Object instance recognition using motion cues and instance specific appearance models

NASA Astrophysics Data System (ADS)

Schumann, Arne

2014-03-01

In this paper we present an object instance retrieval approach. The baseline approach consists of a pool of image features which are computed on the bounding boxes of a query object track and compared to a database of tracks in order to find additional appearances of the same object instance. We improve over this simple baseline approach in multiple ways: 1) we include motion cues to achieve improved robustness to viewpoint and rotation changes, 2) we include operator feedback to iteratively re-rank the resulting retrieval lists and 3) we use operator feedback and location constraints to train classifiers and learn an instance specific appearance model. We use these classifiers to further improve the retrieval results. The approach is evaluated on two popular public datasets for two different applications. We evaluate person re-identification on the CAVIAR shopping mall surveillance dataset and vehicle instance recognition on the VIVID aerial dataset and achieve significant improvements over our baseline results.

QUANTIFYING THE CLIMATE, AIR QUALITY AND HEALTH BENEFITS OF IMPROVED COOKSTOVES: AN INTEGRATED LABORATORY, FIELD AND MODELING STUDY

EPA Science Inventory

Expected results and outputs include: extensive dataset of in-field and laboratory emissions data for traditional and improved cookstoves; parameterization to predict cookstove emissions from drive cycle data; indoor and personal exposure data for traditional and improved cook...

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

Simpson, L.

ITN Energy Systems, Inc., and Global Solar Energy, Inc., with the assistance of NREL's PV Manufacturing R&D program, have continued the advancement of CIGS production technology through the development of trajectory-oriented predictive/control models, fault-tolerance control, control-platform development, in-situ sensors, and process improvements. Modeling activities to date include the development of physics-based and empirical models for CIGS and sputter-deposition processing, implementation of model-based control, and application of predictive models to the construction of new evaporation sources and for control. Model-based control is enabled through implementation of reduced or empirical models into a control platform. Reliability improvement activities include implementation of preventivemore » maintenance schedules; detection of failed sensors/equipment and reconfiguration to continue processing; and systematic development of fault prevention and reconfiguration strategies for the full range of CIGS PV production deposition processes. In-situ sensor development activities have resulted in improved control and indicated the potential for enhanced process status monitoring and control of the deposition processes. Substantial process improvements have been made, including significant improvement in CIGS uniformity, thickness control, efficiency, yield, and throughput. In large measure, these gains have been driven by process optimization, which, in turn, have been enabled by control and reliability improvements due to this PV Manufacturing R&D program. This has resulted in substantial improvements of flexible CIGS PV module performance and efficiency.« less

Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial

PubMed Central

2013-01-01

Background England’s extensive NHS patient survey programme has not fulfilled government promises of widespread improvements in patients’ experiences, and media reports of poor nursing care in NHS hospitals are increasingly common. Impediments to the surveys’ impact on the quality of nursing care may include: the fact that they are not ward-specific, so nurses claim “that doesn’t happen on my ward”; nurses’ scepticism about the relevance of patient feedback to their practice; and lack of prompt communication of results. The surveys’ impact could be increased by: conducting ward-specific surveys; returning results to ward staff more quickly; including patients’ written comments in reports; and offering nurses an opportunity to discuss the feedback. Very few randomised trials have been conducted to test the effectiveness of patient feedback on quality improvement and there have been few, if any, published trials of ward-specific patient surveys. Methods Over two years, postal surveys of recent inpatients were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-specific printed patient survey results including patients’ written comments sent to nurses by letter); Feedback Plus (in addition to printed results, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to questions about nursing care were used to compute wards’ average Nursing Care Scores at each interval. Nurses’ reactions to the patient feedback were recorded. Results Conducting ward-level surveys and delivering ward-specific results was feasible. Ward meetings were effective for engaging nurses and challenging scepticism and patients’ written comments stimulated interest. 4,236 (47%) patients returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between Control and Feedback Plus = 8.28 ± 7.2 (p = 0.02)). Conclusions This study provides preliminary evidence that facilitated patient feedback can improve patients’ experiences such that a full trial is justified. These findings suggest that merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward, but the addition of ward meetings had an important and significant impact. PMID:23826970

Motorized mobility scooters – The use of training/intervention and technology for improving driving skills in aging adults - A Mini-Review

PubMed Central

Toosizadeh, Nima; Bunting, Matthew; Howe, Carol; Mohler, Jane; Sprinkle, Jonathan; Najafi, Bijan

2014-01-01

Background Motorized mobility scooters (MMS) have become the most acceptable powered assistive device for those with impaired mobility, who have sufficient upper body strength and dexterity, and postural stability. Although several benefits have been attributed to MMS usage, there are likewise risks of use, including injuries and even deaths. Objective The aim of the current review was to summarize results from clinical studies regarding the enhancement of MMS driver safety with a primary focus on improving driving skills/performance using clinical approaches. We addressed three main objectives: 1) to identify and summarize any available evidence (strong, moderate, or weak evidence based on the quality of studies) regarding improved driving skills/performance following training/intervention; 2) to identify types of driving skills/performance that might be improved by training/intervention; and 3) to identify the use of technology in improving MMS performance or training procedure. Methods Articles were searched for in the following medical and engineering electronic databases: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, CINAHL, ERIC, EI Compendix, IEEE Explore, and REHABDATA. Inclusion criteria included: aging adults or those with ambulatory problems; intervention or targeted training; and clinical trial. Outcomes included: MMS skills/performance. Results Six articles met the inclusion criteria and are analyzed in this review. Four of the six articles contained training approaches for MMS drivers including skill trainings using real MMS inside and outside (i.e., in community) and in a 3D virtual environment. The other two studies contain infrastructural assessments (i.e., the minimum space required for safe maneuverability of MMS users) and additional mobility assistance tools to improve maneuverability and to enhance driving performance. Conclusions Results from the current review showed improved driving skills/performance by training, infrastructural assessments, and incorporating mobility assistance tools. MMS driving skills that can be improved through driver training include: weaving, negotiating with and avoiding pedestrian interference, simultaneous reading of signs and obstacle avoidance in path, level driving, forward and reverse driving, figure 8s, turning in place, crossing left slope, maneuvering down a 2-inch curb, and driving up and down inclines. However, several limitations exist in the available literature regarding evidence of improved driving skills/performance following training/intervention, such as small sample sizes, lack of control groups and statistical analysis. PMID:24481257

Improved pulse laser ranging algorithm based on high speed sampling

NASA Astrophysics Data System (ADS)

Gao, Xuan-yi; Qian, Rui-hai; Zhang, Yan-mei; Li, Huan; Guo, Hai-chao; He, Shi-jie; Guo, Xiao-kang

2016-10-01

Narrow pulse laser ranging achieves long-range target detection using laser pulse with low divergent beams. Pulse laser ranging is widely used in military, industrial, civil, engineering and transportation field. In this paper, an improved narrow pulse laser ranging algorithm is studied based on the high speed sampling. Firstly, theoretical simulation models have been built and analyzed including the laser emission and pulse laser ranging algorithm. An improved pulse ranging algorithm is developed. This new algorithm combines the matched filter algorithm and the constant fraction discrimination (CFD) algorithm. After the algorithm simulation, a laser ranging hardware system is set up to implement the improved algorithm. The laser ranging hardware system includes a laser diode, a laser detector and a high sample rate data logging circuit. Subsequently, using Verilog HDL language, the improved algorithm is implemented in the FPGA chip based on fusion of the matched filter algorithm and the CFD algorithm. Finally, the laser ranging experiment is carried out to test the improved algorithm ranging performance comparing to the matched filter algorithm and the CFD algorithm using the laser ranging hardware system. The test analysis result demonstrates that the laser ranging hardware system realized the high speed processing and high speed sampling data transmission. The algorithm analysis result presents that the improved algorithm achieves 0.3m distance ranging precision. The improved algorithm analysis result meets the expected effect, which is consistent with the theoretical simulation.

Using video self- and peer modeling to facilitate reading fluency in children with learning disabilities.

PubMed

Decker, Martha M; Buggey, Tom

2014-01-01

The authors compared the effects of video self-modeling and video peer modeling on oral reading fluency of elementary students with learning disabilities. A control group was also included to gauge general improvement due to reading instruction and familiarity with researchers. The results indicated that both interventions resulted in improved fluency. Students in both experimental groups improved their reading fluency. Two students in the self-modeling group made substantial and immediate gains beyond any of the other students. Discussion is included that focuses on the importance that positive imagery can have on student performance and the possible applications of both forms of video modeling with students who have had negative experiences in reading.

Positive Effects of Massage Therapy on a Patient with Narcolepsy

PubMed Central

Hill, Robyn; Baskwill, Amanda

2013-01-01

Purpose The purpose of this case report was to investigate the effects of massage therapy on the sleep patterns of a woman with narcolepsy. Participant The 23-year-old woman’s primary symptoms included excessive daytime sleepiness and periodic leg movements (PLM), which were associated with her diagnoses of both narcolepsy and cataplexy. Intervention Five 45-minute massage therapy treatments were administered over a five-week period. The patient’s sleep patterns were recorded each week before the treatment. A final measurement was recorded in the sixth week. The sleep patterns were monitored using the Leeds Sleep Evaluation Questionnaire, which included ten visual analogue scales. Results The results of this case report included an improvement in getting to sleep by 148%, an improvement in quality of sleep by 1100%, an improvement in awake following sleep by 121%, and an improvement in behaviour following wakening by 28% using the Leeds Sleep Evaluation Questionnaire. Conclusion This case report suggests that massage therapy had a positive effect on this patient with narcolepsy. Further research is needed to investigate the effects of massage therapy on narcolepsy and sleep patterns. PMID:23730398

Improved image processing of road pavement defect by infrared thermography

NASA Astrophysics Data System (ADS)

Sim, Jun-Gi

2018-03-01

This paper intends to achieve improved image processing for the clear identification of defects in damaged road pavement structure using infrared thermography non-destructive testing (NDT). To that goal, 4 types of pavement specimen including internal defects were fabricated to exploit the results obtained by heating the specimens by natural light. The results showed that defects located down to a depth of 3 cm could be detected by infrared thermography NDT using the improved image processing method.

The History and State of Neonatal Nursing Quality Improvement Practice and Education.

PubMed

Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A

2018-03-01

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

Improved Methodology for Benefit Estimation of Preservation Projects

DOT National Transportation Integrated Search

2018-04-01

This research report presents an improved process for evaluating the benefits and economic tradeoffs associated with a variety of highway preservation projects. It includes a summary of results from a comprehensive phone survey concerning the use and...

