of CVD nonadherence, describes key U.S. Food and Drug Administration initiatives, and identifies potential targets for improvement. We describe key adherence factors, methods, and technological applications for simplifying regimens and enhancing adherence, and 4 areas where additional collaborative research and implementation involving the regulatory system and clinical community could substantially reduce nonadherence: 1) identifying monitoring methods; 2) improving the evidence base to better understand adherence; 3) developing patient/health provider team-based engagement strategies; and 4) alleviating health disparities. Alignment of U.S. Food and Drug Administration approaches to dissemination of information about appropriate use with clinical practice could improve adherence, and thereby reduce CVD death and disability. PMID:28126162

Hospital inpatient prospective payment system: incorporating new technology.

PubMed

Durthaler, Jeffrey M; Miller, Alicia

2003-11-01

New technologies in the impatient prospective payment system are discussed. On December 21, 2000, Congress passed Public Law 106-554 that includes a requirement to establish a mechanism to more expeditiously incorporate the costs and establish qualifying criteria for payment of new services and technologies into the hospital inpatient prospective payment system. The final ruling of this law states that a new service or technology must demonstrate substantial improvement, be inadequately paid under the DRG system, and be "new." The intent of these criteria is to identify new technologies that offer substantial improvement over existing technologies and to provide supplemental payment that encourages physicians and hospitals to utilize the new technology. In November 2001, drotrecogin alfa (activated) received fast-track FDA approval because of the robust findings from the PROWESS trial. Drotrecogin alfa (activated) is the first agent proven to reduce mortality in patients suffering from severe sepsis associated with acute organ dysfunction who are at a high risk of death (i.e., APACHE II score > 24). In August 2002, drotrecogin alfa (activated) was one of four such new technologies and the first agent approved for new technology payment under the prospective payment system (PPS). This decision offers confidence that the PPS is effectively striving to incorporate new medical services and technologies at a pace similar to that of innovation. Providers may receive up to $3400 in additional reimbursement when drotrecogin alfa (activated) is administered in the Medicare population. Pharmacy and patient accounting personnel should develop a collaborative process to identify, document, and capture this new source of payment.

Improving data retention in EEG research with children using child-centered eye tracking

PubMed Central

Maguire, Mandy J.; Magnon, Grant; Fitzhugh, Anna E.

2014-01-01

Background Event Related Potentials (ERPs) elicited by visual stimuli have increased our understanding of developmental disorders and adult cognitive abilities for decades; however, these studies are very difficult with populations who cannot sustain visual attention such as infants and young children. Current methods for studying such populations include requiring a button response, which may be impossible for some participants, and experimenter monitoring, which is subject to error, highly variable, and spatially imprecise. New Method We developed a child-centered methodology to integrate EEG data acquisition and eye-tracking technologies that uses “attention-getters” in which stimulus display is contingent upon the child’s gaze. The goal was to increase the number of trials retained. Additionally, we used the eye-tracker to categorize and analyze the EEG data based on gaze to specific areas of the visual display, compared to analyzing based on stimulus presentation. Results Compared with Existing Methods The number of trials retained was substantially improved using the child-centered methodology compared to a button-press response in 7–8 year olds. In contrast, analyzing the EEG based on eye gaze to specific points within the visual display as opposed to stimulus presentation provided too few trials for reliable interpretation. Conclusions By using the linked EEG-eye-tracker we significantly increased data retention. With this method, studies can be completed with fewer participants and a wider range of populations. However, caution should be used when epoching based on participants’ eye gaze because, in this case, this technique provided substantially fewer trials. PMID:25251555

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus.

PubMed

Fitzgerald, Rebecca C; di Pietro, Massimiliano; Ragunath, Krish; Ang, Yeng; Kang, Jin-Yong; Watson, Peter; Trudgill, Nigel; Patel, Praful; Kaye, Philip V; Sanders, Scott; O'Donovan, Maria; Bird-Lieberman, Elizabeth; Bhandari, Pradeep; Jankowski, Janusz A; Attwood, Stephen; Parsons, Simon L; Loft, Duncan; Lagergren, Jesper; Moayyedi, Paul; Lyratzopoulos, Georgios; de Caestecker, John

2014-01-01

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.

A multidisciplinary-based conceptual model of a fractured sedimentary bedrock aquitard: improved prediction of aquitard integrity

NASA Astrophysics Data System (ADS)

Runkel, Anthony C.; Tipping, Robert G.; Meyer, Jessica R.; Steenberg, Julia R.; Retzler, Andrew J.; Parker, Beth L.; Green, Jeff A.; Barry, John D.; Jones, Perry M.

2018-06-01

A hydrogeologic conceptual model that improves understanding of variability in aquitard integrity is presented for a fractured sedimentary bedrock unit in the Cambrian-Ordovician aquifer system of midcontinent North America. The model is derived from multiple studies on the siliciclastic St. Lawrence Formation and adjacent strata across a range of scales and geologic conditions. These studies employed multidisciplinary techniques including borehole flowmeter logging, high-resolution depth-discrete multilevel well monitoring, fracture stratigraphy, fluorescent dye tracing, and three-dimensional (3D) distribution of anthropogenic tracers regionally. The paper documents a bulk aquitard that is highly anisotropic because of poor connectivity of vertical fractures across matrix with low permeability, but with ubiquitous bed parallel partings. The partings provide high bulk horizontal hydraulic conductivity, analogous to aquifers in the system, while multiple preferential termination horizons of vertical fractures serve as discrete low vertical hydraulic conductivity intervals inhibiting vertical flow. The aquitard has substantial variability in its ability to protect underlying groundwater from contamination. Across widespread areas where the aquitard is deeply buried by younger bedrock, preferential termination horizons provide for high aquitard integrity (i.e. protection). Protection is diminished close to incised valleys where stress release and weathering has enhanced secondary pore development, including better connection of fractures across these horizons. These conditions, along with higher hydraulic head gradients in the same areas and more complex 3D flow where the aquitard is variably incised, allow for more substantial transport to deeper aquifers. The conceptual model likely applies to other fractured sedimentary bedrock aquitards within and outside of this region.

TRMM Version 7 Near-Realtime Data Products

NASA Technical Reports Server (NTRS)

Tocker, Erich Franz; Kelley, Owen

2012-01-01

The TRMM data system has been providing near-realtime data products to the community since late 1999. While the TRMM project never had near-realtime production requirements, the science and applications communities had a great interest in receiving TRMM data as quickly as possible. As a result these NRT data are provided under a best-effort scenario but with the objective of having the swath data products available within three hours of data collection 90% of the time. In July of 2011 the Joint Precipitation Measurement Missions Science Team (JPST) authorized the reprocessing of TRMM mission data using the new version 7 algorithms. The reprocessing of the 14+ years of the mission was concluded within 30 days. Version 7 algorithms had substantial changes in the data product file formats both for data and metadata. In addition, the algorithms themselves had major modifications and improvements. The general approach to versioning up the NRT is to wait for the regular production algorithms to have run for a while and shake out any issues that might arise from the new version before updating the NRT products. Because of the substantial changes in data/metadata formats as well as the algorithm improvements themselves, the update of NRT to V7 followed an even more conservative path than usual. This was done to ensure that applications agencies and other users of the TRMM NRT would not be faces with short-timeframes for conversion to the new format. This paper will describe the process by which the TRMM NRT was updated to V7 and the V7 data products themselves.

Vehicular impact absorption system

NASA Technical Reports Server (NTRS)

Knoell, A. C.; Wilson, A. H. (Inventor)

1978-01-01

An improved vehicular impact absorption system characterized by a plurality of aligned crash cushions of substantially cubic configuration is described. Each consists of a plurality of voided aluminum beverage cans arranged in substantial parallelism within a plurality of superimposed tiers and a covering envelope formed of metal hardware cloth. A plurality of cables is extended through the cushions in substantial parallelism with an axis of alignment for the cushions adapted to be anchored at each of the opposite end thereof.

Fusion of Synthetic and Enhanced Vision for All-Weather Commercial Aviation Operations

NASA Technical Reports Server (NTRS)

Bailey, Randall E.; Kramer, Lynda J.; Prinzel, Lawrence, III

2007-01-01

NASA is developing revolutionary crew-vehicle interface technologies that strive to proactively overcome aircraft safety barriers that would otherwise constrain the full realization of the next-generation air transportation system. A piloted simulation experiment was conducted to evaluate the complementary use of Synthetic and Enhanced Vision technologies. Specific focus was placed on new techniques for integration and/or fusion of Enhanced and Synthetic Vision and its impact within a two-crew flight deck during low visibility approach and landing operations. Overall, the experimental data showed that significant improvements in situation awareness, without concomitant increases in workload and display clutter, could be provided by the integration and/or fusion of synthetic and enhanced vision technologies for the pilot-flying and the pilot-not-flying. During non-normal operations, the ability of the crew to handle substantial navigational errors and runway incursions were not adversely impacted by the display concepts although the addition of Enhanced Vision did not, unto itself, provide an improvement in runway incursion detection.

Assessing the efficacy of the Measure of Understanding of Macroevolution as a valid tool for undergraduate non-science majors

NASA Astrophysics Data System (ADS)

Romine, William Lee; Walter, Emily Marie

2014-11-01

Efficacy of the Measure of Understanding of Macroevolution (MUM) as a measurement tool has been a point of contention among scholars needing a valid measure for knowledge of macroevolution. We explored the structure and construct validity of the MUM using Rasch methodologies in the context of a general education biology course designed with an emphasis on macroevolution content. The Rasch model was utilized to quantify item- and test-level characteristics, including dimensionality, reliability, and fit with the Rasch model. Contrary to previous work, we found that the MUM provides a valid, reliable, and unidimensional scale for measuring knowledge of macroevolution in introductory non-science majors, and that its psychometric behavior does not exhibit large changes across time. While we found that all items provide productive measurement information, several depart substantially from ideal behavior, warranting a collective effort to improve these items. Suggestions for improving the measurement characteristics of the MUM at the item and test levels are put forward and discussed.

Time to change the blind men and the elephant approach to Parkinson disease?

PubMed

Racette, Brad A; Willis, Allison W

2015-07-14

Parkinson disease (PD) is a progressive neurodegenerative disease that is associated with substantial morbidity and early mortality. Disease-related costs exceed $10 billion, not including medications, out-of-pocket expenses, or societal costs. Symptomatic treatment with levodopa, which has been available for over 30 years, and advanced therapies such as deep brain stimulation improve outcomes. Yet most new medications for PD provide a therapeutic benefit that is relatively modest compared to the benefits from levodopa. Despite dozens of neuroprotective clinical trials, there are no medications proven to slow the progression of the disease. Given these limitations, we provide evidence of the potential public health impact of a research agenda that emphasizes identification of risk factors to reduce disease burden through exposure mitigation. In addition, we emphasize health care policy that focuses on increasing health care expenditures for neurologic evaluation and management services to increase access to specialists to improve disease outcomes and reduce costs through better disease management. © 2015 American Academy of Neurology.

Time to change the blind men and the elephant approach to Parkinson disease?

PubMed Central

Willis, Allison W.

2015-01-01

Parkinson disease (PD) is a progressive neurodegenerative disease that is associated with substantial morbidity and early mortality. Disease-related costs exceed $10 billion, not including medications, out-of-pocket expenses, or societal costs. Symptomatic treatment with levodopa, which has been available for over 30 years, and advanced therapies such as deep brain stimulation improve outcomes. Yet most new medications for PD provide a therapeutic benefit that is relatively modest compared to the benefits from levodopa. Despite dozens of neuroprotective clinical trials, there are no medications proven to slow the progression of the disease. Given these limitations, we provide evidence of the potential public health impact of a research agenda that emphasizes identification of risk factors to reduce disease burden through exposure mitigation. In addition, we emphasize health care policy that focuses on increasing health care expenditures for neurologic evaluation and management services to increase access to specialists to improve disease outcomes and reduce costs through better disease management. PMID:26070339

Projections for insulin treatment for diabetics.