Warfarin therapy: in need of improvement after all these years

PubMed Central

Kimmel, Stephen E

2010-01-01

Background Warfarin therapy has been used clinically for over 60 years, yet continues to be problematic because of its narrow therapeutic index and large inter-individual variability in patient response. As a result, warfarin is a leading cause of serious medication-related adverse events, and its efficacy is also suboptimal. Objective To review factors that are responsible for variable response to warfarin, including clinical, environmental, and genetic factors, and to explore some possible approaches to improving warfarin therapy. Results Recent efforts have focused on developing dosing algorithms that included genetic information to try to improve warfarin dosing. These dosing algorithms hold promise, but have not been fully validated or tested in rigorous clinical trials. Perhaps equally importantly, adherence to warfarin is a major problem that should be addressed with innovative and cost-effective interventions. Conclusion Additional research is needed to further test whether interventions can be used to improve warfarin dosing and outcomes. PMID:18345947

Improvements in magnetic bearing performance for flywheel energy storage

NASA Technical Reports Server (NTRS)

Plant, David P.; Anand, Davinder K.; Kirk, James A.; Calomeris, Anthony J.; Romero, Robert L.

1988-01-01

The paper considers the development of a 500-Watt-hour magnetically suspended flywheel stack energy storage system. The work includes hardware testing results from a stack flywheel energy storage system, improvements in the area of noncontacting displacement transducers, and performance enhancements of magnetic bearings. Experimental results show that a stack flywheel energy storage system is feasible technology.

At-a-Glance B3 Resource Guide for Supporting Academic Achievement for Students with Disabilities

ERIC Educational Resources Information Center

Regional Resource Center Program, 2011

2011-01-01

This results improvement resource guide includes a listing of TA&D programs and centers that provide technical assistance related to academic achievement results improvement for students with disabilities. The website URL, target audience(s), and purpose are provided for each center/program. In addition, a brief example describing the…

The effects of Crew Resource Mangement (CRM) training in airline maintenance: Results following three years' experience

NASA Technical Reports Server (NTRS)

Taylor, J. C.; Robertson, M. M.

1995-01-01

This report describes three years' evaluation of the effects of one airline's Crew Resources Management (CRM) training operation for maintenance. This evaluation focuses on the post-training attitudes of maintenance managers' and technical support professionals, their reported behaviors, and the safety, efficiency and dependable maintenance performance of their units. The results reveal a strong positive effect of the training. The overall program represents the use of CRM training as a long-term commitment to improving performance through effective communication at all levels in airline maintenance operations. The initial findings described in our previous progress reports are reinforced and elaborated here. The current results benefit from the entire pre-post training survey, which now represents total attendance of all managers and staff professionals. Additionally there are now full results from the two-month, six-month, and 12-month follow-up questionnaires, together with as many as 33 months of post-training performance data, using several indicators. In this present report, we examine participants' attitudes, their reported behaviors following the training, the performance of their work units, and the relationships among these variables. Attitudes include those measured immediately before and after the training as well as participants' attitudes months after their training. Performance includes measures, by work units, of on-time flight departures, on-schedule maintenance releases, occupational and aircraft safety, and efficient labor costs. We report changes in these performance measures following training, as well their relationships with the training participants' attitudes. Highlights of results from this training program include increased safety and improved costs associated with positive attitudes about the use of more assertive communication, and the improved management of stress. Improved on-time performance is also related to those improved attitudes, as well as favorable attitudes about participative management.

Improving Student Outcomes with mCLASS: Math, a Technology-Enhanced CBM and Diagnostic Interview Assessment

ERIC Educational Resources Information Center

Wang, Ye; Gushta, Matthew

2013-01-01

The No Child Left Behind Act resulted in increased school-level implementation of assessment-based school interventions that aim to improve student performance. Diagnostic assessments are included among these interventions, designed to help teachers use evidence about student performance to modify and differentiate instruction and improve student…

Six Sigma in healthcare delivery.

PubMed

Liberatore, Matthew J

2013-01-01

The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

Further Examination of a Simplified Model for Positronium-Helium Scattering

NASA Technical Reports Server (NTRS)

DiRienzi, J.; Drachman, Richard J.

2012-01-01

While carrying out investigations on Ps-He scattering we realized that it would be possible to improve the results of a previous work on zero-energy scattering of ortho-positronium by helium atoms. The previous work used a model to account for exchange and also attempted to include the effect of short-range Coulomb interactions in the close-coupling approximation. The 3 terms that were then included did not produce a well-converged result but served to give some justification to the model. Now we improve the calculation by using a simple variational wave function, and derive a much better value of the scattering length. The new result is compared with other computed values, and when an approximate correction due to the van der Waals potential is included the total is consistent with an earlier conjecture.

Improvement of reusable surface insulation material

NASA Technical Reports Server (NTRS)

1972-01-01

The results are presented of a program to improve the reusable surface insulation (RSI) system through the improvement of the LI-1500 material properties and the simplification of the RSI system. The improvements made include: 2500 F-capability RSI systems, water-impervious surface coatings, establishment of a high-emittance coating constituent, development of a secondary water-reduction system, and achievement of a lower density (9 pcf) RSI material.

Final Technical Report. Project Boeing SGS

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

Bell, Thomas E.

Boeing and its partner, PJM Interconnection, teamed to bring advanced “defense-grade” technologies for cyber security to the US regional power grid through demonstration in PJM’s energy management environment. Under this cooperative project with the Department of Energy, Boeing and PJM have developed and demonstrated a host of technologies specifically tailored to the needs of PJM and the electric sector as a whole. The team has demonstrated to the energy industry a combination of processes, techniques and technologies that have been successfully implemented in the commercial, defense, and intelligence communities to identify, mitigate and continuously monitor the cyber security of criticalmore » systems. Guided by the results of a Cyber Security Risk-Based Assessment completed in Phase I, the Boeing-PJM team has completed multiple iterations through the Phase II Development and Phase III Deployment phases. Multiple cyber security solutions have been completed across a variety of controls including: Application Security, Enhanced Malware Detection, Security Incident and Event Management (SIEM) Optimization, Continuous Vulnerability Monitoring, SCADA Monitoring/Intrusion Detection, Operational Resiliency, Cyber Range simulations and hands on cyber security personnel training. All of the developed and demonstrated solutions are suitable for replication across the electric sector and/or the energy sector as a whole. Benefits identified include; Improved malware and intrusion detection capability on critical SCADA networks including behavioral-based alerts resulting in improved zero-day threat protection; Improved Security Incident and Event Management system resulting in better threat visibility, thus increasing the likelihood of detecting a serious event; Improved malware detection and zero-day threat response capability; Improved ability to systematically evaluate and secure in house and vendor sourced software applications; Improved ability to continuously monitor and maintain secure configuration of network devices resulting in reduced vulnerabilities for potential exploitation; Improved overall cyber security situational awareness through the integration of multiple discrete security technologies into a single cyber security reporting console; Improved ability to maintain the resiliency of critical systems in the face of a targeted cyber attack of other significant event; Improved ability to model complex networks for penetration testing and advanced training of cyber security personnel« less

Geotechnical Centrifuge Experiments to Evaluate Piping in Foundation Soils

DTIC Science & Technology

2014-05-01

verifiable results. These tests were successful in design , construction, and execution of a realistic simulation of internal erosion leading to failure...possible “scale effects,” “modeling of models” testing protocol should be included in the test program. Also, the model design should minimize the scale...recommendations for improving the centrifuge tests include the following: • Design improved system for reservoir control to provide definitive and

Improvements to the FATOLA computer program including nosewheel steering: Supplemental instruction manual

NASA Technical Reports Server (NTRS)

Carden, H. D.; Mcgehee, J. R.

1978-01-01

Modifications to a multidegree of freedom flexible aircraft take-off and landing analysis (FATOLA) computer program, which improved its simulation capabilities, are discussed, and supplemental instructions for use of the program are included. Sample analytical results which illustrate the capabilities of an added nosewheel steering option indicate consistent behavior of the airplane tracking, attitude, motions, and loads for the landing cases and steering situations which were investigated.

Improving nutritional status in a pediatric cystic fibrosis center.

PubMed

Ramírez, Ixsy; Filbrun, Amy; Hasan, Aws; Kidwell, Kelley M; Nasr, Samya Z

2015-06-01

The nutritional status of patients with cystic fibrosis (CF) is strongly associated with pulmonary function, respiratory status and survival. Malnutrition could result from a discrepancy between energy needs and food intake while malabsorption results from pancreatic insufficiency which occurs in 85% of people with CF. A quality improvement (QI) project was designed to improve the nutritional status of patients with CF with low Body Mass Index (BMI) between 3 and 19 years of age. An algorithm was developed which included clinic-based assessments of patients' nutritional status and periodic assessment by a dietitian, social worker and/or psychologist during the project. Gastrostomy tube placement and feeding was offered as a last resort to improve caloric intake. 173 patients seen during January-June, 2010, were included in this project. They were classified into four BMI groups and data were collected quarterly through June, 2012. The project target population (BMI percentile ≤ 24) had a median BMI percentile at the start of the project of 11.8. At the end of the project median BMI percentile was 22 (46% improvement). Improving nutrition and BMI for patients with CF is achievable. There must be a motivated, multi-disciplinary team that includes patients and families. A patient-specific combination of interventions must be used. These interventions could be quite basic for patients with BMI percentile ≥ 25, yet more elaborate for patients with BMI percentile <25. Clinic-based algorithms such as ours can successfully improve the BMI percentile in patients with CF. © 2014 Wiley Periodicals, Inc.

Research activities to improve the utilization of antibiotics in Africa.

PubMed

Massele, Amos; Tiroyakgosi, Celda; Matome, Matshediso; Desta, Abayneh; Muller, Arno; Paramadhas, Bene D Anand; Malone, Brighid; Kurusa, Gobuiwang; Didimalang, Thatayaone; Moyo, Mosana; Godman, Brian

2017-02-01

There is a need to improve the rational use of antibiotics across continents including Africa. This has resulted in initiatives in Botswana including treatment guidelines and the instigation of Antibiotic Stewardship Programs (ASPs). The next steps involve a greater understanding of current antibiotic utilization and resistance patterns (AMR). This resulted in a 2-day meeting involving key stakeholders principally from Botswana to discuss key issues including AMR rates as well as ASPs in both the public and private sectors. Following this, the findings will be used to plan future studies across Africa including point prevalence studies. The findings will be presented in July 2016 at the next Medicines Utilization Research in Africa meeting will ideally serve as a basis for planning future pertinent interventional studies to enhance the rational use of antibiotics in Botswana and wider.

Fiber composite fan blade impact improvement program

NASA Technical Reports Server (NTRS)

Oller, T. L.

1976-01-01

The results of a 20-month program, designed to investigate parameters which effect the foreign object damage resulting from ingestion of birds into fan blades are described. Work performed on this program included the design, fabrication, and impact testing of QCSEE fan blades to demonstrate improvement in resistance relative to existing blades and also the design and demonstration of a pin root attachment concept.

Strategy for the Management of Macular Edema in Retinal Vein Occlusion: The European VitreoRetinal Society Macular Edema Study

PubMed Central

Adelman, Ron A.; Parnes, Aaron J.; Bopp, Silvia; Saad Othman, Ihab; Ducournau, Didier

2015-01-01

Objective. To compare the efficacy of different therapies in the treatment of macular edema associated with retinal vein occlusion (RVO). Design. This is a nonrandomized, multicenter collaborative study. Participants. 86 retina specialists from 29 countries provided clinical information, including choice of treatment and outcome, on 2,603 patients with macular edema including 738 cases of RVO. Methods. Reported data included the type and number of treatments performed, visual acuities, and other clinical and diagnostic findings. Main Outcome Measures. The mean increase in visual acuity and mean number of treatments performed. Results. 358 cases of central retinal vein occlusion (CRVO) and 380 cases of branch retinal vein occlusion (BRVO) were included in this investigation. Taking all RVO cases together, pars plana vitrectomy with internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than other therapies. Those treated with intravitreal antivascular endothelial growth factor (anti-VEGF) injection alone showed the second greatest improvement in vision. Dexamethasone intravitreal implant alone and intravitreal triamcinolone alone both resulted in modest visual gains. Conclusions. In the treatment of macular edema in RVO, vitrectomy with ILM peeling may achieve visual improvement and may be a good option for certain cases. Anti-VEGF injection is the most effective of the nonsurgical treatments. PMID:25705695

The Early Grade Reading Assessment: Applications and Interventions to Improve Basic Literacy

ERIC Educational Resources Information Center

Gove, Amber, Ed.; Wetterberg, Anna, Ed.

2011-01-01

This book highlights the experience of Liberia in both assessing and improving reading in primary schools. As a result of an Early Grade Reading Assessment, the Ministry of Education and partners, including the United States Agency for International Development, came together to identify and develop strategies for improving reading in schools.…

Helping agencies improve their planning analysis techniques.

DOT National Transportation Integrated Search

2011-11-18

This report summarizes the results of a peer review of the AZTDM. The peer review was : supported by the Travel Model Improvement Program (TMIP), which is sponsored by FHWA. : The peer review of a travel model can serve multiple purposes, including i...

Improved business driveway delineation in urban work zones.

DOT National Transportation Integrated Search

2015-04-01

This report documents the efforts and results of a two-year research project aimed at improving driveway : delineation in work zones. The first year of the project included a closed-course study to identify the most : promising driveway delineation a...

ISPI's Value Proposition: Two Examples.

ERIC Educational Resources Information Center

Swinney, John

2003-01-01

Describes two experiences that illustrate the value of the International Society for Performance Improvement (ISPI). Highlights include measuring organizational results; identifying opportunities to improve performance; training as part of the solution; the role of ISD (instructional systems design); HPT (human performance technology) issues; and…

Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

PubMed

Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

2015-09-01

A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

Civil propulsion technology for the next twenty-five years

NASA Technical Reports Server (NTRS)

Rosen, Robert; Facey, John R.

1987-01-01

The next twenty-five years will see major advances in civil propulsion technology that will result in completely new aircraft systems for domestic, international, commuter and high-speed transports. These aircraft will include advanced aerodynamic, structural, and avionic technologies resulting in major new system capabilities and economic improvements. Propulsion technologies will include high-speed turboprops in the near term, very high bypass ratio turbofans, high efficiency small engines and advanced cycles utilizing high temperature materials for high-speed propulsion. Key fundamental enabling technologies include increased temperature capability and advanced design methods. Increased temperature capability will be based on improved composite materials such as metal matrix, intermetallics, ceramics, and carbon/carbon as well as advanced heat transfer techniques. Advanced design methods will make use of advances in internal computational fluid mechanics, reacting flow computation, computational structural mechanics and computational chemistry. The combination of advanced enabling technologies, new propulsion concepts and advanced control approaches will provide major improvements in civil aircraft.

Promoting clinical and laboratory interaction by harmonization.

PubMed

Plebani, Mario; Panteghini, Mauro

2014-05-15

The lack of interchangeable results in current practice among clinical laboratories has underpinned greater attention to standardization and harmonization projects. Although the focus was mainly on the standardization and harmonization of measurement procedures and their results, the scope of harmonization goes beyond method and analytical results: it includes all other aspects of laboratory testing, including terminology and units, report formats, reference limits and decision thresholds, as well as test profiles and criteria for the interpretation of results. In particular, as evidence collected in last decades demonstrates that pre-pre- and post-post-analytical steps are more vulnerable to errors, harmonization initiatives should be performed to improve procedures and processes at the laboratory-clinical interface. Managing upstream demand, down-stream interpretation of laboratory results, and subsequent appropriate action through close relationships between laboratorians and clinicians remains a crucial issue of the laboratory testing process. Therefore, initiatives to improve test demand management from one hand and to harmonize procedures to improve physicians' acknowledgment of laboratory data and their interpretation from the other hand are needed in order to assure quality and safety in the total testing process. © 2013.

National Airspace System Plan: Facilities, Equipment, Associated Development and Other Capital Needs

DTIC Science & Technology

1988-06-01

services will reflect a yes include: better balance between trip frequency and cost than would be the case under a closely regulated 0 Having an operating...terminal system). 0 Improved traffic flow planning and manage- ment, resulting in a more balanced workload. 0 A major improvement and integration of the...The AAS supervisors and specialists to assist them in will include AERA I functions and facilitate balancing sector staffing levels, later

Partnering With a Family Advisor to Improve Communication in a Pediatric Intensive Care Unit.

PubMed

Czulada, Laura; Leino, Patience; Willis, Tina Schade

2016-11-01

Inadequate communication between medical teams and families can lead to errors and poor-quality care. The objective was to understand why communication between the clinical team and families was not occurring consistently in the pediatric intensive care unit and improve the system using a multidisciplinary improvement team including a family advisor. This improvement project used Lean Six Sigma. The team observed updates and collected documented communication, survey, interview, and focus group data from families and staff. Root causes of failures included lack of assigned responsibility, lack of defined daily update, and lack of a daily communication standard. Process changes were implemented, resulting in an increased mean documented communication rate from 13% pre intervention to 65% post intervention that was sustained for more than 2 years (P < .001). Including a family advisor as an equal member of an improvement team provides family empowerment and a greater chance of success in complex areas. © The Author(s) 2015.

Combat Ration Network for Technology Implementation (CORANET II) Knurled Seal Heat Bar

DTIC Science & Technology

2010-08-01

bench top comparison of ultrasonic sealing technology that included the participation of five ultrasonic sealing equipment manufacturers . Project...packaging journals • On-line web search yielded no useful research results • Contact with machine manufactures produced anecdotal evidence of improved...seal characteristics without documentation or research results • One manufacturer suggested rounded seal bars or seal rubbers for improved sealing

Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults

PubMed Central

Taylor-Piliae, Ruth E.; Newell, Kathryn A.; Cherin, Rise; Lee, Martin J.; King, Abby C.; Haskell, William L.

2015-01-01

Objective To compare the effects of Tai Chi (TC, n = 37) and Western exercise (WE, n = 39) with an attention-control group (C, n = 56) on physical and cognitive functioning in healthy adults age 69 ± 5.8 yr, in a 2-phase randomized trial. Methods TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis. Results At 6 mo, WE had greater improvements in upper body flexibility (F = 4.67, p = .01) than TC and C. TC had greater improvements in balance (F = 3.36, p = .04) and a cognitive-function measure (F = 7.75, p < .001) than WE and C. The differential cognitive-function improvements observed in TC were maintained through 12 mo. Conclusion The TC and WE interventions resulted in differential improvements in physical functioning among generally healthy older adults. TC led to improvement in an indicator of cognitive functioning that was maintained through 12 mo. PMID:20651414

Non-formal educator use of evaluation results.

PubMed

Baughman, Sarah; Boyd, Heather H; Franz, Nancy K

2012-08-01

Increasing demands for accountability in educational programming have resulted in increasing calls for program evaluation in educational organizations. Many organizations include conducting program evaluations as part of the job responsibilities of program staff. Cooperative Extension is a complex organization offering non-formal educational programs through land grant universities. Many Extension services require non-formal educational program evaluations be conducted by field-based Extension educators. Evaluation research has focused primarily on the efforts of professional, external evaluators. The work of program staff with many responsibilities including program evaluation has received little attention. This study examined how field based Extension educators (i.e. program staff) in four Extension services use the results of evaluations of programs that they have conducted themselves. Four types of evaluation use are measured and explored; instrumental use, conceptual use, persuasive use and process use. Results indicate that there are few programmatic changes as a result of evaluation findings among the non-formal educators surveyed in this study. Extension educators tend to use evaluation results to persuade others about the value of their programs and learn from the evaluation process. Evaluation use is driven by accountability measures with very little program improvement use as measured in this study. Practical implications include delineating accountability and program improvement tasks within complex organizations in order to align evaluation efforts and to improve the results of both. There is some evidence that evaluation capacity building efforts may be increasing instrumental use by educators evaluating their own programs. Copyright © 2011 Elsevier Ltd. All rights reserved.

Endometrial cancer risk prediction including serum-based biomarkers: results from the EPIC cohort.