PubMed

Cao, Ying; Lam, Laura

2002-06-01

The evolution of insulin treatment of diabetes has dramatically changed the natural course of this disease. Modern recombinant DNA technology has brought about many new insulin analogues with improved pharmacokinetics, resulting in better glycemic control. In addition, improved insulin delivery systems, such as insulin pumps and pens, have been introduced to provide convenience and to enhance patient compliance. Efforts are currently being devoted to developing noninvasive insulin formulations, such as oral and pulmonary insulin. A number of products are at different stages of clinical trials. Meanwhile, the quest for a permanent cure for diabetes continues. The frontier of diabetes research has gone through a period of substantial expansion, with the emergence of new areas that include gene therapy, islet cell transplantation and diabetic vaccine. Technological breakthroughs, such as recombinant DNA, nanotechnology, microarray-aided genomics and proteomics, will provide more profound insights into the pathogenesis, and the immunological and biological basis of diabetes. Our growing knowledge in these areas will ultimately contribute to the discovery of preventive methods against or a cure for this disease.

Ocean Heat Content Reveals Secrets of Fish Migrations

PubMed Central

Luo, Jiangang; Ault, Jerald S.; Shay, Lynn K.; Hoolihan, John P.; Prince, Eric D.; Brown, Craig A.; Rooker, Jay R.

2015-01-01

For centuries, the mechanisms surrounding spatially complex animal migrations have intrigued scientists and the public. We present a new methodology using ocean heat content (OHC), a habitat metric that is normally a fundamental part of hurricane intensity forecasting, to estimate movements and migration of satellite-tagged marine fishes. Previous satellite-tagging research of fishes using archival depth, temperature and light data for geolocations have been too coarse to resolve detailed ocean habitat utilization. We combined tag data with OHC estimated from ocean circulation and transport models in an optimization framework that substantially improved geolocation accuracy over SST-based tracks. The OHC-based movement track provided the first quantitative evidence that many of the tagged highly migratory fishes displayed affinities for ocean fronts and eddies. The OHC method provides a new quantitative tool for studying dynamic use of ocean habitats, migration processes and responses to environmental changes by fishes, and further, improves ocean animal tracking and extends satellite-based animal tracking data for other potential physical, ecological, and fisheries applications. PMID:26484541

The value of trauma registries.

PubMed

Moore, Lynne; Clark, David E

2008-06-01

Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

Modified laser-annealing process for improving the quality of electrical P-N junctions and devices

DOEpatents

Wood, Richard F.; Young, Rosa T.

1984-01-01

The invention is a process for producing improved electrical-junction devices. The invention is applicable, for example, to a process in which a light-sensitive electrical-junction device is produced by (1) providing a body of crystalline semiconductor material having a doped surface layer, (2) irradiating the layer with at least one laser pulse to effect melting of the layer, (3) permitting recrystallization of the melted layer, and (4) providing the resulting body with electrical contacts. In accordance with the invention, the fill-factor and open-circuit-voltage parameters of the device are increased by conducting the irradiation with the substrate as a whole at a selected elevated temperature, the temperature being selected to effect a reduction in the rate of the recrystallization but insufficient to effect substantial migration of impurities within the body. In the case of doped silicon substrates, the substrate may be heated to a temperature in the range of from about 200.degree. C. to 500.degree. C.

Marker-assisted selection: an approach for precision plant breeding in the twenty-first century.

PubMed

Collard, Bertrand C Y; Mackill, David J

2008-02-12

DNA markers have enormous potential to improve the efficiency and precision of conventional plant breeding via marker-assisted selection (MAS). The large number of quantitative trait loci (QTLs) mapping studies for diverse crops species have provided an abundance of DNA marker-trait associations. In this review, we present an overview of the advantages of MAS and its most widely used applications in plant breeding, providing examples from cereal crops. We also consider reasons why MAS has had only a small impact on plant breeding so far and suggest ways in which the potential of MAS can be realized. Finally, we discuss reasons why the greater adoption of MAS in the future is inevitable, although the extent of its use will depend on available resources, especially for orphan crops, and may be delayed in less-developed countries. Achieving a substantial impact on crop improvement by MAS represents the great challenge for agricultural scientists in the next few decades.

Using GIS to assess priorities of infrastructure and health needs of colonias along the United States-Mexico border

USGS Publications Warehouse

Parcher, J.W.; Humberson, D.G.

2009-01-01

Colonias, which are unincorporated border setdements in the United. States, have emerged in rural areas without the governance and services normally provided by local government. Colonia residents live in poverty and lack adequate health care, potable water, and sanitation systems. These conditions create substantial health risks for themselves and surrounding communities. By 2001, more than 1,400 colonias were identified in Texas. Cooperation with several Federal and Texas state agencies has allowed the U.S. Geological Survey (USGS) to improve colonia Geographic Information System (GIS) boundaries and develop the Colonia Health, Infrastructure, and Platting Status tool (CHIPS). Together, the GIS boundaries and CHIPS aid the Texas government in prioritizing the limited funds that are available for infrastructure improvement. CHIPS's report: generator can be tailored, to the needs of the user, providing either broad or specific output. CHIPS is publicly available on the U.S. Geological Survey Border Environmental Health Initiative website at http://borderhealth.cr. usgs.gov.

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

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

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

1987-04-01

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

Accurate and reproducible functional maps in 127 human cell types via 2D genome segmentation

PubMed Central

Hardison, Ross C.

2017-01-01

Abstract The Roadmap Epigenomics Consortium has published whole-genome functional annotation maps in 127 human cell types by integrating data from studies of multiple epigenetic marks. These maps have been widely used for studying gene regulation in cell type-specific contexts and predicting the functional impact of DNA mutations on disease. Here, we present a new map of functional elements produced by applying a method called IDEAS on the same data. The method has several unique advantages and outperforms existing methods, including that used by the Roadmap Epigenomics Consortium. Using five categories of independent experimental datasets, we compared the IDEAS and Roadmap Epigenomics maps. While the overall concordance between the two maps is high, the maps differ substantially in the prediction details and in their consistency of annotation of a given genomic position across cell types. The annotation from IDEAS is uniformly more accurate than the Roadmap Epigenomics annotation and the improvement is substantial based on several criteria. We further introduce a pipeline that improves the reproducibility of functional annotation maps. Thus, we provide a high-quality map of candidate functional regions across 127 human cell types and compare the quality of different annotation methods in order to facilitate biomedical research in epigenomics. PMID:28973456

A pilot prospective feasibility study of organ-at-risk definition using Target Contour Testing/Instructional Computer Software (TaCTICS), a training and evaluation platform for radiotherapy target delineation.

PubMed

Kalpathy-Cramer, Jayashree; Bedrick, Steven D; Boccia, Kelly; Fuller, Clifton D

2011-01-01

Target volume delineation is a critical, but time-consuming step in the creation of radiation therapy plans used in the treatment of many types of cancer. However, variability in target volume definitions can introduce substantial differences in resulting doses to tumors and critical structures. We developed TaCTICS, a web-based educational training software application targeted towards non-expert users. We report on a small, prospective study to evaluate the utility of this online tool in improving conformance of regions-of-interest (ROIs) with a reference set. Eight residents contoured a set of structures for a head-and-neck cancer case. Subsequently, they were provided access to TaCTICS as well as contouring atlases to allow evaluation of their contours in reference to other users as well as reference ROIs. The residents then contoured a second case using these resources. Volume overlap metrics between the users showed a substantial improvement following the intervention. Additionally, 66% of users reported that they found TaCTICS to be a useful educational tool and all participants reported they would like to use TaCTICS to track their contouring skills over the course of their residency.

Water demand for electricity in deep decarbonisation scenarios: a multi-model assessment

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

Mouratiadou, I.; Bevione, M.; Bijl, D. L.

This study assesses the effects of deep electricity decarbonisation and shifts in the choice of power plant cooling technologies on global electricity water demand, using a suite of five integrated assessment models. We find that electricity sector decarbonisation results in co-benefits for water resources primarily due to the phase-out of water-intensive coal-based thermoelectric power generation, although these co-benefits vary substantially across decarbonisation scenarios. Wind and solar photovoltaic power represent a win-win option for both climate and water resources, but further expansion of nuclear or fossil- and biomass-fuelled power plants with carbon capture and storage may result in increased pressures onmore » the water environment. Further to these results, the paper provides insights on the most crucial factors of uncertainty with regards to future estimates of water demand. These estimates varied substantially across models in scenarios where the effects of decarbonisation on the electricity mix were less clear-cut. Future thermal and water efficiency improvements of power generation technologies and demand-side energy efficiency improvements were also identified to be important factors of uncertainty. We conclude that in order to ensure positive effects of decarbonisation on water resources, climate policy should be combined with technology-specific energy and/or water policies.« less

Digital Care in Epilepsy: A Conceptual Framework for Technological Therapies.

PubMed

Page, Rupert; Shankar, Rohit; McLean, Brendan N; Hanna, Jane; Newman, Craig

2018-01-01

Epilepsy is associated with a significant increase in morbidity and mortality. The likelihood is significantly greater for those patients with specific risk factors. Identifying those at greatest risk of injury and providing expert management from the earliest opportunity is made more challenging by the circumstances in which many such patients present. Despite increasing recognition of the importance of earlier identification of those at risk, there is little or no improvement in outcomes over more than 30 years. Despite ever increasing sophistication of drug development and delivery, there has been no meaningful improvement in 1-year seizure freedom rates over this time. However, in the last few years, there has been an increase in patient-triggered interventions based on automated monitoring of indicators and risk factors facilitated by technological advances. The opportunities such approaches provide will only be realized if accompanied by current working practice changes. Replacing traditional follow-up appointments at arbitrary intervals with dynamic interventions, remotely and at the point and place of need provides a better chance of a substantial reduction in seizures for people with epilepsy. Properly implemented, electronic platforms can offer new opportunities to provide expert advice and management from first presentation thus improving outcomes. This perspective paper provides and proposes an informed critical opinion built on current evidence base of an outline techno-therapeutic approach to harnesses these technologies. This conceptual framework is generic, rather than tied to a specific product or solution, and the same generalized approach could be beneficially applied to other long-term conditions.

Nanostructured lipid carriers: versatile oral delivery vehicle

PubMed Central

Poonia, Neelam; Kharb, Rajeev; Lather, Viney; Pandita, Deepti

2016-01-01

Oral delivery is the most accepted and economical route for drug administration and leads to substantial reduction in dosing frequency. However, this route still remains a challenge for the pharmaceutical industry due to poorly soluble and permeable drugs leading to poor oral bioavailability. Incorporating bioactives into nanostructured lipid carriers (NLCs) has helped in boosting their therapeutic functionality and prolonged release from these carrier systems thus providing improved pharmacokinetic parameters. The present review provides an overview of noteworthy studies reporting impending benefits of NLCs in oral delivery and highlights recent advancements for developing engineered NLCs either by conjugating polymers over their surface or modifying their charge to overcome the mucosal barrier of GI tract for active transport across intestinal membrane. PMID:28031979

Improved Electrical Contact For Dowhhole Drilling Networks

DOEpatents

Hall, David R.; Hall, Jr., H. Tracy; Pixton, David S.; Dahlgren, Scott; Fox, Joe; Sneddon, Cameron

2005-08-16

An electrical contact system for transmitting information across tool joints while minimizing signal reflections that occur at the tool joints includes a first electrical contact comprising an annular resilient material. An annular conductor is embedded within the annular resilient material and has a surface exposed from the annular resilient material. A second electrical contact is provided that is substantially equal to the first electrical contact. Likewise, the second electrical contact has an annular resilient material and an annular conductor. The two electrical contacts configured to contact one another such that the annular conductors of each come into physical contact. The annular resilient materials of each electrical contact each have dielectric characteristics and dimensions that are adjusted to provide desired impedance to the electrical contacts.