PubMed

Fortner, Renée T; Hüsing, Anika; Kühn, Tilman; Konar, Meric; Overvad, Kim; Tjønneland, Anne; Hansen, Louise; Boutron-Ruault, Marie-Christine; Severi, Gianluca; Fournier, Agnès; Boeing, Heiner; Trichopoulou, Antonia; Benetou, Vasiliki; Orfanos, Philippos; Masala, Giovanna; Agnoli, Claudia; Mattiello, Amalia; Tumino, Rosario; Sacerdote, Carlotta; Bueno-de-Mesquita, H B As; Peeters, Petra H M; Weiderpass, Elisabete; Gram, Inger T; Gavrilyuk, Oxana; Quirós, J Ramón; Maria Huerta, José; Ardanaz, Eva; Larrañaga, Nerea; Lujan-Barroso, Leila; Sánchez-Cantalejo, Emilio; Butt, Salma Tunå; Borgquist, Signe; Idahl, Annika; Lundin, Eva; Khaw, Kay-Tee; Allen, Naomi E; Rinaldi, Sabina; Dossus, Laure; Gunter, Marc; Merritt, Melissa A; Tzoulaki, Ioanna; Riboli, Elio; Kaaks, Rudolf

2017-03-15

Endometrial cancer risk prediction models including lifestyle, anthropometric and reproductive factors have limited discrimination. Adding biomarker data to these models may improve predictive capacity; to our knowledge, this has not been investigated for endometrial cancer. Using a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, we investigated the improvement in discrimination gained by adding serum biomarker concentrations to risk estimates derived from an existing risk prediction model based on epidemiologic factors. Serum concentrations of sex steroid hormones, metabolic markers, growth factors, adipokines and cytokines were evaluated in a step-wise backward selection process; biomarkers were retained at p < 0.157 indicating improvement in the Akaike information criterion (AIC). Improvement in discrimination was assessed using the C-statistic for all biomarkers alone, and change in C-statistic from addition of biomarkers to preexisting absolute risk estimates. We used internal validation with bootstrapping (1000-fold) to adjust for over-fitting. Adiponectin, estrone, interleukin-1 receptor antagonist, tumor necrosis factor-alpha and triglycerides were selected into the model. After accounting for over-fitting, discrimination was improved by 2.0 percentage points when all evaluated biomarkers were included and 1.7 percentage points in the model including the selected biomarkers. Models including etiologic markers on independent pathways and genetic markers may further improve discrimination. © 2016 UICC.

Conventional engine technology. Volume 1: Status of OTTO cycle engine technology

NASA Technical Reports Server (NTRS)

Dowdy, M. W.

1981-01-01

Federally-mandated emissions standards have led to major changes in automotive technology during the last decade. Efforts to satisfy the new standards were directed more toward the use of add-on devices, such as catalytic converters, turbochargers, and improved fuel metering, than toward complete engine redesign. The resulting changes are described and the improvement brought about by them in fuel economy and emissions levels are fully documented. Four specific categories of gasoline-powered internal combustion engines are covered, including subsystem and total engine development. Also included are the results of fuel economy and exhaust emissions tests performed on representative vehicles from each category.

Active Music Therapy and Physical Improvements From Rehabilitation for Neurological Conditions.

PubMed

Kogutek, Demian Leandro; Holmes, Jeffrey David; Grahn, Jessica Adrienne; Lutz, Sara G; Ready, Emily

2016-01-01

Context • A variety of rehabilitation-based interventions are currently available for individuals with physical impairments resulting from neurological conditions, including physiotherapy, occupational therapy, and speech language pathology. Many individuals find participation in those therapies to be challenging. Alternative therapies have emerged as beneficial adjunctive treatments for individuals undergoing neurological rehabilitation, including music therapy (MT). Objective • The study intended to identify and collate systematically the evidence on MT interventions that address physical improvements in a rehabilitative setting. Design • The research team performed a literature review, searching electronic databases from their inception to April 2014, including Embase, CINAHL, PubMed, Scopus, and ProQuest. The review included original studies that examined the use of active MT as an intervention that promotes physical improvements for adults >18 y of age. Articles were excluded if the studies focused primarily on psychosocial, emotional, or spiritual therapeutic goals. The review identified the studies' outcome measures for different populations and the MT approaches and interventions and obtained a general description of the clinical sessions, such as the frequency and duration of the therapy, interventions performed, sessions designs, populations, equipment used, and credentials of the therapists. Results • Eleven studies identified 2 major categories for the delivery of MT sessions: individual and group. One study included group sessions, and 10 studies included individual sessions. The studies included a total of 290 participants, 32 in the group MT, and 258 in the individual MT. The one study that used group therapy was based on active MT improvisation. For the individual therapy, 2 studies had investigated therapeutic instrument music performance and 8 used music-supported therapy. Conclusions • The findings of the review suggested that active MT can improve motor skills and should be considered as a potential adjunctive treatment.

Centering the voices of international students in family studies and family therapy graduate programs.

PubMed

McDowell, Teresa; Fang, Shi-Ruei; Kosutic, Iva; Griggs, Julie

2012-06-01

In this article, we report the results of a survey that accessed the perceptions of family studies and family therapy international master's and doctoral students across the United States. Our goals included giving collective voice to the experience of international students and gathering their suggestions for improving programs. Themes that emerged from responses to open- and closed-ended questions included feeling (mis)understood and (de)valued; forming personal connections and experiencing marginalization; the importance of including international perspectives in curricula; considering the relevance/transferability of knowledge; and attending to barriers to learning. Based on the results, we share suggestions for improving family studies and family therapy graduate programs relative to program planning, curricula revision, teaching strategies, and faculty development. © 2012 American Association for Marriage and Family Therapy.

Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews

PubMed Central

Loh, Siew Yim; Musa, Aisya Nadia

2015-01-01

Context Breast cancer is the most prevalent cancer amongst women but it has the highest survival rates amongst all cancer. Rehabilitation therapy of post-treatment effects from cancer and its treatment is needed to improve functioning and quality of life. This review investigated the range of methods for improving physical, psychosocial, occupational, and social wellbeing in women with breast cancer after receiving breast cancer surgery. Method A search for articles published in English between the years 2009 and 2014 was carried out using The Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, PubMed, and ScienceDirect. Search terms included: ‘breast cancer’, ‘breast carcinoma’, ‘surgery’, ‘mastectomy’, ‘lumpectomy’, ‘breast conservation’, ‘axillary lymph node dissection’, ‘rehabilitation’, ‘therapy’, ‘physiotherapy’, ‘occupational therapy’, ‘psychological’, ‘psychosocial’, ‘psychotherapy’, ‘exercise’, ‘physical activity’, ‘cognitive’, ‘occupational’, ‘alternative’, ‘complementary’, and ‘systematic review’. Study selection Systematic reviews on the effectiveness of rehabilitation methods in improving post-operative physical, and psychological outcomes for breast cancer were selected. Sixteen articles met all the eligibility criteria and were included in the review. Data extraction Included review year, study aim, total number of participants included, and results. Data synthesis Evidence for exercise rehabilitation is predominantly in the improvement of shoulder mobility and limb strength. Inconclusive results exist for a range of rehabilitation methods (physical, psycho-education, nutritional, alternative-complementary methods) for addressing the domains of psychosocial, cognitive, and occupational outcomes. Conclusion There is good evidence for narrowly-focused exercise rehabilitation in improving physical outcome particularly for shoulder mobility and lymphedema. There were inconclusive results for methods to improve psychosocial, cognitive, and occupational outcomes. There were no reviews on broader performance areas and lifestyle factors to enable effective living after treatment. The review suggests that comprehensiveness and effectiveness of post-operative breast cancer rehabilitation should consider patients’ self-management approaches towards lifestyle redesign, and incorporate health promotion aspects, in light of the fact that breast cancer is now taking the form of a chronic illness with longer survivorship years. PMID:25792854

STIP State of the Practice Review: Development and Use of Statewide Transportation Improvement Programs

DOT National Transportation Integrated Search

2016-05-03

This report examines the state of the practice in the development and use of statewide transportation improvement programs (STIPs) by state departments of transportation (State DOTs). It includes the results of a scan of all 52 publicly-available STI...

Life Improvement, Life Satisfaction and Care Arrangement Among AIDS Orphans in Rural Henan, China

PubMed Central

Zhao, Qun; Li, Xiaoming; Fang, Xiaoyi; Stanton, Bonita; Zhao, Guoxiang; Zhao, Junfeng; Zhang, Liying

2009-01-01

The Chinese government’s response to the increasing number of children orphaned in the HIV epidemic included setting up AIDS orphanages and supporting community-based group homes for double orphans (children who lost both parents to HIV). The impact of these strategies, compared to traditional kinship care, on children’s outcomes has not been studied in China. The purpose of this study was to compare perceived life improvement and life satisfaction among double orphans in 3 main care arrangements (group home, AIDS orphanage, kinship care) in 2 rural Chinese counties. Participants included 176 children from 4 orphanages, 30 from 8 group homes, and 90 from kinship households. Findings indicated that children living in government-supported group homes were more likely to report greater life improvement and positive attitudes toward their current lives than children in orphanages and kinship care. Results suggested that perceived life improvements may have resulted from access to basic needs in extremely poor communities. PMID:19286124

Some Improvements in H-PDLCs

NASA Technical Reports Server (NTRS)

Crawford, Gregory P.; Li, Liuliu

2005-01-01

Some improvements have been made in the formulation of holographically formed polymer-dispersed liquid crystals (H-PDLCs) and in the fabrication of devices made from these materials, with resulting improvements in performance. H-PDLCs are essentially volume Bragg gratings. Devices made from H-PDLCs function as electrically switchable reflective filters. Heretofore, it has been necessary to apply undesirably high drive voltages in order to switch H-PDLC devices. Many scientific papers on H-PDLCs and on the potential utility of H-PDLC devices for display and telecommunication applications have been published. However, until now, little has been published about improving quality control in synthesis of H-PDLCs and fabrication of H-PDLC devices to minimize (1) spatial nonuniformities within individual devices, (2) nonuniformities among nominally identical devices, and (3) variations in performance among nominally identical devices. The improvements reported here are results of a research effort directed partly toward solving these quality-control problems and partly toward reducing switching voltages. The quality-control improvements include incorporation of a number of process controls to create a relatively robust process, such that the H-PDLC devices fabricated in this process are more nearly uniform than were those fabricated in a prior laboratory-type process. The improved process includes ultrasonic mixing, ultrasonic cleaning, the use of a micro dispensing technique, and the use of a bubble press.

Thermal barrier coating on high temperature industrial gas turbine engines

NASA Technical Reports Server (NTRS)

Carlson, N.; Stoner, B. L.

1977-01-01

The thermal barrier coating used was a yttria stabilized zirconia material with a NiCrAlY undercoat, and the base engine used to establish improvements was the P&WA FT50A-4 industrial gas turbine engine. The design benefits of thermal barrier coatings include simplified cooling schemes and the use of conventional alloys in the engine hot section. Cooling flow reductions and improved heating rates achieved with thermal barrier coating result in improved performance. Economic benefits include reduced power production costs and reduced fuel consumption. Over the 30,000 hour life of the thermal barrier coated parts, fuel savings equivalent to $5 million are projected and specific power (megawatts/mass of engine airflow) improvements on the order of 13% are estimated.

Workplace physical activity interventions: a systematic review.

PubMed

To, Quyen G; Chen, Ted T L; Magnussen, Costan G; To, Kien G

2013-01-01

To assess the effectiveness of workplace interventions in improving physical activity. EBSCO research database (and all subdatabases). Articles were published from 2000 to 2010 in English, had appropriate designs, and measured employees' physical activity, energy consumption, and/or body mass index (BMI) as primary outcomes. Articles that did not meet the inclusion criteria were excluded. Data extracted included study design, study population, duration, intervention activities, outcomes, and results. Data were synthesized into one table. Results of each relevant outcome including p values were combined. Twelve (60%) of 20 selected interventions reported an improvement in physical activity level, steps, or BMI, and there was one slowed step reduction in the intervention group. Among these, 10 were less than 6 months in duration; 9 used pedometers; 6 applied Internet-based approaches; and 5 included activities targeting social and environmental levels. Seven of 8 interventions with pre-posttest and quasi-experimental controlled design showed improvement on at least one outcome. However, 7 of 12 randomized controlled trials (RCTs) did not prove effective in any outcome. Interventions that had less rigorous research designs, used pedometers, applied Internet-based approaches, and included activities at social and environmental levels were more likely to report being effective than those without these characteristics.

Systematic Review of Parameters of Stimulation, Clinical Trial Design Characteristics, and Motor Outcomes in Non-Invasive Brain Stimulation in Stroke

PubMed Central

Adeyemo, Bamidele O.; Simis, Marcel; Macea, Debora Duarte; Fregni, Felipe

2012-01-01

Introduction/Objectives: Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation are two powerful non-invasive neuromodulatory therapies that have the potential to alter and evaluate the integrity of the corticospinal tract. Moreover, recent evidence has shown that brain stimulation might be beneficial in stroke recovery. Therefore, investigating and investing in innovative therapies that may improve neurorehabilitative stroke recovery are next steps in research and development. Participants/Materials and Methods: This article presents an up-to-date systematic review of the treatment effects of rTMS and tDCS on motor function. A literary search was conducted, utilizing search terms “stroke” and “transcranial stimulation.” Items were excluded if they failed to: (1) include stroke patients, (2) study motor outcomes, or (3) include rTMS/tDCS as treatments. Other exclusions included: (1) reviews, editorials, and letters, (2) animal or pediatric populations, (3) case reports or sample sizes ≤2 patients, and (4) primary outcomes of dysphagia, dysarthria, neglect, or swallowing. Results: Investigation of PubMed English Database prior to 01/01/2012 produced 695 applicable results. Studies were excluded based on the aforementioned criteria, resulting in 50 remaining studies. They included 1314 participants (1282 stroke patients and 32 healthy subjects) evaluated by motor function pre- and post-tDCS or rTMS. Heterogeneity among studies’ motor assessments was high and could not be accounted for by individual comparison. Pooled effect sizes for the impact of post-treatment improvement revealed consistently demonstrable improvements after tDCS and rTMS therapeutic stimulation. Most studies provided limited follow-up for long-term effects. Conclusion: It is apparent from the available studies that non-invasive stimulation may enhance motor recovery and may lead to clinically meaningful functional improvements in the stroke population. Only mild to no adverse events have been reported. Though results have been positive results, the large heterogeneity across articles precludes firm conclusions. PMID:23162477

49 CFR 611.5 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... following definitions apply: Alternatives analysis is a corridor level analysis which evaluates all... should include transit improvements lower in cost than the new start which result in a better ratio of... preparation of final construction plans (including construction management plans), detailed specifications...

49 CFR 611.5 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... following definitions apply: Alternatives analysis is a corridor level analysis which evaluates all... should include transit improvements lower in cost than the new start which result in a better ratio of... preparation of final construction plans (including construction management plans), detailed specifications...

49 CFR 611.5 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... following definitions apply: Alternatives analysis is a corridor level analysis which evaluates all... should include transit improvements lower in cost than the new start which result in a better ratio of... preparation of final construction plans (including construction management plans), detailed specifications...

TRENDS IN INDICATORS OF EUTROPHICATION IN WESTERN LONG ISLAND SOUND AND THE HUDSON-RARITAN ESTUARY

EPA Science Inventory

Significant improvements in water quality have been observed for several decades throughout much of the Hudson-Raritan Estuary, largely as a result of regional abatement of municipal and industrial discharges. these improvements include area-wide, order-of-magnatude reductions i...

TRENDS IN INDICATORS OF EUTOPHICATION IN WESTERN LONG ISLAND SOUND AND THE HUDSON-RARITAN ESTUARY

EPA Science Inventory

Significant improvements in water quality have been observed for several decades throughout much of the Hudson-Raritan Estuary, largely as a result of regional abatement of municipal and industrial discharges. these improvements include area-wide, order-of-magnatude reductions i...

Transformed by Literacy

ERIC Educational Resources Information Center

Szachowicz, Susan

2010-01-01

When low test scores demanded a hard look at the curriculum, literacy became a focus for improvement at Brockton (MA) High School. Schoolwide training for teachers and a rolling implementation model ensured consistency and reinforcement of the skills. Results came in improved scores and national recognitions, including selection as a National…

BEMRP: Conducting research, sharing results

Treesearch

Greg Jones

2007-01-01

A couple of years ago the Bitterroot National Forest began planning the Trapper Bunkhouse Land Stewardship Project (Trapper-Bunkhouse Project). This project includes fuels reduction, watershed improvements, noncommercial thinning in plantations to improve resiliency to insects and disease, and commercial timber harvest to provide economic value to the community and...

The Older Woman: Increased Psychosocial Benefits from Physical Activity.

ERIC Educational Resources Information Center

Wakat, Diane; Odom, Sarah

1982-01-01

Older women who participate in physical activity programs find physical benefits in the improvement of cardiovascular and musculoskeletal systems. The psychosocial benefits which result from physical activity include an increase in self-esteem, increased social contacts, a counteraction to depression, and improved stress management. Suggestions…

Group-based microfinance for collective empowerment: a systematic review of health impacts

PubMed Central

Pennington, Andy; Nayak, Shilpa; Sowden, Amanda; White, Martin; Whitehead, Margaret

2016-01-01

Abstract Objective To assess the impact on health-related outcomes, of group microfinance schemes based on collective empowerment. Methods We searched the databases Social Sciences Citation Index, Embase, MEDLINE, MEDLINE In-Process, PsycINFO, Social Policy & Practice and Conference Proceedings Citation Index for articles published between 1 January 1980 and 29 February 2016. Articles reporting on health impacts associated with group-based microfinance were included in a narrative synthesis. Findings We identified one cluster-randomized control trial and 22 quasi-experimental studies. All of the included interventions targeted poor women living in low- or middle-income countries. Some included a health-promotion component. The results of the higher quality studies indicated an association between membership of a microfinance scheme and improvements in the health of women and their children. The observed improvements included reduced maternal and infant mortality, better sexual health and, in some cases, lower levels of interpersonal violence. According to the results of the few studies in which changes in empowerment were measured, membership of the relatively large and well-established microfinance schemes generally led to increased empowerment but this did not necessarily translate into improved health outcomes. Qualitative evidence suggested that increased empowerment may have contributed to observed improvements in contraceptive use and mental well-being and reductions in the risk of violence from an intimate partner. Conclusion Membership of the larger, well-established group-based microfinance schemes is associated with improvements in some health outcomes. Future studies need to be designed to cope better with bias and to assess negative as well as positive social and health impacts. PMID:27708475

Group-based microfinance for collective empowerment: a systematic review of health impacts.

PubMed

Orton, Lois; Pennington, Andy; Nayak, Shilpa; Sowden, Amanda; White, Martin; Whitehead, Margaret

2016-09-01

To assess the impact on health-related outcomes, of group microfinance schemes based on collective empowerment. We searched the databases Social Sciences Citation Index, Embase, MEDLINE, MEDLINE In-Process, PsycINFO, Social Policy & Practice and Conference Proceedings Citation Index for articles published between 1 January 1980 and 29 February 2016. Articles reporting on health impacts associated with group-based microfinance were included in a narrative synthesis. We identified one cluster-randomized control trial and 22 quasi-experimental studies. All of the included interventions targeted poor women living in low- or middle-income countries. Some included a health-promotion component. The results of the higher quality studies indicated an association between membership of a microfinance scheme and improvements in the health of women and their children. The observed improvements included reduced maternal and infant mortality, better sexual health and, in some cases, lower levels of interpersonal violence. According to the results of the few studies in which changes in empowerment were measured, membership of the relatively large and well-established microfinance schemes generally led to increased empowerment but this did not necessarily translate into improved health outcomes. Qualitative evidence suggested that increased empowerment may have contributed to observed improvements in contraceptive use and mental well-being and reductions in the risk of violence from an intimate partner. Membership of the larger, well-established group-based microfinance schemes is associated with improvements in some health outcomes. Future studies need to be designed to cope better with bias and to assess negative as well as positive social and health impacts.

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

Elliott, C.

The Rocky Flats Environmental Technology Site (RFETS) has initiated a major work process improvement campaign using the tools of formalized benchmarking and streamlining. This paper provides insights into some of the process improvement activities performed at Rocky Flats from November 1995 through December 1996. It reviews the background, motivation, methodology, results, and lessons learned from this ongoing effort. The paper also presents important gains realized through process analysis and improvement including significant cost savings, productivity improvements, and an enhanced understanding of site work processes.

Dynamic high pressure process for fabricating superconducting and permanent magnetic materials

DOEpatents

Nellis, William J.; Geballe, Theodore H.; Maple, M. Brian

1990-01-01

Shock wave formation of thin layers of materials with improved superconducting and permanent magnetic properties and improved microstructures. The material fabrication system includes a sandwiched structure including a powder material placed between two solid members to enable explosive shock consolidation. The two solid members are precooled to about 80.degree.-100.degree. K. to reduce the residual temperatures attained as a result of the shock wave treatment, and thereby increase the quench rate of the consolidated powder.

Dynamic high pressure process for fabricating superconducting and permanent magnetic materials

DOEpatents

Nellis, W.J.; Geballe, T.H.; Maple, M.B.

1990-03-13

Shock wave formation of thin layers of materials with improved superconducting and permanent magnetic properties and improved microstructures is disclosed. The material fabrication system includes a sandwiched structure including a powder material placed between two solid members to enable explosive shock consolidation. The two solid members are precooled to about 80--100 K to reduce the residual temperatures attained as a result of the shock wave treatment, and thereby increase the quench rate of the consolidated powder. 9 figs.

Development of an improved overlay design procedure for Oregon : vol. I, interim report, background and framework.

DOT National Transportation Integrated Search

1986-12-01

This report is the first in a three-volume series dealing with the development of an improved overlay design procedure for Oregon. This report presents the results of the first-year findings and includes: (1) a detailed review of the literature; (2) ...

How-to-Do-It: Further Improvements to the Steucek & Hill Assay of Photosynthesis.