Water Quality and Sustainable Environmental Health

NASA Astrophysics Data System (ADS)

Setegn, S. G.

2014-12-01

Lack of adequate safe water, the pollution of the aquatic environment and the mismanagement of resources are major causes of ill-health and mortality, particularly in the developing countries. In order to accommodate more growth, sustainable fresh water resource management will need to be included in future development plans. One of the major environmental issues of concern to policy-makers is the increased vulnerability of ground water quality. The main challenge for the sustainability of water resources is the control of water pollution. To understand the sustainability of the water resources, one needs to understand the impact of future land use and climate changes on the natural resources. Providing safe water and basic sanitation to meet the Millennium Development Goals will require substantial economic resources, sustainable technological solutions and courageous political will. A balanced approach to water resources exploitation for development, on the one hand, and controls for the protection of health, on the other, is required if the benefits of both are to be realized without avoidable detrimental effects manifesting themselves. Meeting the millennium development goals for water and sanitation in the next decade will require substantial economic resources, sustainable technological solutions and courageous political will. In addition to providing "improved" water and "basic" sanitation services, we must ensure that these services provide: safe drinking water, adequate quantities of water for health, hygiene, agriculture and development and sustainable sanitation approaches to protect health and the environment.

Frozen shoulder contracture syndrome - Aetiology, diagnosis and management.

PubMed

Lewis, Jeremy

2015-02-01

Frozen shoulder is a poorly understood condition that typically involves substantial pain, movement restriction, and considerable morbidity. Although function improves overtime, full and pain free range, may not be restored in everyone. Frozen shoulder is also known as adhesive capsulitis, however the evidence for capsular adhesions is refuted and arguably, this term should be abandoned. The aim of this Masterclass is to synthesise evidence to provide a framework for assessment and management for Frozen Shoulder. Although used in the treatment of this condition, manipulation under anaesthetic has been associated with joint damage and may be no more effective than physiotherapy. Capsular release is another surgical procedure that is supported by expert opinion and published case series, but currently high quality research is not available. Recommendations that supervised neglect is preferable to physiotherapy have been based on a quasi-experimental study associated with a high risk of bias. Physiotherapists in the United Kingdom have developed dedicated care pathways that provide; assessment, referral for imaging, education, health screening, ultrasound guided corticosteroid and hydro-distension injections, embedded within physiotherapy rehabilitation. The entire pathway is provided by physiotherapists and evidence exists to support each stage of the pathway. Substantial on-going research is required to better understand; epidemiology, patho-aetiology, assessment, best management, health economics, patient satisfaction and if possible prevention. Copyright © 2014 Elsevier Ltd. All rights reserved.

Method for nanoencapsulation of aerogels and nanoencapsulated aerogels produced by such method

NASA Technical Reports Server (NTRS)

Sullivan, Thomas A. (Inventor)

2007-01-01

A method for increasing the compressive modulus of aerogels comprising: providing aerogel substrate comprising a bubble matrix in a chamber; providing monomer to the chamber, the monomer comprising vapor phase monomer which polymerizes substantially free of polymerization byproducts; depositing monomer from the vapor phase onto the surface of the aerogel substrate under deposition conditions effective to produce a vapor pressure sufficient to cause the vapor phase monomer to penetrate into the bubble matrix and deposit onto the surface of the aerogel substrate, producing a substantially uniform monomer film; and, polymerizing the substantially uniform monomer film under polymerization conditions effective to produce polymer coated aerogel comprising a substantially uniform polymer coating substantially free of polymerization byproducts.Polymer coated aerogel comprising aerogel substrate comprising a substantially uniform polymer coating, said polymer coated aerogel comprising porosity and having a compressive modulus greater than the compressive modulus of the aerogel substrate, as measured by a 100 lb. load cell at 1 mm/minute in the linear range of 20% to 40% compression.

Coherent combining pulse bursts in time domain

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

Galvanauskas, Almantas

A beam combining and pulse stacking technique is provided that enhances laser pulse energy by coherent stacking pulse bursts (i.e. non-periodic pulsed signals) in time domain. This energy enhancement is achieved by using various configurations of Fabry-Perot, Gires-Tournois and other types of resonant cavities, so that a multiple-pulse burst incident at either a single input or multiple inputs of the system produces an output with a solitary pulse, which contains the summed energy of the incident multiple pulses from all beams. This disclosure provides a substantial improvement over conventional coherent-combining methods in that it achieves very high pulse energies usingmore » a relatively small number of combined laser systems, thus providing with orders of magnitude reduction in system size, complexity, and cost compared to current combining approaches.« less

Improved nutrition in the first 1000 days and adult human capital and health.

PubMed

Martorell, Reynaldo

2017-03-01

The aim of this article is to review why the first 1000 days of life are a vulnerable period of human development and the long-term effects of a nutrition experiment carried out in Guatemala (1969-1977). In 1969-77, a supplement called Atole, containing high quality protein, energy and micronutrients, was provided to women during pregnancy and lactation and to children <7 years of age in two villages while in two control villages a low-energy drink called Fresco was provided. The villages were assigned at random to the treatment groups. Several reasons explain the vulnerability of the first 1000 days: rapid growth and development, high nutritional requirements, greater susceptibility to infections, high sensitivity to programming effects and full dependence on others for care, nutrition, and social interaction. Compared with Fresco, Atole improved total nutrient intakes (protein, energy, and micronutrients) and reduced stunting, but only in children < 3 years of age. A study in 2002-2004 showed that schooling, reading, and intelligence were improved in Atole villages, but only in those who received Atole before the age of 3 years. Wages of men were increased by 46% in those provided Atole through the age of 2 years. Findings for cardiovascular disease risk factors were inconclusive, perhaps because of the young age of the sample. A new study focusing on chronic diseases is ongoing (ages 38-54 years). The Guatemalan studies indicate that substantial improvement in adult human capital and economic productivity resulted from the nutrition intervention. This provides a powerful argument for promoting improvements in nutrition in pregnant women and young children in low income countries. © 2017 Wiley Periodicals, Inc.

Improved Nutrition in the First 1000 Days and Adult Human Capital and Health

PubMed Central

Martorell, Reynaldo

2017-01-01

Objective The aim of this article is to review why the first 1000 days of life are a vulnerable period of human development, and the long-term effects of a nutrition experiment carried out in Guatemala (1969–1977). Methods In 1969–77, a supplement called Atole, containing high quality protein, energy and micronutrients, was provided to women during pregnancy and lactation and to children <7 years of age in two villages while in two control villages a low-energy drink called Fresco was provided. The villages were assigned at random to the treatment groups. Results Several reasons explain the vulnerability of the first 1000 days: rapid growth and development, high nutritional requirements, greater susceptibility to infections, high sensitivity to programming effects and full dependence on others for care, nutrition, and social interaction. Compared to Fresco, Atole improved total nutrient intakes (protein, energy and micronutrients) and reduced stunting, but only in children < 3 years of age. A study in 2002–2004 showed that schooling, reading, and intelligence were improved in Atole villages, but only in those who received Atole before the age of 3 years. Wages of men were increased by 46% in those provided Atole through the age of 2 years. Findings for cardiovascular disease risk factors were inconclusive, perhaps because of the young age of the sample. A new study focusing on chronic diseases is ongoing (ages 38–54 years). Conclusions The Guatemalan studies indicate that substantial improvement in adult human capital and economic productivity resulted from the nutrition intervention. This provides a powerful argument for promoting improvements in nutrition in pregnant women and young children in low income countries. PMID:28117514

Hepatitis C videoconferencing: the impact on continuing medical education for rural healthcare providers.

PubMed

Rossaro, Lorenzo; Tran, Thu P; Ransibrahmanakul, Kanat; Rainwater, Julie A; Csik, Genell; Cole, Stacey L; Prosser, Colette C; Nesbitt, Thomas S

2007-06-01

This study compared the impact of multipoint videoconferencing (VC) versus standard lecturing (ST) on primary care providers' (MDs, NPs/PAs, and RNs) education regarding hepatitis C virus (HCV). The hypothesis was that the educational impact of teaching through telemedicine is comparable to the traditional method. The aim was to provide participants clinically relevant information and knowledge about the natural history, diagnosis, and management of HCV. Improved knowledge was scored from a 10-item quiz administered before and after the educational intervention. Comparison of the pretest knowledge scores within provider groups showed no statistically significant difference in baseline knowledge for the ST versus VC method. However, for all practitioners combined, the VC group scored significantly lower on the pretest than the ST group (p < 0.05). All three types of learners improved their knowledge scores following intervention. On average, MDs and NP/PAs correctly answered two to 3.5 more questions in the posttest. RNs showed the greatest improvements, correctly answering an average of four to five more questions following intervention. Improvement in knowledge scores between the two methods was statistically significant in favor of VC for the MDs (VC = 3.56 +/- 1.92 vs. ST = 2.13 +/- 1.89, p < 0.001) and all groups combined (VC 4.37 +/- 1.92 vs ST 3.06 +/- 1.89, p < 0.001). The results of this study indicate that VC is equivalent, if not better, than standard continuing medical education (CME). VC can potentially improve clinician education regarding the history, diagnosis, and management of HCV, thereby making a substantial impact on the clinical course of patients with this condition. In addition, VC has the potential to eliminate the financial and geographic barriers to professional education for rural practitioners.

Early detection monitoring for larval dreissenid mussels: How much plankton sampling is enough?

USGS Publications Warehouse

Counihan, Timothy D.; Bollens, Stephen M.

2017-01-01

The development of quagga and zebra mussel (dreissenids) monitoring programs in the Pacific Northwest provides a unique opportunity to evaluate a regional invasive species detection effort early in its development. Recent studies suggest that the ecological and economic costs of a dreissenid infestation in the Pacific Northwest of the USA would be significant. Consequently, efforts are underway to monitor for the presence of dreissenids. However, assessments of whether these efforts provide for early detection are lacking. We use information collected from 2012 to 2014 to characterize the development of larval dreissenid monitoring programs in the states of Idaho, Montana, Oregon, and Washington in the context of introduction and establishment risk. We also estimate the effort needed for high-probability detection of rare planktonic taxa in four Columbia and Snake River reservoirs and assess whether the current level of effort provides for early detection. We found that the effort expended to monitor for dreissenid mussels increased substantially from 2012 to 2014, that efforts were distributed across risk categories ranging from high to very low, and that substantial gaps in our knowledge of both introduction and establishment risk exist. The estimated volume of filtered water required to fully census planktonic taxa or to provide high-probability detection of rare taxa was high for the four reservoirs examined. We conclude that the current level of effort expended does not provide for high-probability detection of larval dreissenids or other planktonic taxa when they are rare in these reservoirs. We discuss options to improve early detection capabilities.

Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.