ERIC Educational Resources Information Center

Juliao, Fernando; Butcher, Henry C., IV

1989-01-01

Several modifications that improve upon the assay of photosynthesis are suggested. Described are the apparatus, materials, light intensity and photosynthesis measurements, and results. A table of the average light intensity values versus the screen number and a sketch of the experimental set-up is included. (RT)

Successful Leadership: A Review of the International Literature

ERIC Educational Resources Information Center

Day, Christopher; Sammons, Pamela

2013-01-01

School leaders are under considerable pressure to demonstrate the contribution of their work to school improvement, which has resulted in the creation of a wide range of literature which addresses leadership in the context of school improvement. This review pays particular attention to issues including transformational leadership,…

A Logic of Appropriation: Enacting National Testing (NAPLAN) in Australia

ERIC Educational Resources Information Center

Hardy, Ian

2014-01-01

This paper explores how the strong policy push to improve students' results on national literacy and numeracy tests -- the National Assessment Program, Literacy and Numeracy (NAPLAN) -- in the Australian state of Queensland influenced schooling practices, including teachers' learning. The paper argues the focus upon improved test scores on NAPLAN…

Performance of a logging truck with a central tire inflation system.

Treesearch

John A. Sturos; Douglas B. Brumm; Andrew Lehto

1995-01-01

Describes the performance of an 11-axle logging truck with a central tire inflation system. Results included reduced damages to roads, improved ride of the truck, improved drawbar pull, and reduced rolling resistance. Road construction costs were reduced 62%, primarily due to using 33% less gravel.

Quantitative evaluation of vision-related and health-related quality of life after endoscopic transsphenoidal surgery for pituitary adenoma.

PubMed

Wolf, Amparo; Coros, Alexandra; Bierer, Joel; Goncalves, Sandy; Cooper, Paul; Van Uum, Stan; Lee, Donald H; Proulx, Alain; Nicolle, David; Fraser, J Alexander; Rotenberg, Brian W; Duggal, Neil

2017-08-01

OBJECTIVE Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%-90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas. METHODS The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas. This cohort included 32 patients (64%) with visual impairment preoperatively. Twenty-seven patients (54%) had pituitary dysfunction, including 17 (34%) with hormone-producing tumors. Patients completed the National Eye Institute Visual Functioning Questionnaire and the 36-Item Short Form Health Survey preoperatively and 6 weeks and 6 months after surgery. RESULTS Patients with preoperative visual impairment reported a significant impact of this condition on VR-QOL preoperatively, including general vision, near activities, and peripheral vision; they also noted vision-specific impacts on mental health, role difficulties, dependency, and driving. After endoscopic resection of adenomas, patients reported improvement across all these categories 6 weeks postoperatively, and this improvement was maintained by 6 months postoperatively. Patients with preoperative pituitary dysfunction, including hormone-producing tumors, perceived their general health and physical function as poorer, with some of these patients reporting improvement in perceived general health after the endoscopic surgery. All patients noted that their ability to work or perform activities of daily living was transiently reduced 6 weeks postoperatively, followed by significant improvement by 6 months after the surgery. CONCLUSIONS Both VR-QOL and patient's perceptions of their ability to do work and perform other daily activities as a result of their physical health significantly improved by 6 months after endoscopic resection of pituitary adenoma. The use of multidimensional QOL questionnaires provides a precise assessment of perceived outcomes after endoscopic surgery.

Examining the nexus between domestic violence and animal abuse in a national sample of service providers.

PubMed

Krienert, Jessie L; Walsh, Jeffrey A; Matthews, Kevin; McConkey, Kelly

2012-01-01

Companion animals play a complex role in families impacted by violence. An outlet of emotional support for victims, the family pet often becomes a target for physical abuse. Results from a comprehensive e-survey of domestic violence shelters nationwide (N = 767) highlight both improvements and existing gaps in service provision for domestic violence victims and their pets. Quantitative and qualitative data noted frequently encountered obstacles to successful shelter seeking by abuse victims with companion animals including a lack of availability, funding, space, and reliable programming. Although results indicate an overall improvement in organizational awareness, fewer than half of surveyed shelters include intake questions about animals. Continued awareness and an expansion of services is needed to create viable safety planning strategies and reliable alternatives for women with companion animals in order to improve the likelihood that abuse victims will seek escape and refuge for themselves, their children, and their pets.

Titan I propulsion system modeling and possible performance improvements

NASA Astrophysics Data System (ADS)

Giusti, Oreste

This thesis features the Titan I propulsion systems and offers data-supported suggestions for improvements to increase performance. The original propulsion systems were modeled both graphically in CAD and via equations. Due to the limited availability of published information, it was necessary to create a more detailed, secondary set of models. Various engineering equations---pertinent to rocket engine design---were implemented in order to generate the desired extra detail. This study describes how these new models were then imported into the ESI CFD Suite. Various parameters are applied to these imported models as inputs that include, for example, bi-propellant combinations, pressure, temperatures, and mass flow rates. The results were then processed with ESI VIEW, which is visualization software. The output files were analyzed for forces in the nozzle, and various results were generated, including sea level thrust and ISP. Experimental data are provided to compare the original engine configuration models to the derivative suggested improvement models.

Recent Development of Augmented Reality in Surgery: A Review.

PubMed

Vávra, P; Roman, J; Zonča, P; Ihnát, P; Němec, M; Kumar, J; Habib, N; El-Gendi, A

2017-01-01

The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms "augmented reality" and "surgery." Results . The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.

Collaborative field research and training in occupational health and ergonomics.

PubMed

Kogi, K

1998-01-01

Networking collaborative research and training in Asian developing countries includes three types of joint activities: field studies of workplace potentials for better safety and health, intensive action training for improvement of working conditions in small enterprises, and action-oriented workshops on low-cost improvements for managers, workers, and farmers. These activities were aimed at identifying workable strategies for making locally adjusted improvements in occupational health and ergonomics. Many improvements have resulted as direct outcomes. Most these improvements were multifaceted, low-cost, and practicable using local skills. Three common features of these interactive processes seem important in facilitating realistic improvements: 1) voluntary approaches building on local achievements; 2) the use of practical methods for identifying multiple improvements; and 3) participatory steps for achieving low-cost results first. The effective use of group work tools is crucial. Stepwise training packages have thus proven useful for promoting local problem-solving interventions based on voluntary initiatives.

[Improvement of Psychosomatic Rehabilitation after Prestationary Intervention].

PubMed

Sander, K; Winkler, G; Hofer, N; Hunatschek, S; Doerr, R

2016-12-01

Aim of the study: Improvement of psychosomatic rehabilitation efforts with prestationary intervention. Method: The study is designed as a prospective and randomisized interventon study including 317 in patients. Result: Most of the patients were women (69.4 %), the mean age was 50.2 years. As measured with the BDI-II patients with prestationary intervention improved more than patients without intervention. The motivation has not been changed significantly in both treatment arms. Various independent cofactors like long duration of unemployment, disablement and patients who apply to pension were identified. Conclusion: Finally a prestationary telephon interview improves the results of psychosomatic rehabilitation measured with BDI. © Georg Thieme Verlag KG Stuttgart · New York.

Current Status of Concentrator Photovoltaic (CPV) Technology

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

Philipps, Simon P.; Bett, Andreas W.; Horowitz, Kelsey

2015-12-01

This report summarizes the status of the concentrator photovoltaic (CPV) market and industry as well as current trends in research and technology. This report is intended to guide research agendas for Fraunhofer ISE, the National Renewable Energy Laboratory (NREL), and other R&D organizations. Version 1.1 of this report includes recent progress in CPV. The recent record module efficiency of 38.9% at Concentrator Standard Test Conditions (CSTC) is an impressive result, demonstrating the continuing opportunity for CPV technology to improve. 38.9% at Concentrator Standard Test Conditions (CSTC) is an impressive result, demonstrating the continuing opportunity for CPV technology to improve. 38.9%more » at Concentrator Standard Test Conditions (CSTC) is an impressive result, demonstrating the continuing opportunity for CPV technology to improve. 38.9% at Concentrator Standard Test Conditions (CSTC) is an impressive result, demonstrating the continuing opportunity for CPV technology to improve.« less

Impact of newer pharmacological treatments on quality of life in patients with Parkinson's disease.

PubMed

Gallagher, David A; Schrag, Anette

2008-01-01

Parkinson's disease is a common progressive neurodegenerative condition with multiple motor and nonmotor features contributing to impairment of health-related quality of life (HR-QOL). Pharmacological treatments have been directed primarily at dopamine replacement with levodopa and agents to improve its bioavailability, including DOPA decarboxylase inhibitors, catechol-O-methyltransferase (COMT) inhibitors and monoamine oxidase B (MAO-B) inhibitors, as well as synthetic dopamine agonists. These treatments to restore motor function are often very successful in early Parkinson's disease, with objective improvement and concomitant improvement in subjective HR-QOL scores. However, as the disease progresses, motor complications and nonmotor symptoms predominate and are often refractory to therapeutic interventions. Antiparkinsonian medications have been shown to improve motor severity and motor complications of advancing disease, and there is increasing evidence that this can be translated into subjective improvement of HR-QOL from a patient's point of view. However, the degree of improvement is less marked on HR-QOL scores than on motor scores, and some studies do not show improvement of HR-QOL in parallel to motor improvements. A number of explanations are possible, including limitations of the scales used, trial designs and lack of clinical improvement from the patients' point of view. This review concentrates on clinical trials with an index of HR-QOL as an outcome measure, with particular emphasis on well designed, randomized, double-blind, placebo-controlled or active comparator-controlled methodology. Drugs that have been more recently added to the armamentarium of Parkinson's disease, including the oral (pramipexole, ropinirole and piribedil) and transdermal (rotigotine) non-ergotamine-derived dopamine agonists, the novel MAO-B inhibitor rasagiline and the COMT inhibitors tolcapone and entacapone, were included. The effect of each of these agents on overall HR-QOL and depression, a factor that has been shown to significantly contribute to HR-QOL in several multivariate analyses, is discussed.Overall, the literature search revealed 14 double-blind, placebo- or active comparator-controlled trials with an index of HR-QOL as an outcome measure. Entacapone resulted in HR-QOL improvement in nonfluctuating patients (one study) but not clearly in those with motor fluctuations (two studies). Tolcapone was only tested in patients with motor fluctuations and resulted in significant improvement in two of four studies using HR-QOL as an outcome measure. Rasagiline improved HR-QOL as monotherapy in early Parkinson's disease (one study), but not clearly in more advanced disease (one study). Rotigotine improved HR-QOL in both early Parkinson's disease (one study) and more advanced disease with motor fluctuations (one study). The impact of ropinirole and pramipexole on HR-QOL as monotherapy in early Parkinson's disease versus placebo has not been assessed, but both agents have resulted in improved HR-QOL in patients with motor fluctuations (ropinirole one study, pramipexole one study). The evidence for antidepressant efficacy of antiparkinsonian medications is limited.

Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis

PubMed Central

Tang, Kai; Si, Jun-Kang; Guo, Da-Dong; Cui, Yan; Du, Yu-Xiang; Pan, Xue-Mei; Bi, Hong-Sheng

2015-01-01

AIM To compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV). METHODS A systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis. RESULTS Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study. CONCLUSION IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV. PMID:26558226

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

Simpson, L.; Britt, J.; Birkmire, R.

ITN Energy Systems, Inc., and Global Solar Energy, Inc., assisted by NREL's PV Manufacturing R&D program, have continued to advance CIGS production technology by developing trajectory-oriented predictive/control models, fault-tolerance control, control platform development, in-situ sensors, and process improvements. Modeling activities included developing physics-based and empirical models for CIGS and sputter-deposition processing, implementing model-based control, and applying predictive models to the construction of new evaporation sources and for control. Model-based control is enabled by implementing reduced or empirical models into a control platform. Reliability improvement activities include implementing preventive maintenance schedules; detecting failed sensors/equipment and reconfiguring to tinue processing; and systematicmore » development of fault prevention and reconfiguration strategies for the full range of CIGS PV production deposition processes. In-situ sensor development activities have resulted in improved control and indicated the potential for enhanced process status monitoring and control of the deposition processes. Substantial process improvements have been made, including significant improvement in CIGS uniformity, thickness control, efficiency, yield, and throughput. In large measure, these gains have been driven by process optimization, which in turn have been enabled by control and reliability improvements due to this PV Manufacturing R&D program.« less

Role of extracorporeal shock wave therapy in management of Peyronie's disease: A preliminary report

PubMed Central

Shimpi, Rajendra Kashinath; Jain, Ravi Jineshkumar

2016-01-01

Introduction: Peyronie's Disease (PD) is a disease causing psycho social trauma to the patient. Multiple treatment options are available with variable results. Extra Corporeal Shock Wave Therapy (ESWT) is a new insight into the non invasive modality of management. It focuses on the mechanism of inducing angiogenesis in the penile cavernous tissue. Materials and Methods: The aim of the study is to determine the role of ESWT in the management of PD. The objectives include demonstrating the improvement in mean International Index of Erectile Function Score (IIEFS), improvement in pain score by Visual Analogue Scale (VAS), change in cavernosal artery flow on colour penile Doppler, reduction in plaque size, and improvement in penile curvature degree after the therapy. 30 patients, between 25-65 years, who were non responders to conservative line of management, were treated with ESWT. The results were evaluated at baseline and 18-24 weeks after the therapy. Results: ESWT significantly improves the cavernosal artery velocity, thereby supporting the theory of angiogenesis. ESWT improves all the domains of IIEF including Erectile Function, Sexual Desire, Sexual Satisfaction, Orgasm and Overall Satisfaction. There is a significant improvement in the pain and penile curvature, and reduction in the plaque size. No adverse effects have been recorded. Conclusion: ESWT offers a safe, minimally invasive, OPD based option to the management of the patients of PD in the stable phase of the disease. Patients who do not respond to the conservative line of management can be really benefited by ESWT. PMID:28057983

Reducing the Clinical and Socioeconomic Burden of Narcolepsy by Earlier Diagnosis and Effective Treatment.

PubMed

Thorpy, Michael; Morse, Anne Marie

2017-03-01

The burden of narcolepsy is likely the result of 2 main aspects: the clinical difficulties and disability incurred as a direct effect of the disorder and the socioeconomic burden. The clinical burden includes the symptoms, diagnosis, comorbidities, treatment, and even mortality that can be associated with narcolepsy. Lifelong therapy is necessary for these patients. Effective treatment results in long-term benefits from both patient and societal perspectives by improving clinical outcomes, potentially enabling improved education and increased employment and work productivity, and quality of life. Thus, reducing the time to appropriate management results in improved outcomes in these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Compression of real time volumetric echocardiographic data using modified SPIHT based on the three-dimensional wavelet packet transform.

PubMed

Hang, X; Greenberg, N L; Shiota, T; Firstenberg, M S; Thomas, J D

2000-01-01

Real-time three-dimensional echocardiography has been introduced to provide improved quantification and description of cardiac function. Data compression is desired to allow efficient storage and improve data transmission. Previous work has suggested improved results utilizing wavelet transforms in the compression of medical data including 2D echocardiogram. Set partitioning in hierarchical trees (SPIHT) was extended to compress volumetric echocardiographic data by modifying the algorithm based on the three-dimensional wavelet packet transform. A compression ratio of at least 40:1 resulted in preserved image quality.

Urban land rights and child nutritional status in Peru, 2004.

PubMed

Vogl, Tom S

2007-07-01

Advocates of land-titling programs in developing countries posit that these programs lead to a multitude of benefits, including health improvements. This paper presents the results of a child health survey of several Lima communities after various time exposures to Peru's urban land-titling program. The results provide suggestive evidence that improved property rights increase children's weight but not their height, which is consistent with previous work on the topic. However, titles also appear to raise children's risk of being overweight or obese, implying that the observed weight gain is not necessarily an improvement in nutritional status.

Applications of fuzzy ranking methods to risk-management decisions

NASA Astrophysics Data System (ADS)

Mitchell, Harold A.; Carter, James C., III

1993-12-01

The Department of Energy is making significant improvements to its nuclear facilities as a result of more stringent regulation, internal audits, and recommendations from external review groups. A large backlog of upgrades has resulted. Currently, a prioritization method is being utilized which relies on a matrix of potential consequence and probability of occurrence. The attributes of the potential consequences considered include likelihood, exposure, public health and safety, environmental impact, site personnel safety, public relations, legal liability, and business loss. This paper describes an improved method which utilizes fuzzy multiple attribute decision methods to rank proposed improvement projects.

Role of WhatsApp-based discussions in improving residents' knowledge of post-operative pain management: a pilot study

PubMed Central

Bhawalkar, Pranay

2017-01-01

Background To provide a platform for the dissemination of basic knowledge of pain management, a WhatsApp group was created by residents and consultants. Common clinical scenarios, resident queries, and important instructions to be followed by residents with respect to running the Acute Pain Service were discussed in the group. This study evaluates the benefits of this interaction. Methods This study was approved by the hospital ethics board and was registered with the Clinical Trial Registry of India. Second- and third-year anesthesia residents were included in a WhatsApp group, along with consultants (board certified anesthesiologists with a special interest in pain). Pain knowledge assessment was performed pre- and post-discussion using a standard 22-point questionnaire. A feedback form, which included self-rated confidence scores (1–10, 10-most confident) and opinions about the 3-month WhatsApp discussion, was collected. Improvements in the documentation in clinical sheets post-discussion were also analyzed. Results A total of 38 residents were included in the WhatsApp group. An improvement in the percentage of correct answers from 69.1% (pre-discussion) to 73.6% (post-discussion) was observed (P = 0.031). Improvements in the self-rated residents' confidence levels were also noted (P < 0.05). A total of 37 residents felt that the WhatsApp-based discussion was useful. Documentation of the details of epidural blockade in clinical sheets improved from 30% to 100%. Conclusions The WhatsApp discussion improved residents' knowledge and confidence levels, and also resulted in improved documentation of essential details in the clinical notes. This form of education is promising and should be explored in future studies. PMID:29046774

Improving patient safety culture in Saudi Arabia (2012-2015): trending, improvement and benchmarking.

PubMed

Alswat, Khalid; Abdalla, Rawia Ahmad Mustafa; Titi, Maher Abdelraheim; Bakash, Maram; Mehmood, Faiza; Zubairi, Beena; Jamal, Diana; El-Jardali, Fadi

2017-08-02

Measuring patient safety culture can provide insight into areas for improvement and help monitor changes over time. This study details the findings of a re-assessment of patient safety culture in a multi-site Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Results were compared to an earlier assessment conducted in 2012 and benchmarked with regional and international studies. Such assessments can provide hospital leadership with insight on how their hospital is performing on patient safety culture composites as a result of quality improvement plans. This paper also explored the association between patient safety culture predictors and patient safety grade, perception of patient safety, frequency of events reported and number of events reported. We utilized a customized version of the patient safety culture survey developed by the Agency for Healthcare Research and Quality. The Medical City is a tertiary care teaching facility composed of two sites (total capacity of 904 beds). Data was analyzed using SPSS 24 at a significance level of 0.05. A t-Test was used to compare results from the 2012 survey to that conducted in 2015. Two adopted Generalized Estimating Equations in addition to two linear models were used to assess the association between composites and patient safety culture outcomes. Results were also benchmarked against similar initiatives in Lebanon, Palestine and USA. Areas of strength in 2015 included Teamwork within units, and Organizational Learning-Continuous Improvement; areas requiring improvement included Non-Punitive Response to Error, and Staffing. Comparing results to the 2012 survey revealed improvement on some areas but non-punitive response to error and Staffing remained the lowest scoring composites in 2015. Regression highlighted significant association between managerial support, organizational learning and feedback and improved survey outcomes. Comparison to international benchmarks revealed that the hospital is performing at or better than benchmark on several composites. The Medical City has made significant progress on several of the patient safety culture composites despite still having areas requiring additional improvement. Patient safety culture outcomes are evidently linked to better performance on specific composites. While results are comparable with regional and international benchmarks, findings confirm that regular assessment can allow hospitals to better understand and visualize changes in their performance and identify additional areas for improvement.

An Improved Version of the NASA-Lockheed Multielement Airfoil Analysis Computer Program

NASA Technical Reports Server (NTRS)

Brune, G. W.; Manke, J. W.

1978-01-01

An improved version of the NASA-Lockheed computer program for the analysis of multielement airfoils is described. The predictions of the program are evaluated by comparison with recent experimental high lift data including lift, pitching moment, profile drag, and detailed distributions of surface pressures and boundary layer parameters. The results of the evaluation show that the contract objectives of improving program reliability and accuracy have been met.

Excerpts from Managing CQI in Radiology and Diagnostic Imaging Services: A CQI Handbook.