PubMed

Cima, Robert R; Brown, Michael J; Hebl, James R; Moore, Robin; Rogers, James C; Kollengode, Anantha; Amstutz, Gwendolyn J; Weisbrod, Cheryl A; Narr, Bradly J; Deschamps, Claude

2011-07-01

Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency. A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Highly porous ceramic oxide aerogels having improved flexibility

NASA Technical Reports Server (NTRS)

Guo, Haiquan (Inventor); Meador, Mary Ann B. (Inventor); Nguyen, Baochau N. (Inventor)

2012-01-01

Ceramic oxide aerogels having improved flexibility are disclosed. Preferred embodiments exhibit high modulus and other strength properties despite their improved flexibility. The gels may be polymer cross-linked via organic polymer chains to further improve strength properties, without substantially detracting from the improved flexibility. Methods of making such aerogels are also disclosed.

Advances in Dental Materials through Nanotechnology: Facts, Perspectives and Toxicological Aspects.

PubMed

Padovani, Gislaine C; Feitosa, Victor P; Sauro, Salvatore; Tay, Franklin R; Durán, Gabriela; Paula, Amauri J; Durán, Nelson

2015-11-01

Nanotechnology is currently driving the dental materials industry to substantial growth, thus reflecting on improvements in materials available for oral prevention and treatment. The present review discusses new developments in nanotechnology applied to dentistry, focusing on the use of nanomaterials for improving the quality of oral care, the perspectives of research in this arena, and discussions on safety concerns regarding the use of dental nanomaterials. Details are provided on the cutting-edge properties (morphological, antibacterial, mechanical, fluorescence, antitumoral, and remineralization and regeneration potential) of polymeric, metallic and inorganic nano-based materials, as well as their use as nanocluster fillers, in nanocomposites, mouthwashes, medicines, and biomimetic dental materials. Nanotoxicological aspects, clinical applications, and perspectives for these nanomaterials are also discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Review of optical freeform surface representation technique and its application

NASA Astrophysics Data System (ADS)

Ye, Jingfei; Chen, Lu; Li, Xinhua; Yuan, Qun; Gao, Zhishan

2017-11-01

Modern advanced manufacturing and testing technologies allow the application of freeform optical elements. Compared with traditional spherical surfaces, an optical freeform surface has more degrees of freedom in optical design and provides substantially improved imaging performance. In freeform optics, the representation technique of a freeform surface has been a fundamental and key research topic in recent years. Moreover, it has a close relationship with other aspects of the design, manufacturing, testing, and application of optical freeform surfaces. Improvements in freeform surface representation techniques will make a significant contribution to the further development of freeform optics. We present a detailed review of the different types of optical freeform surface representation techniques and their applications and discuss their properties and differences. Additionally, we analyze the future trends of optical freeform surface representation techniques.

Novel Non-Carbonate Based Electrolytes for Silicon Anodes

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

Zhu, Ye; Yang, Johnny; Cheng, Gang

2016-09-09

Substantial improvement in the energy density of rechargeable lithium batteries is required to meet the future needs for electric and plug-in electric vehicles (EV and PHEV). Present day lithium ion battery technology is based on shuttling lithium between graphitic carbon and inorganic oxides. Non-graphitic anodes, such as silicon can provide significant improvements in energy density but are currently limited in cycle life due to reactivity with the electrolyte. Wildcat/3M proposes the development of non-carbonate electrolyte formulations tailored for silicon alloy anodes. Combining these electrolytes with 3M’s anode and an NMC cathode will enable up to a 20% increase in themore » volumetric cell energy density, while still meeting the PHEV/EV cell level cycle/calendar life goals.« less

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

Kuypers, Marshall A.; Lambert, Gregory Joseph; Moore, Thomas W.

Chronic infection with Hepatitis C virus (HCV) results in cirrhosis, liver cancer and death. As the nations largest provider of care for HCV, US Veterans Health Administration (VHA) invests extensive resources in the diagnosis and treatment of the disease. This report documents modeling and analysis of HCV treatment dynamics performed for the VHA aimed at improving service delivery efficiency. System dynamics modeling of disease treatment demonstrated the benefits of early detection and the role of comorbidities in disease progress and patient mortality. Preliminary modeling showed that adherence to rigorous treatment protocols is a primary determinant of treatment success. In depthmore » meta-analysis revealed correlations of adherence and various psycho-social factors. This initial meta-analysis indicates areas where substantial improvement in patient outcomes can potentially result from VA programs which incorporate these factors into their design.« less

Improving the Spacelab mass memory unit tape layout with a simulation model

NASA Technical Reports Server (NTRS)

Noneman, S. R.

1984-01-01

A tape drive called the Mass Memory Unit (MMU) stores software used by Spacelab computers. MMU tape motion must be minimized during typical flight operations to avoid a loss of scientific data. A projection of the tape motion is needed for evaluation of candidate tape layouts. A computer simulation of the scheduled and unscheduled MMU tape accesses is developed for this purpose. This simulation permits evaluations of candidate tape layouts by tracking and summarizing tape movements. The factors that affect tape travel are investigated and a heuristic is developed to find a good tape layout. An improved tape layout for Spacelab I is selected after the evaluation of fourteen candidates. The simulation model will provide the ability to determine MMU layouts that substantially decrease the tape travel on future Spacelab flights.

Face adaptation improves gender discrimination.

PubMed

Yang, Hua; Shen, Jianhong; Chen, Juan; Fang, Fang

2011-01-01

Adaptation to a visual pattern can alter the sensitivities of neuronal populations encoding the pattern. However, the functional roles of adaptation, especially in high-level vision, are still equivocal. In the present study, we performed three experiments to investigate if face gender adaptation could affect gender discrimination. Experiments 1 and 2 revealed that adapting to a male/female face could selectively enhance discrimination for male/female faces. Experiment 3 showed that the discrimination enhancement induced by face adaptation could transfer across a substantial change in three-dimensional face viewpoint. These results provide further evidence suggesting that, similar to low-level vision, adaptation in high-level vision could calibrate the visual system to current inputs of complex shapes (i.e. face) and improve discrimination at the adapted characteristic. Copyright © 2010 Elsevier Ltd. All rights reserved.

Physical complications in acute lung injury survivors: a two-year longitudinal prospective study.

PubMed

Fan, Eddy; Dowdy, David W; Colantuoni, Elizabeth; Mendez-Tellez, Pedro A; Sevransky, Jonathan E; Shanholtz, Carl; Himmelfarb, Cheryl R Dennison; Desai, Sanjay V; Ciesla, Nancy; Herridge, Margaret S; Pronovost, Peter J; Needham, Dale M

2014-04-01

Survivors of severe critical illness frequently develop substantial and persistent physical complications, including muscle weakness, impaired physical function, and decreased health-related quality of life. Our objective was to determine the longitudinal epidemiology of muscle weakness, physical function, and health-related quality of life and their associations with critical illness and ICU exposures. A multisite prospective study with longitudinal follow-up at 3, 6, 12, and 24 months after acute lung injury. Thirteen ICUs from four academic teaching hospitals. Two hundred twenty-two survivors of acute lung injury. None. At each time point, patients underwent standardized clinical evaluations of extremity, hand grip, and respiratory muscle strength; anthropometrics (height, weight, mid-arm circumference, and triceps skin fold thickness); 6-minute walk distance, and the Medical Outcomes Short-Form 36 health-related quality of life survey. During their hospitalization, survivors also had detailed daily evaluation of critical illness and related treatment variables. Over one third of survivors had objective evidence of muscle weakness at hospital discharge, with most improving within 12 months. This weakness was associated with substantial impairments in physical function and health-related quality of life that persisted at 24 months. The duration of bed rest during critical illness was consistently associated with weakness throughout 24-month follow-up. The cumulative dose of systematic corticosteroids and use of neuromuscular blockers in the ICU were not associated with weakness. Muscle weakness is common after acute lung injury, usually recovering within 12 months. This weakness is associated with substantial impairments in physical function and health-related quality of life that continue beyond 24 months. These results provide valuable prognostic information regarding physical recovery after acute lung injury. Evidence-based methods to reduce the duration of bed rest during critical illness may be important for improving these long-term impairments.

A fuzzy set preference model for market share analysis

NASA Technical Reports Server (NTRS)

Turksen, I. B.; Willson, Ian A.

1992-01-01

Consumer preference models are widely used in new product design, marketing management, pricing, and market segmentation. The success of new products depends on accurate market share prediction and design decisions based on consumer preferences. The vague linguistic nature of consumer preferences and product attributes, combined with the substantial differences between individuals, creates a formidable challenge to marketing models. The most widely used methodology is conjoint analysis. Conjoint models, as currently implemented, represent linguistic preferences as ratio or interval-scaled numbers, use only numeric product attributes, and require aggregation of individuals for estimation purposes. It is not surprising that these models are costly to implement, are inflexible, and have a predictive validity that is not substantially better than chance. This affects the accuracy of market share estimates. A fuzzy set preference model can easily represent linguistic variables either in consumer preferences or product attributes with minimal measurement requirements (ordinal scales), while still estimating overall preferences suitable for market share prediction. This approach results in flexible individual-level conjoint models which can provide more accurate market share estimates from a smaller number of more meaningful consumer ratings. Fuzzy sets can be incorporated within existing preference model structures, such as a linear combination, using the techniques developed for conjoint analysis and market share estimation. The purpose of this article is to develop and fully test a fuzzy set preference model which can represent linguistic variables in individual-level models implemented in parallel with existing conjoint models. The potential improvements in market share prediction and predictive validity can substantially improve management decisions about what to make (product design), for whom to make it (market segmentation), and how much to make (market share prediction).

Synthesis and Pharmacokinetic Evaluation of Siderophore Biosynthesis Inhibitors for Mycobacterium tuberculosis

PubMed Central

Nelson, Kathryn M.; Viswanathan, Kishore; Dawadi, Surendra; Duckworth, Benjamin P.; Boshoff, Helena I.; Barry, Clifton E.; Aldrich, Courtney C.

2015-01-01

MbtA catalyzes the first committed biosynthetic step of the mycobactins, which are important virulence factors associated with iron acquisition in Mycobacterium tuberculosis. MbtA is a validated therapeutic target for antitubercular drug development. 5′-O-[N-(salicyl)sulfamoyl]adenosine (1) is a bisubstrate inhibitor of MbtA and exhibits exceptionally potent biochemical and antitubercular activity. However, 1 suffers from sub-optimal drug disposition properties resulting in a short half-life (t1/2), low exposure (AUC), and low bioavailability (F). Four strategies were pursued to address these liabilities including the synthesis of prodrugs, increasing the pKa of the acyl-sulfonyl moiety, modulation of the lipophilicity, and strategic introduction of fluorine into 1. Complete pharmacokinetic (PK) analysis of all compounds was performed. The most successful modifications involved fluorination of the nucleoside that provided substantial improvements in t1/2 and AUC. Increasing the pKa of the acyl-sulfonyl linker yielded incremental enhancements while modulation of the lipophilicity and prodrug approaches led to substantially poorer PK parameters. PMID:26110337

Absorption-enhanced imaging through scattering media using carbon black nano-particles: from visible to near infrared wavelengths

NASA Astrophysics Data System (ADS)

Tanzid, Mehbuba; Hogan, Nathaniel J.; Robatjazi, Hossein; Veeraraghavan, Ashok; Halas, Naomi J.

2018-05-01

Imaging through scattering media can be improved with the addition of absorbers, since multiply-scattered photons, with their longer path length, are absorbed with a higher probability than ballistic photons. The image resolution enhancement is substantially greater when imaging through isotropic scatterers than when imaging through an ensemble of strongly forward-scattering particles. However, since the angular scattering distribution is determined by the size of the scatterers with respect to the wavelength of incident light, particles that are forward scatterers at visible wavelengths can be isotropic scatterers at infrared (IR) wavelengths. Here, we show that substantial image resolution enhancement can be achieved in the near-infrared wavelength regime for particles that are forward scattering at visible wavelengths using carbon black nanoparticles as a broadband absorber. This observation provides a new strategy for image enhancement through scattering media: by selecting the appropriate wavelength range for imaging, in this case the near-IR, the addition of absorbers more effectively enhances the image resolution.

Photostability Can Be Significantly Modulated by Molecular Packing in Glasses

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

Qiu, Yue; Antony, Lucas W.; de Pablo, Juan J.

2016-08-12

While previous work has demonstrated that molecular packing in organic crystals can strongly influence photochemical stability, efforts to tune photostability in amorphous materials have shown much smaller effects. Here we show that physical vapor deposition can substantially improve the photostability of organic glasses. Disperse Orange 37 (DO37), an azobenzene derivative, is studied as a model system. Photostability is assessed through changes in the density and molecular orientation of glassy thin films during light irradiation. By optimizing the substrate temperature used for deposition, we can increase photostability by a factor of 50 relative to the liquid-cooled glass. Photostability correlates with glassmore » density, with density increases of up to 1.3%. Coarse-grained molecular simulations, which mimic glass preparation and the photoisomerization reaction, also indicate that glasses with higher density have substantially increased photostability. These results provide insights that may assist in the design of organic photovoltaics and light emission devices with longer lifetimes.« less

Positional reference system for ultraprecision machining

DOEpatents

Arnold, Jones B.; Burleson, Robert R.; Pardue, Robert M.

1982-01-01

A stable positional reference system for use in improving the cutting tool-to-part contour position in numerical controlled-multiaxis metal turning machines is provided. The reference system employs a plurality of interferometers referenced to orthogonally disposed metering bars which are substantially isolated from machine strain induced position errors for monitoring the part and tool positions relative to the metering bars. A microprocessor-based control system is employed in conjunction with the plurality of position interferometers and part contour description data inputs to calculate error components for each axis of movement and output them to corresponding axis drives with appropriate scaling and error compensation. Real-time position control, operating in combination with the reference system, makes possible the positioning of the cutting points of a tool along a part locus with a substantially greater degree of accuracy than has been attained previously in the art by referencing and then monitoring only the tool motion relative to a reference position located on the machine base.

Positional reference system for ultraprecision machining

DOEpatents

Arnold, J.B.; Burleson, R.R.; Pardue, R.M.

1980-09-12

A stable positional reference system for use in improving the cutting tool-to-part contour position in numerical controlled-multiaxis metal turning machines is provided. The reference system employs a plurality of interferometers referenced to orthogonally disposed metering bars which are substantially isolated from machine strain induced position errors for monitoring the part and tool positions relative to the metering bars. A microprocessor-based control system is employed in conjunction with the plurality of positions interferometers and part contour description data input to calculate error components for each axis of movement and output them to corresponding axis driven with appropriate scaling and error compensation. Real-time position control, operating in combination with the reference system, makes possible the positioning of the cutting points of a tool along a part locus with a substantially greater degree of accuracy than has been attained previously in the art by referencing and then monitoring only the tool motion relative to a reference position located on the machine base.

Operating Experience and Reliability Improvements on the 5 kW CW Klystron at Jefferson Lab

NASA Astrophysics Data System (ADS)

Nelson, R.; Holben, S.

1997-05-01

With substantial operating hours on the RF system, considerable information on reliability of the 5 kW CW klystrons has been obtained. High early failure rates led to examination of the operating conditions and failure modes. Internal ceramic contamination caused premature failure of gun potting material and ultimate tube demise through arcing or ceramic fracture. A planned course of repotting and reconditioning of approximately 300 klystrons, plus careful attention to operating conditions and periodic analysis of operational data, has substantially reduced the failure rate. It is anticipated that implementation of planned supplemental monitoring systems for the klystrons will allow most catastrophic failures to be avoided. By predicting end of life, tubes can be changed out before they fail, thus minimizing unplanned downtime. Initial tests have also been conducted on this same klystron operated at higher voltages with resultant higher output power. The outcome of these tests will provide information to be considered for future upgrades to the accelerator.

Investigation of low energy space plasma

NASA Technical Reports Server (NTRS)

Comfort, R. H.; Horwitz, J. L.

1986-01-01

A statistical study of 1982 data for occurrences of equatorially trapped plasma has been extended. The previous survey, which utilized only the MSFC summary fiche, has been supplemented with the GSFC summary fiche, which has had the effect of substantially improving the late 1982 coverage. It was found that in the post midnight region (1 - 3 LT), the trapped plasma is limited to + or - 5 degrees magnetic latitude, while in the early afternoon (13-15 LT), latitude ranges as high as + or 30 degrees are found. This survey has provided a link to earlier ATS-6 and ISEE studies of pancake distributions. Although the most energetic, and most anisotopic plasmas are trapped within a few degrees of the equator, the results of these equatorial interactions extend substantially along the magnetic field line in the afternoon and dusk region and these high latitude extensions were previously studied by the Huntsville group. Results of this study were incorporated into a revision of the equatorial ion paper, which has been resubmitted and accepted for publication.

Adaptive subdomain modeling: A multi-analysis technique for ocean circulation models

NASA Astrophysics Data System (ADS)

Altuntas, Alper; Baugh, John

2017-07-01

Many coastal and ocean processes of interest operate over large temporal and geographical scales and require a substantial amount of computational resources, particularly when engineering design and failure scenarios are also considered. This study presents an adaptive multi-analysis technique that improves the efficiency of these computations when multiple alternatives are being simulated. The technique, called adaptive subdomain modeling, concurrently analyzes any number of child domains, with each instance corresponding to a unique design or failure scenario, in addition to a full-scale parent domain providing the boundary conditions for its children. To contain the altered hydrodynamics originating from the modifications, the spatial extent of each child domain is adaptively adjusted during runtime depending on the response of the model. The technique is incorporated in ADCIRC++, a re-implementation of the popular ADCIRC ocean circulation model with an updated software architecture designed to facilitate this adaptive behavior and to utilize concurrent executions of multiple domains. The results of our case studies confirm that the method substantially reduces computational effort while maintaining accuracy.

French intensive truck garden

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

Edwards, T D

1983-01-01

The French Intensive approach to truck gardening has the potential to provide substantially higher yields and lower per acre costs than do conventional farming techniques. It was the intent of this grant to show that there is the potential to accomplish the gains that the French Intensive method has to offer. It is obvious that locally grown food can greatly reduce transportation energy costs but when there is the consideration of higher efficiencies there will also be energy cost reductions due to lower fertilizer and pesticide useage. As with any farming technique, there is a substantial time interval for completemore » soil recovery after there have been made substantial soil modifications. There were major crop improvements even though there was such a short time since the soil had been greatly disturbed. It was also the intent of this grant to accomplish two other major objectives: first, the garden was managed under organic techniques which meant that there were no chemical fertilizers or synthetic pesticides to be used. Second, the garden was constructed so that a handicapped person in a wheelchair could manage and have a higher degree of self sufficiency with the garden. As an overall result, I would say that the garden has taken the first step of success and each year should become better.« less

The financial performance of labor and delivery units.

PubMed

von Gruenigen, Vivian E; Powell, Diane M; Sorboro, Susan; McCarroll, Michelle L; Kim, Unhee

2013-07-01

Hospitals and health care systems are already seeing the effect of health care reform with declining dollars. Hospital services, which had narrow financial margins in the past, will have further challenges. This article will review definitions, challenges, and potential financial solutions for labor and delivery units. Improving quality, efficiency, and cost requires substantial physician cooperation in the changing paradigm from physician-centric care to the transparent safety of teams. The financial contribution margin should increase the net revenue, but significant volumes are also needed. The challenge of this model for obstetrics is the slowing birth rate with the ultimate limitation for growth. Therefore, cost containment is imperative for sustainability. Standardization of hospital policies and procedures can improve quality and cost-savings with new incentive models. Examples include decreasing expensive pharmaceuticals, minimizing elective inductions of labor, and encouraging breast-feeding. As providers of health care to women, we all must engage in the triple aim of (1) improving the experience of care, (2) improving the health of populations, and (3) reducing per capita costs of health care. Although accountable care organizations presently are focused on Medicare populations for cost containment, all health care providers and institutions must be vigilant on both quality cost-effective care for sustainability, especially in obstetrics. Copyright © 2013 Mosby, Inc. All rights reserved.

Evaluation of Fused Synthetic and Enhanced Vision Display Concepts for Low-Visibility Approach and Landing

NASA Technical Reports Server (NTRS)

Bailey, Randall E.; Kramer, Lynda J.; Prinzel, Lawrence J., III; Wilz, Susan J.

2009-01-01

NASA is developing revolutionary crew-vehicle interface technologies that strive to proactively overcome aircraft safety barriers that would otherwise constrain the full realization of the next generation air transportation system. A piloted simulation experiment was conducted to evaluate the complementary use of Synthetic and Enhanced Vision technologies. Specific focus was placed on new techniques for integration and/or fusion of Enhanced and Synthetic Vision and its impact within a two-crew flight deck during low-visibility approach and landing operations. Overall, the experimental data showed that significant improvements in situation awareness, without concomitant increases in workload and display clutter, could be provided by the integration and/or fusion of synthetic and enhanced vision technologies for the pilot-flying and the pilot-not-flying. Improvements in lateral path control performance were realized when the Head-Up Display concepts included a tunnel, independent of the imagery (enhanced vision or fusion of enhanced and synthetic vision) presented with it. During non-normal operations, the ability of the crew to handle substantial navigational errors and runway incursions were neither improved nor adversely impacted by the display concepts. The addition of Enhanced Vision may not, of itself, provide an improvement in runway incursion detection without being specifically tailored for this application.

7 CFR 1955.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... applies to all members of an entity. (3) Will materially and substantially participate in the operation of... substantially participate in the operation of the farm or ranch. Material and substantial participation requires...-to-day activities, such that if the individual did not provide these inputs, operation of the farm or...

7 CFR 1955.103 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... applies to all members of an entity. (3) Will materially and substantially participate in the operation of... substantially participate in the operation of the farm or ranch. Material and substantial participation requires...-to-day activities, such that if the individual did not provide these inputs, operation of the farm or...

7 CFR 1955.103 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... applies to all members of an entity. (3) Will materially and substantially participate in the operation of... substantially participate in the operation of the farm or ranch. Material and substantial participation requires...-to-day activities, such that if the individual did not provide these inputs, operation of the farm or...

7 CFR 1955.103 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... applies to all members of an entity. (3) Will materially and substantially participate in the operation of... substantially participate in the operation of the farm or ranch. Material and substantial participation requires...-to-day activities, such that if the individual did not provide these inputs, operation of the farm or...

42 CFR 422.356 - Determining substantial financial risk and majority financial interest.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Determining substantial financial risk. The PSO must demonstrate to CMS's satisfaction that it apportions a significant part of the financial risk of the PSO enterprise under the MA contract to each affiliated provider. The PSO must demonstrate that the financial arrangements among its affiliated providers constitute...

42 CFR 422.356 - Determining substantial financial risk and majority financial interest.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Determining substantial financial risk. The PSO must demonstrate to CMS's satisfaction that it apportions a significant part of the financial risk of the PSO enterprise under the MA contract to each affiliated provider. The PSO must demonstrate that the financial arrangements among its affiliated providers constitute...

Massage Therapy for Patients with Metastatic Cancer: A Pilot Randomized Controlled Trial

PubMed Central

Toth, Maria; Marcantonio, Edward R.; Davis, Roger B.; Walton, Tracy; Kahn, Janet R.

2013-01-01

Abstract Objectives The study objectives were to determine the feasibility and effects of providing therapeutic massage at home for patients with metastatic cancer. Design This was a randomized controlled trial. Settings/location Patients were enrolled at Oncology Clinics at a large urban academic medical center; massage therapy was provided in patients' homes. Subjects Subjects were patients with metastatic cancer. Interventions There were three interventions: massage therapy, no-touch intervention, and usual care. Outcome measures Primary outcomes were pain, anxiety, and alertness; secondary outcomes were quality of life and sleep. Results In this study, it was possible to provide interventions for all patients at home by professional massage therapists. The mean number of massage therapy sessions per patient was 2.8. A significant improvement was found in the quality of life of the patients who received massage therapy after 1-week follow-up, which was not observed in either the No Touch control or the Usual Care control groups, but the difference was not sustained at 1 month. There were trends toward improvement in pain and sleep of the patients after therapeutic massage but not in patients in the control groups. There were no serious adverse events related to the interventions. Conclusions The study results showed that it is feasible to provide therapeutic massage at home for patients with advanced cancer, and to randomize patients to a no-touch intervention. Providing therapeutic massage improves the quality of life at the end of life for patients and may be associated with further beneficial effects, such as improvement in pain and sleep quality. Larger randomized controlled trials are needed to substantiate these findings. PMID:23368724

Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999-2012; Overall Diet Remains Poor.

PubMed

Wang, Dong D; Li, Yanping; Chiuve, Stephanie E; Hu, Frank B; Willett, Walter C

2015-11-01

Evaluation of time trends in dietary quality and their relation to disease burden provides essential feedback for policy making. We used an index titled the Alternate Healthy Eating Index 2010 to evaluate trends in dietary quality among 33,885 US adults. From 1999 to 2012 the index increased from 39.9 to 48.2 (perfect score = 110). Gaps in performance on the index across socioeconomic groups persisted or widened. Using data relating index scores to health outcomes in two large cohorts, we estimated that the improvements in dietary quality from 1999 to 2012 prevented 1.1 million premature deaths. Also, this improvement in diet quality resulted in 8.6 percent fewer cardiovascular disease cases, 1.3 percent fewer cancer cases, and 12.6 percent fewer type 2 diabetes cases. Although the steady improvement in dietary quality likely accounted for substantial reductions in disease burden from 1999 to 2012, overall dietary quality in the United States remains poor. Policy initiatives are needed to ensure further improvements. Project HOPE—The People-to-People Health Foundation, Inc.

Substantial injuries influence ranking position in young elite athletes of athletics, cross-country skiing and orienteering.

PubMed

von Rosen, P; Heijne, A

2018-04-01

The relationship between injury and performance in young athletes is scarcely studied. The aim of this study was therefore to explore the association between injury prevalence and ranking position among adolescent elite athletes. One hundred and sixty-two male and female adolescent elite athletes (age range 15-19), competing in athletics (n = 59), cross-country skiing (n = 66), and orienteering (n = 37), were monitored weekly over 22-47 weeks using a web-based injury questionnaire. Ranking lists were collected. A significant (P = .003) difference was found in the seasonal substantial injury prevalence across the ranked athletes over the season, where the top-ranked (median 3.6%, 25-75th percentiles 0%-14.3%) and middle-ranked athletes (median 2.3%, 25-75th percentiles 0%-10.0%) had a lower substantial injury prevalence compared to the low-ranked athletes (median 11.3%, 25-75th percentiles 2.5%-27.1%), during both preseason (P = .002) and competitive season (P = .031). Athletes who improved their ranking position (51%, n = 51) reported a lower substantial injury prevalence (median 0%, 25-75th percentiles 0%-10.0%) compared to those who decreased (49%, n = 49) their ranking position (md 6.7%, 25-75th percentiles 0%-22.5%). In the top-ranked group, no athlete reported substantial injury more than 40% of all data collection time points compared to 9.6% (n = 5) in the middle-ranked, and 17.3% (n = 9) in the low-ranked group. Our results provide supporting evidence that substantial injuries, such as acute and overuse injuries leading to moderate or severe reductions in training or sports performance, influence ranking position in adolescent elite athletes. The findings are crucial to stakeholders involved in adolescent elite sports and support the value of designing effective preventive interventions for substantial injuries. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Inside the Black Box of Audit and Feedback: a Laboratory Study to Explore Determinants of Improvement Target Selection by Healthcare Professionals in Cardiac Rehabilitation.

PubMed

Gude, Wouter T; van der Veer, Sabine N; van Engen-Verheul, Mariëtte M; de Keizer, Nicolette F; Peek, Niels

2015-01-01

Audit and feedback (A&F) is widely used to aid healthcare professionals in improving clinical performance, but there is little understanding of the underlying mechanism that determines its effectiveness. The aim of this paper is to investigate the process by which healthcare professionals select indicators as improvement targets based on A&F. We performed a laboratory study among 41 healthcare professionals in the context of a web-based A&F intervention designed to improve the quality of cardiac rehabilitation care in the Netherlands. Feedback was provided on eighteen quality indicators, including a score and a colour (representing a recommendation for selection (red and yellow) or non-selection (green)). Indicators with more room for improvement were more likely to be selected, although this varied substantially between participants. In more than a quarter of the cases, participants did not select indicators with obvious room for improvement (yellow or red colour), or selected indicators without apparent room for improvement (green colour). We conclude that personal preferences and beliefs concerning quality and performance targets may dilute the efficiency of A&F.

FRD and scrambling properties of recent non-circular fibres

NASA Astrophysics Data System (ADS)

Avila, Gerardo

2012-09-01

Optical fibres with octagonal, square and rectangular core shapes have been proposed as alternative to the circular fibres to link the telescopes to spectrographs in order to increase the accuracy of radial velocity measurements. Theoretically they offer better scrambling properties than their circular counterparts. First commercial octagonal fibres provided good near field scrambling gains. Unfortunately the far field scrambling did not show important figures. This article shows test results on new fibres from CeramOptec. The measurements show substantial improvements of the far field scrambling gains. In addition, evaluation of their focal ratio degradation (FRD) shows much better performances than previous fibres.

Regional Anesthesia in Total Joint Arthroplasty: What Is the Evidence?

PubMed

Elmofty, Dalia H; Buvanendran, Asokumar

2017-09-01

Total joint arthroplasty is one of the most common surgical procedures performed for end-stage osteoarthritis. The increasing demand for knee and hip arthroplasties along with the improvement in life expectancy has created a substantial medical and economic impact on the society. Effective planning of health care for these individuals is vital. The best method for providing anesthesia and analgesia for total joint arthroplasty has not been defined. Yet, emerging evidence suggests that the type of anesthesia can affect morbidity and mortality of patients undergoing these procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

Accounting for reciprocal host-microbiome interactions in experimental science.

PubMed

Stappenbeck, Thaddeus S; Virgin, Herbert W

2016-06-09

Mammals are defined by their metagenome, a combination of host and microbiome genes. This knowledge presents opportunities to further basic biology with translation to human diseases. However, the now-documented influence of the metagenome on experimental results and the reproducibility of in vivo mammalian models present new challenges. Here we provide the scientific basis for calling on all investigators, editors and funding agencies to embrace changes that will enhance reproducible and interpretable experiments by accounting for metagenomic effects. Implementation of new reporting and experimental design principles will improve experimental work, speed discovery and translation, and properly use substantial investments in biomedical research.

BINARY STORAGE ELEMENT

DOEpatents

Chu, J.C.

1958-06-10

A binary storage device is described comprising a toggle provided with associsted improved driver circuits adapted to produce reliable action of the toggle during clearing of the toggle to one of its two states. or transferring information into and out of the toggle. The invention resides in the development of a self-regulating driver circuit to minimize the fluctuation of the driving voltages for the toggle. The disclosed driver circuit produces two pulses in response to an input pulse: a first or ''clear'' pulse beginning nt substantially the same time but endlrg slightly sooner than the second or ''transfer'' output pulse.

26 CFR 1.6043-3 - Return regarding liquidation, dissolution, termination, or substantial contraction of...

Code of Federal Regulations, 2012 CFR

2012-04-01

..., termination, or substantial contraction of organizations exempt from taxation under section 501(a). 1.6043-3..., dissolution, termination, or substantial contraction of organizations exempt from taxation under section 501(a... the organization was exempt from taxation under section 501(a) shall provide the information will...

26 CFR 1.6043-3 - Return regarding liquidation, dissolution, termination, or substantial contraction of...

Code of Federal Regulations, 2014 CFR

2014-04-01

..., termination, or substantial contraction of organizations exempt from taxation under section 501(a). 1.6043-3..., dissolution, termination, or substantial contraction of organizations exempt from taxation under section 501(a... the organization was exempt from taxation under section 501(a) shall provide the information will...

26 CFR 1.6043-3 - Return regarding liquidation, dissolution, termination, or substantial contraction of...

Code of Federal Regulations, 2013 CFR

2013-04-01

..., termination, or substantial contraction of organizations exempt from taxation under section 501(a). 1.6043-3..., dissolution, termination, or substantial contraction of organizations exempt from taxation under section 501(a... the organization was exempt from taxation under section 501(a) shall provide the information will...

26 CFR 1.6043-3 - Return regarding liquidation, dissolution, termination, or substantial contraction of...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., termination, or substantial contraction of organizations exempt from taxation under section 501(a). 1.6043-3..., dissolution, termination, or substantial contraction of organizations exempt from taxation under section 501(a... the organization was exempt from taxation under section 501(a) shall provide the information will...

Developing Asthma-Friendly Childcare Centers with Online Training and Evaluation

PubMed Central

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

2016-01-01

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

AMATS FY 1997-2000 Transportation Improvement Program

DOT National Transportation Integrated Search

1996-06-26

Planning, design and construction of major transportation capital : investment projects, such as major highway relocations and transit service expansions, are costly and time-consuming. Even relatively minor improvements require substantial investmen...

Implementing a combined polar-geostationary algorithm for smoke emissions estimation in near real time

NASA Astrophysics Data System (ADS)

Hyer, E. J.; Schmidt, C. C.; Hoffman, J.; Giglio, L.; Peterson, D. A.

2013-12-01

Polar and geostationary satellites are used operationally for fire detection and smoke source estimation by many near-real-time operational users, including operational forecast centers around the globe. The input satellite radiance data are processed by data providers to produce Level-2 and Level -3 fire detection products, but processing these data into spatially and temporally consistent estimates of fire activity requires a substantial amount of additional processing. The most significant processing steps are correction for variable coverage of the satellite observations, and correction for conditions that affect the detection efficiency of the satellite sensors. We describe a system developed by the Naval Research Laboratory (NRL) that uses the full raster information from the entire constellation to diagnose detection opportunities, calculate corrections for factors such as angular dependence of detection efficiency, and generate global estimates of fire activity at spatial and temporal scales suitable for atmospheric modeling. By incorporating these improved fire observations, smoke emissions products, such as NRL's FLAMBE, are able to produce improved estimates of global emissions. This talk provides an overview of the system, demonstrates the achievable improvement over older methods, and describes challenges for near-real-time implementation.

Hyper-Realistic, Team-Centered Fleet Surgical Team Training Provides Sustained Improvements in Performance.

PubMed

Hoang, Tuan N; Kang, Jeff; Siriratsivawong, Kris; LaPorta, Anthony; Heck, Amber; Ferraro, Jessica; Robinson, Douglas; Walsh, Jonathan

2016-01-01

The high-stress, fast-paced environment of combat casualty care relies on effective teamwork and communication which translates into quality patient care. A training course was developed for U.S. Navy Fleet Surgical Teams to address these aspects of patient care by emphasizing efficiency and appropriate patient care. An effective training course provides knowledge and skills to pass the course evaluation and sustain the knowledge and skills acquired over time. The course included classroom didactic hours, and hands-on simulation sessions. A pretest was administered before the course, a posttest upon completion, and a sustainment test 5 months following course completion. The evaluation process measured changes in patient time to disposition and critical errors made during patient care. Naval Base San Diego, with resuscitation and surgical simulations carried out within the shipboard medical spaces. United States Navy medical personnel including physicians of various specialties, corpsmen, nurses, and nurse anesthetists deploying aboard ships. Time to disposition improved significantly, 11 ± 3 minutes, from pretest to posttest, and critical errors improved by 4 ± 1 errors per encounter. From posttest to sustainment test, time to disposition increased by 3 ± 1, and critical errors decreased by 1 ± 1. This course showed value in improving teamwork and communication skills of participants, immediately upon completion of the course, and after 5 months had passed. Therefore, with ongoing sustainment activities within 6 months, this course can substantially improve trauma care provided by shipboard deployed Navy medical personnel to wounded service members. Published by Elsevier Inc.

The journey of primary care practices to meaningful use: a Colorado Beacon Consortium study.

PubMed

Fernald, Douglas H; Wearner, Robyn; Dickinson, W Perry

2013-01-01

The Health Information Technology for Economic and Clinical Health Act of 2009 provides for incentive payments through Medicare and Medicaid for clinicians who implement electronic health records (EHRs) and use this technology meaningfully to improve patient care. There are few comprehensive descriptions of how primary care practices achieve the meaningful use of clinical data, including the formal stage 1 meaningful use requirements. Evaluation of the Colorado Beacon Consortium project included iterative qualitative analysis of practice narratives, provider and staff interviews, and separate focus groups with quality improvement (QI) advisors and staff from the regional health information exchange (HIE). Most practices described significant realignment of practice priorities and aims, which often required substantial education and training of physicians and staff. Re-engineering office processes, data collection protocols, EHRs, staff roles, and practice culture comprised the primary effort and commitment to attest to stage 1 meaningful use and subsequent meaningful use of clinical data. While realizing important benefits, practices bore a significant burden in learning the true capabilities of their EHRs with little effective support from vendors. Attestation was an important initial milestone in the process, but practices faced substantial ongoing work to use their data meaningfully for patient care and QI. Key resources were instrumental to these practices: local technical EHR expertise; collaborative learning mechanisms; and regular contact and support from QI advisors. Meeting the stage 1 requirements for incentives under Medicare and Medicaid meaningful use criteria is the first waypoint in a longer journey by primary care practices to the meaningful use of electronic data to continuously improve the care and health of their patients. The intensive re-engineering effort for stage 1 yielded practice changes consistent with larger practice aims and goals. While many of these practices are now poised to use data meaningfully, faster progress will likely come with continued local QI and technical support and planned community-wide learning.

Strategies to improve water productivity in a water-stressed future

USDA-ARS?s Scientific Manuscript database

In the fiscal years 2011 through 2014, ARS scientists and engineers made substantial progress in addressing research problems related to improving water productivity and creating new knowledge, products and outcomes to improve American agricultural production, efficiency of resource use, safety and ...

Strengthening of certain types of arch dams at broad sites

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

Kaganov, G. M.; Volkov, V. I.; Uchevatkin, A. A.

2012-01-15

The problem of strengthening defective and damaged arch dams is formulated, and methodical calculations are performed to substantiate a set of structural and production measures permitting substantial improvement in the stress-strain state and an increase in the safety factor of the structure. Feasibility of practical implementation of the results is foreseen.

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

PubMed

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

2015-05-01

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

Craft Training in Russia: Theory and Practice of Development

ERIC Educational Resources Information Center

Romantsev, Gennadij M.; Efanov, Andrei V.; Moiseev, Andrei V.; Bychkova, Ekaterina Yu.; Karpova, Natalia P.; Tidemann, Bruno

2016-01-01

The relevance of the research topic is substantiated by the social commitment to the establishment of a system of craft training focused on training personnel for craft enterprises. The purpose of the article is to provide theoretical and methodological substantiation of the necessity to provide organizational and pedagogical foundations for the…

Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial.

PubMed

Graham, Hamish R; Ayede, Adejumoke I; Bakare, Ayobami A; Oyewole, Oladapo B; Peel, David; Gray, Amy; McPake, Barbara; Neal, Eleanor; Qazi, Shamim; Izadnegahdar, Rasa; Falade, Adegoke G; Duke, Trevor

2017-10-27

Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity. This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies. We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018. Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally. Australian New Zealand Clinical Trials Registry: ACTRN12617000341325 . Retrospectively registered on 6 March 2017.

Project ORDER: Organization for Responsibility, Dependability, Education and Reality. Evaluation Report 1974-75.

ERIC Educational Resources Information Center

North Forest Independent School District, Houston, TX.

Project ORDER is a pilot project tested in an urban middle school in Houston, Texas. The program was intended to improve the general school atmosphere; to improve students' attitudes toward the school, its program, faculty, and administration; to show significant improvement in pupil behavior; and to substantially improve teaching-learning…

AIRS Version 6 Products and Data Services at NASA GES DISC

NASA Astrophysics Data System (ADS)

Ding, F.; Savtchenko, A. K.; Hearty, T. J.; Theobald, M. L.; Vollmer, B.; Esfandiari, E.

2013-12-01

The NASA Goddard Earth Sciences Data and Information Services Center (GES DISC) is the home of processing, archiving, and distribution services for data from the Atmospheric Infrared Sounder (AIRS) mission. The AIRS mission is entering its 11th year of global observations of the atmospheric state, including temperature and humidity profiles, outgoing longwave radiation, cloud properties, and trace gases. The GES DISC, in collaboration with the AIRS Project, released data from the Version 6 algorithm in early 2013. The new algorithm represents a significant improvement over previous versions in terms of greater stability, yield, and quality of products. Among the most substantial advances are: improved soundings of Tropospheric and Sea Surface Temperatures; larger improvements with increasing cloud cover; improved retrievals of surface spectral emissivity; near-complete removal of spurious temperature bias trends seen in earlier versions; substantially improved retrieval yield (i.e., number of soundings accepted for output) for climate studies; AIRS-Only retrievals with comparable accuracy to AIRS+AMSU (Advanced Microwave Sounding Unit) retrievals; and more realistic hemispheric seasonal variability and global distribution of carbon monoxide. The GES DISC is working to bring the distribution services up-to-date with these new developments. Our focus is on popular services, like variable subsetting and quality screening, which are impacted by the new elements in Version 6. Other developments in visualization services, such as Giovanni, Near-Real Time imagery, and a granule-map viewer, are progressing along with the introduction of the new data; each service presents its own challenge. This presentation will demonstrate the most significant improvements in Version 6 AIRS products, such as newly added variables (higher resolution outgoing longwave radiation, new cloud property products, etc.), the new quality control schema, and improved retrieval yields. We will also demonstrate the various distribution and visualization services for AIRS data products. The cloud properties, model physics, and water and energy cycles research communities are invited to take advantage of the improvements in Version 6 AIRS products and the various services at GES DISC which provide them.

Testosterone replacement therapy and the internet: an assessment of providers' health-related web site information content.

PubMed

Oberlin, Daniel T; Masson, Puneet; Brannigan, Robert E

2015-04-01

To compare how providers of testosterone replacement therapy (TRT) in large metropolitan cities promote androgen replacement on their patient-oriented Web sites. TRT provider Web sites were identified using Google search and the terms "Testosterone replacement" and the name of the 5 most populous US cities. These Web sites were assessed for (1) type or specialty of medical provider, (2) discussion of the benefits and risks of TRT, and (3) industry affiliations. In total, 75 Web sites were evaluated. Twenty-seven of the 75 clinics (36%) were directed by nonphysicians, 35 (47%) were overseen by nonurology or nonendocrine physicians, and only 13 (17%) were specialist managed. Fourteen of 75 (18.6%) Web sites disclosed industry relationships. Ninety-five percent of Web sites promoted the benefits of TRT including improved sex drive, cognitive improvement, increased muscle strength, and/or improved energy. Only 20 of 75 Web sites (26.6%) described any side effect of TRT. Web sites directed by specialists were twice as likely to discuss risks of TRT compared with nonspecialist providers (41% vs 20%; odds ratio = 2.77; P <.01). Nine of 75 (12%) of all Web sites actually refuted that TRT was associated with significant side effects. Urologists and endocrinologists are in the minority of providers promoting TRT on the Internet. Specialists are more likely to discuss risks associated with TRT although the majority of surveyed Web sites that promote TRT do not mention treatment risks. There is substantial variability in quality and quantity of information on provider Web sites, which may contribute to misinformation regarding this prevalent health issue. Copyright © 2015 Elsevier Inc. All rights reserved.

75 FR 64683 - Liability for Termination of Single-Employer Plans; Treatment of Substantial Cessation of Operations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-20

... Termination of Single-Employer Plans; Treatment of Substantial Cessation of Operations AGENCY: Pension Benefit... cessations of operations by employers that maintain single-employer plans. DATES: Comments must be submitted... 4062(e), which provides for reporting of and liability for certain substantial cessations of operations...

26 CFR 1.6043-3 - Return regarding liquidation, dissolution, termination, or substantial contraction of...

Code of Federal Regulations, 2010 CFR

2010-04-01

..., termination, or substantial contraction of organizations exempt from taxation under section 501(a). 1.6043-3..., termination, or substantial contraction of organizations exempt from taxation under section 501(a). (a) In... organization was exempt from taxation under section 501(a) shall provide the information will respect to such...

42 CFR 418.66 - Condition of participation: Nursing services-Waiver of requirement that substantially all nursing...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Nursing services-Waiver of requirement that substantially all nursing services be routinely provided directly by a hospice... Services § 418.66 Condition of participation: Nursing services—Waiver of requirement that substantially all...

42 CFR 418.66 - Condition of participation: Nursing services-Waiver of requirement that substantially all nursing...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Condition of participation: Nursing services-Waiver of requirement that substantially all nursing services be routinely provided directly by a hospice... Services § 418.66 Condition of participation: Nursing services—Waiver of requirement that substantially all...

Conformational dynamics of a crystalline protein from microsecond-scale molecular dynamics simulations and diffuse X-ray scattering.

PubMed

Wall, Michael E; Van Benschoten, Andrew H; Sauter, Nicholas K; Adams, Paul D; Fraser, James S; Terwilliger, Thomas C

2014-12-16

X-ray diffraction from protein crystals includes both sharply peaked Bragg reflections and diffuse intensity between the peaks. The information in Bragg scattering is limited to what is available in the mean electron density. The diffuse scattering arises from correlations in the electron density variations and therefore contains information about collective motions in proteins. Previous studies using molecular-dynamics (MD) simulations to model diffuse scattering have been hindered by insufficient sampling of the conformational ensemble. To overcome this issue, we have performed a 1.1-μs MD simulation of crystalline staphylococcal nuclease, providing 100-fold more sampling than previous studies. This simulation enables reproducible calculations of the diffuse intensity and predicts functionally important motions, including transitions among at least eight metastable states with different active-site geometries. The total diffuse intensity calculated using the MD model is highly correlated with the experimental data. In particular, there is excellent agreement for the isotropic component of the diffuse intensity, and substantial but weaker agreement for the anisotropic component. Decomposition of the MD model into protein and solvent components indicates that protein-solvent interactions contribute substantially to the overall diffuse intensity. We conclude that diffuse scattering can be used to validate predictions from MD simulations and can provide information to improve MD models of protein motions.

Continuous glucose monitoring reveals different glycemic responses of moderate- vs high-carbohydrate lunch meals in people with type 2 diabetes.

PubMed

Powers, Margaret A; Cuddihy, Robert M; Wesley, David; Morgan, Blaine

2010-12-01

This single-center, meal-intervention, crossover study was conducted to determine the glycemic response to fixed meals with varying carbohydrate content. Continuous glucose monitoring was used to document the glycemic response. Participants were 14 people with type 2 diabetes on metformin only. On 4 consecutive days in March or July 2008, study participants consumed a fixed breakfast and one of two test meals (lunch) provided in random order. The two lunch types varied only in carbohydrate content; the protein, fat, fiber, and glycemic index were similar. They consumed no caloric food or beverages for 4 hours after each meal. Consuming double the carbohydrate content did not double the glycemic response variables, yet most were substantially different in glucose value (mg/dL) or minutes. General linear model analyses revealed substantial differences for peak glucose, change from baseline glucose to peak, time to return to preprandial glucose, 4-hour glucose area under the curve, and 4-hour mean glucose. Continuous glucose monitoring data provided a robust description of the glycemic response to the two meals. Such data can help improve postprandial glucose levels through more informed nutrition recommendations and synchronization of food intake, diabetes medication, and/or physical activity. Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Computerised Analysis of Telemonitored Respiratory Sounds for Predicting Acute Exacerbations of COPD.

PubMed

Fernandez-Granero, Miguel Angel; Sanchez-Morillo, Daniel; Leon-Jimenez, Antonio

2015-10-23

Chronic obstructive pulmonary disease (COPD) is one of the commonest causes of death in the world and poses a substantial burden on healthcare systems and patients' quality of life. The largest component of the related healthcare costs is attributable to admissions due to acute exacerbation (AECOPD). The evidence that might support the effectiveness of the telemonitoring interventions in COPD is limited partially due to the lack of useful predictors for the early detection of AECOPD. Electronic stethoscopes and computerised analyses of respiratory sounds (CARS) techniques provide an opportunity for substantial improvement in the management of respiratory diseases. This exploratory study aimed to evaluate the feasibility of using: (a) a respiratory sensor embedded in a self-tailored housing for ageing users; (b) a telehealth framework; (c) CARS and (d) machine learning techniques for the remote early detection of the AECOPD. In a 6-month pilot study, 16 patients with COPD were equipped with a home base-station and a sensor to daily record their respiratory sounds. Principal component analysis (PCA) and a support vector machine (SVM) classifier was designed to predict AECOPD. 75.8% exacerbations were early detected with an average of 5 ± 1.9 days in advance at medical attention. The proposed method could provide support to patients, physicians and healthcare systems.

Future directions in high-pressure neutron diffraction

NASA Astrophysics Data System (ADS)

Guthrie, M.

2015-04-01

The ability to manipulate structure and properties using pressure has been well known for many centuries. Diffraction provides the unique ability to observe these structural changes in fine detail on lengthscales spanning atomic to nanometre dimensions. Amongst the broad suite of diffraction tools available today, neutrons provide unique capabilities of fundamental importance. However, to date, the growth of neutron diffraction under extremes of pressure has been limited by the weakness of available sources. In recent years, substantial government investments have led to the construction of a new generation of neutron sources while existing facilities have been revitalized by upgrades. The timely convergence of these bright facilities with new pressure-cell technologies suggests that the field of high-pressure (HP) neutron science is on the cusp of substantial growth. Here, the history of HP neutron research is examined with the hope of gleaning an accurate prediction of where some of these revolutionary capabilities will lead in the near future. In particular, a dramatic expansion of current pressure-temperature range is likely, with corresponding increased scope for extreme-conditions science with neutron diffraction. This increase in coverage will be matched with improvements in data quality. Furthermore, we can also expect broad new capabilities beyond diffraction, including in neutron imaging, small angle scattering and inelastic spectroscopy.

ASSESSING PARENTING IN THE CONTEXT OF REUNIFICATION OF INFANTS/TODDLERS AND THEIR FAMILIES: HOW TO FACE THE CHALLENGES?

PubMed

Vischer, Anne-Fleur W K; Grietens, Hans; Knorth, Erik J; Mulder, Hans

2017-05-01

Since a substantial portion of infants and toddlers reenter care after reunification, the question of whether family reunification is feasible needs to be answered very cautiously. How parenting is assessed is of major importance in answering this question, but the quality of these assessments is often poor. With an eye to improving current practice, we conducted an integrative review, in which we analyzed the challenges related to the assessment of parenting vis-à-vis reunification and linked relevant knowledge from research with significant know-how from practice. The challenges appear to be embedded in the struggle to define (especially good enough) parenting and the complex context of child protection. As an answer to the challenges, the integrative review resulted in a framework of four key components required for sufficient parenting-assessment practice: (a) the use and development of expertise; and (b) providing families aiming for reunification with an intervention that is intensive, (c) flexible, and (d) organized as teamwork. Providing families with such an intervention gives them the opportunity to make substantial changes in their parenting and helps professionals assess the capacity of parents to grow to an acceptable level of caretaking for their child. Further implications for research and practice are discussed. © 2017 Michigan Association for Infant Mental Health.

Multiple stage multiple filter hydrate store

DOEpatents

Bjorkman, H.K. Jr.

1983-05-31

An improved hydrate store for a metal halogen battery system is disclosed which employs a multiple stage, multiple filter means for separating the halogen hydrate from the liquid used in forming the hydrate. The filter means is constructed in the form of three separate sections which combine to substantially cover the interior surface of the store container. Exit conduit means is provided in association with the filter means for transmitting liquid passing through the filter means to a hydrate former subsystem. The hydrate former subsystem combines the halogen gas generated during the charging of the battery system with the liquid to form the hydrate in association with the store. Relief valve means is interposed in the exit conduit means for controlling the operation of the separate sections of the filter means, such that the liquid flow through the exit conduit means from each of the separate sections is controlled in a predetermined sequence. The three separate sections of the filter means operate in three discrete stages to provide a substantially uniform liquid flow to the hydrate former subsystem during the charging of the battery system. The separation of the liquid from the hydrate causes an increase in the density of the hydrate by concentrating the hydrate along the filter means. 7 figs.

Multiple stage multiple filter hydrate store

DOEpatents

Bjorkman, Jr., Harry K.

1983-05-31

An improved hydrate store for a metal halogen battery system is disclosed which employs a multiple stage, multiple filter means or separating the halogen hydrate from the liquid used in forming the hydrate. The filter means is constructed in the form of three separate sections which combine to substantially cover the interior surface of the store container. Exit conduit means is provided in association with the filter means for transmitting liquid passing through the filter means to a hydrate former subsystem. The hydrate former subsystem combines the halogen gas generated during the charging of the battery system with the liquid to form the hydrate in association with the store. Relief valve means is interposed in the exit conduit means for controlling the operation of the separate sections of the filter means, such that the liquid flow through the exit conduit means from each of the separate sections is controlled in a predetermined sequence. The three separate sections of the filter means operate in three discrete stages to provide a substantially uniform liquid flow to the hydrate former subsystem during the charging of the battery system. The separation of the liquid from the hydrate causes an increase in the density of the hydrate by concentrating the hydrate along the filter means.

Cancer survivorship: challenges and changing paradigms.

PubMed

Gilbert, Scott M; Miller, David C; Hollenbeck, Brent K; Montie, James E; Wei, John T

2008-02-01

We summarize the potential issues faced by cancer survivors, define a conceptual framework for cancer survivorship, describe challenges associated with improving the quality of survivorship care and outline proposed survivorship programs that may be implemented going forward. We performed a nonsystematic review of current cancer survivorship literature. Given the comprehensive scope and high profile, the recent report by the Institute of Medicine, From Cancer Patient to Cancer Survivor: Lost in Transition, served as the principal guide for the review. In recognition of the increasing number of cancer survivors in the United States survivorship has become an important health care concern. The recent report by the Institute of Medicine comprehensively outlined deficits in the care provided to cancer survivors, and proposed mechanisms to improve the coordination and quality of followup care for this increasing number of Americans. Measures to achieve these objectives include improving communication between health care providers through a survivorship care plan, providing evidence based surveillance guidelines and assessing different models of survivorship care. Implementing coordinated survivorship care broadly will require additional health care resources, and commitment from health care providers and payers. Research demonstrating the effectiveness of survivorship care will be important on this front. Potential shortcomings in the recognition and management of ongoing issues faced by cancer survivors may impact the overall quality of long-term care in this increasing population. Although programs to address these issues have been proposed, there is substantial work to be done in this area.

National quality improvement policies and strategies in European healthcare systems.

PubMed

Spencer, E; Walshe, K

2009-02-01

This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact. A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems. There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement. Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer.

Improving LHC searches for dark photons using lepton-jet substructure

NASA Astrophysics Data System (ADS)

Barello, G.; Chang, Spencer; Newby, Christopher A.; Ostdiek, Bryan

2017-03-01

Collider signals of dark photons are an exciting probe for new gauge forces and are characterized by events with boosted lepton jets. Existing techniques are efficient in searching for muonic lepton jets but due to substantial backgrounds have difficulty constraining lepton jets containing only electrons. This is unfortunate since upcoming intensity frontier experiments are sensitive to dark photon masses which only allow electron decays. Analyzing a recently proposed model of kinetic mixing, with new scalar particles decaying into dark photons, we find that existing techniques for electron jets can be substantially improved. We show that using lepton-jet-substructure variables, in association with a boosted decision tree, improves background rejection, significantly increasing the LHC's reach for dark photons in this region of parameter space.

Restricting resident work hours: the good, the bad, and the ugly.

PubMed

Peets, Adam; Ayas, Najib T

2012-03-01

Inadequate sleep and long work hours are long-standing traditions in the medical profession, and work schedules are especially intense in resident physicians. However, it has been increasingly recognized that the extreme hours commonly worked by residents may have substantial occupational and patient safety consequences. Largely because of these concerns, new regulations related to resident work hours came into effect July 2011, in the United States. Residents in their first year of training are now restricted to a maximum shift length of 16 hrs, with residents in subsequent years restricted to a maximum of 24 hrs. The purpose of this review is to summarize the literature regarding resident work hours in the intensive care unit, focusing on the potential positive and negative impacts of work hour limits. The authors electronically searched MEDLINE, manually searched reference lists from retrieved articles, and reviewed their own personal databases for articles relevant to resident work hour limits. To function well, humans, including physicians, require adequate sleep. Resident work hour limits will likely reduce the incidence of fatigue-related medical errors and improve resident safety and quality of life. However, a reduction in work hours may not represent the panacea for patient safety given the potential for increased errors because of discontinuity. Furthermore, there may be other substantial negative impacts, including reduced clinical exposure, erosion of professionalism, and inadequate preparation for independent practice. Costs of implementation are likely to be substantial. Currently, there is fairly limited evidence available, and a more in-depth understanding of this complex topic is required to design a residency experience that will provide the next generation of physicians the best compromise between education, experience, and quality patient care. In the end, the primary goal of the postgraduate medical education system must be to ensure the creation of healthy physicians who can provide excellent clinical care in this complex interdisciplinary medical industry and who will have long fulfilling careers providing this outstanding care to their patients.