PubMed

Joseph, E D; Lesher, C; Zage, R

1994-01-01

Continuous quality improvement (CQI) is currently the most popular and influential quality management program used in healthcare organizations. It is an effective methodology for identifying and acting on opportunities to improve the efficiency, effectiveness and value of services provided to customers. CQI implementation can be broken down into four components: (1) achievement objectives and goal identification, (2) system process analysis, (3) action planning and implementation, and (4) performance measurement and follow-up. As the project team establishes goals, it should consider customer and staff needs, what constitutes "quality," existing guidelines and regulations, and how results will be measured. Many techniques can be used to analyze the procedure or function targeted for improvement, including charts and diagrams, formal monitoring, data collection and statistical analysis. After the project team has identified potential service improvements, they develop an action plan, which may include education, recruitment, reassignment or equipment acquisition. The team must consider the impact of proposed changes and the financial and logistical feasibility of various proposals. The dynamic challenges of radiology and diagnostic imaging cannot be addressed through single, isolated actions; efforts to improve quality should be continuous. Accordingly, the project team should measure and analyze results of the action plan, reappraise goals and look for opportunities to further improve service.

Improving health status of homeless patients at a nurse-managed clinic in the Midwest USA.

PubMed

Savage, Christine L; Lindsell, Christopher J; Gillespie, Gordon L; Lee, Roberta J; Corbin, Adele

2008-09-01

Homeless adults have a higher rate of morbidity and mortality than their housed counterparts. Improving the health of homeless adults is a complex problem because of the overlay of individual risk factors, social issues and lack of economic resources. Due to the increased morbidity and mortality rate in homeless adults, it is imperative to develop interventions with demonstrated efficacy that result in improved health outcomes. The purpose of this pre-post pilot study was to compare pre- and post-test scores on specific health outcomes in a group of homeless adults receiving a nurse intervention when utilising a nurse-managed clinic located in the urban core of a Midwestern city in the USA. Between September of 2004 and January 2006, 43 homeless adults completed a health survey at baseline and 2 months later that included measures of health-related quality of life (HRQOL), substance use and health resource use. There was a significant improvement on the post-test scores including substance use, perceived quality and availability of health care, and on two domains of HRQOL: mental health and vitality. This study provides evidence that a nursing intervention can result in improved health outcomes for adult homeless persons.

Improved stove interventions to reduce household air pollution in low and middle income countries: a descriptive systematic review.

PubMed

Thomas, Emma; Wickramasinghe, Kremlin; Mendis, Shanthi; Roberts, Nia; Foster, Charlie

2015-07-14

Household air pollution (HAP) resulting from the use of solid fuels presents a major public health hazard. Improved stoves have been offered as a potential tool to reduce exposure to HAP and improve health outcomes. Systematic information on stove interventions is limited. We conducted a systematic review of the current evidence of improved stove interventions aimed at reducing HAP in real life settings. An extensive search of ten databases commenced in April 2014. In addition, we searched clinical trial registers and websites for unpublished studies and grey literature. Studies were included if they reported on an improved stove intervention aimed at reducing HAP resulting from solid fuel use in a low or middle-income country. The review identified 5,243 records. Of these, 258 abstracts and 57 full texts were reviewed and 36 studies identified which met the inclusion criteria. When well-designed, implemented and monitored, stove interventions can have positive effects. However, the impacts are unlikely to reduce pollutant levels to World Health Organization recommended levels. Additionally, many participants in the included studies continued to use traditional stoves either instead of, or in additional to, new improved options. Current evidence suggests improved stove interventions can reduce exposure to HAP resulting from solid fuel smoke. Studies with longer follow-up periods are required to assess if pollutant reductions reported in the current literature are sustained over time. Adoption of new technologies is challenging and interventions must be tailored to the needs and preferences of the households of interest. Future studies require greater process evaluation to improve knowledge of implementation barriers and facilitators. The review was registered on Prospero (registration number CRD42014009796).

Development of Responder Definitions for Fibromyalgia Clinical Trials

PubMed Central

Arnold, Lesley M.; Williams, David A.; Hudson, James I.; Martin, Susan A.; Clauw, Daniel J.; Crofford, Leslie J.; Wang, Fujun; Emir, Birol; Lai, Chinglin; Zablocki, Rong; Mease, Philip J.

2011-01-01

Objective To develop responder definitions for fibromyalgia clinical trials using key symptom and functional domains. Methods 24 candidate responder definitions were developed by expert consensus and evaluated in 12 randomized, placebo-controlled fibromyalgia trials of 4 medications. For each definition, treatment effects of the medication compared with placebo were analyzed using the Cochran-Mantel-Haenszel test or Chi Square test. A meta-analysis of the pooled results for the 4 medications established risk ratios to determine the definitions that best favored medication over placebo. Results Two definitions performed best in the analyses. Both definitions included ≥ 30% reduction in pain and ≥ 10% improvement in physical function. They differed in that one (FM30 short version) included ≥ 30% improvement in sleep or fatigue, and the other (FM30 long version) required ≥ 30% improvement in 2 of the following symptoms: sleep, fatigue, depression, anxiety, or cognition. In the analysis of both versions, the response rate was ≥ 15% for each medication and significantly greater than placebo. The risk ratio favoring drug over placebo (95% CI) in the pooled analysis for the FM30 short version was 1.50 (1.24, 1.82), P ≤ 0.0001; the FM30 long version was 1.60 (1.31, 1.96), P ≤ 0.00001. Conclusion Among the 24 responder definitions tested, 2 were identified as most sensitive in identifying response to treatment. The identification of responder definitions for fibromyalgia clinical trials that include assessments of key symptom and functional domains may improve the sensitivity of clinical trials to identify meaningful improvements, leading to improved management of fibromyalgia. PMID:21953205

Integrative medicine for chronic pain

PubMed Central

Saha, Felix J.; Brüning, Alexander; Barcelona, Cyrus; Büssing, Arndt; Langhorst, Jost; Dobos, Gustav; Lauche, Romy; Cramer, Holger

2016-01-01

Abstract Introduction: Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Methods: Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients’ pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. Results: A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P < 0.05). Ability to change and implementation, disease acceptance, mindfulness, life and health satisfaction, and light heartedness/easiness likewise improved (all P < 0.05). Improved outcomes were associated with increases in process variables, mainly ability to change and implementation, disease acceptance, life and health satisfaction, and light heartedness/easiness (R2 = 0.03–0.40). Conclusions: Results of this study suggest that a 2-week integrative medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction. PMID:27399133

Advances in facial reanimation.

PubMed

Tate, James R; Tollefson, Travis T

2006-08-01

Facial paralysis often has a significant emotional impact on patients. Along with the myriad of new surgical techniques in managing facial paralysis comes the challenge of selecting the most effective procedure for the patient. This review delineates common surgical techniques and reviews state-of-the-art techniques. The options for dynamic reanimation of the paralyzed face must be examined in the context of several patient factors, including age, overall health, and patient desires. The best functional results are obtained with direct facial nerve anastomosis and interpositional nerve grafts. In long-standing facial paralysis, temporalis muscle transfer gives a dependable and quick result. Microvascular free tissue transfer is a reliable technique with reanimation potential whose results continue to improve as microsurgical expertise increases. Postoperative results can be improved with ancillary soft tissue procedures, as well as botulinum toxin. The paper provides an overview of recent advances in facial reanimation, including preoperative assessment, surgical reconstruction options, and postoperative management.

Turnover among Filipino nurses in Ministry of Health hospitals in Saudi Arabia: causes and recommendations for improvement.

PubMed

Aljohani, Khalid Abdullah; Alomari, Omar

2018-01-01

Nurse turnover is a critical challenge for healthcare organizations as it results in a decreasing nurse/patient ratio and increasing costs. Identify factors influencing the termination of Filipino nurses in Ministry of Health (MOH) hospitals and record nurse recommendations to improve retention. Cross-sectional. Data was gathered from a convenience sample of Filipino nurses with previous experience in MOH hospitals in Saudi Arabia who attended recruitment interviews at the Saudi employment office in Manila. The sample included 124 nurses. Major turnover factors included low salary (18.3%), low nurse/patient ratio (15%), end of contract (14.5%), discrimination (13.5%), and bad accommodations (9%). Suggested areas of improvement included financial motivations (34%), administration support (25%), quality of life (25%), and work environment (16%). Managing nurse turnover can be implemented on the organizational as well as at MOH levels. The recommendations given by the participants provide direct targets to improve retention. With convenience sampling, the sample is probably not representative of the Filipino nursing population. None.

Creating Quality Improvement Culture in Public Health Agencies

PubMed Central

Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

PubMed Central

Shanbhag, Deepti; Graham, Ian D; Harlos, Karen; Haynes, R. Brian; Gabizon, Itzhak; Connolly, Stuart J; Van Spall, Harriette Gillian Christine

2018-01-01

Background The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. Methods We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. Results We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Conclusion Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions. PMID:29511005

Active-Learning Methods To Improve Student Performance and Scientific Interest in a Large Introductory Oceanography Course.

ERIC Educational Resources Information Center

Yuretich, Richard F.; Khan, Samia A.; Leckie, R. Mark; Clement, John J.

2001-01-01

Transfers the environment of a large enrollment oceanography course by modifying lectures to include cooperative learning via interactive in-class exercises and directed discussion. Results of student surveys, course evaluations, and exam performance demonstrate that learning of the subject under these conditions has improved. (Author/SAH)

Improving the Transition Outcomes of Low-Income Minority Youth with Disabilities

ERIC Educational Resources Information Center

Balcazar, Fabricio E.; Taylor-Ritzler, Tina; Dimpfl, Shawn; Portillo-Pena, Nelson; Guzman, Alberto; Schiff, Rachel; Murvay, Michele

2012-01-01

This study describes the results of a program developed to improve the transition outcomes of low-income minority youth with disabilities. The program relies on case management support to facilitate interagency collaboration. The participants included 164 graduates from special education and 26 youth from an equivalent comparison group. Two case…

A Phenomenological Examination of Perceived Skills and Concepts Necessary for Teaching Scientific Thinking

ERIC Educational Resources Information Center

Kapetanis, Ana Cristina

2011-01-01

The use of high stakes testing to improve educational outcomes falls short in many settings. Proposals for improvement include providing more opportunities for students to extend their thinking, gaining experience in the social nature of science, and learning how to interpret, explain, and justify results. This phenomenological qualitative project…

Results of the Arizona Medicaid health information technology pharmacy focus groups.

PubMed

Warholak, Terri L; Murcko, Anita; McKee, Megan; Urbine, Terry

2011-12-01

In 2007, a federal Medicaid Transformation Grant was awarded to design, develop, and deploy a statewide Health Information Exchange and Electronic Health Record in Arizona, United States. To explore the health information technology needs, knowledge, and expectations of Arizona's health care professionals, moderated focus groups were conducted. This article describes the results of the pharmacist focus groups. Focus group activities included a brief presentation, completion of a paper-based survey, and group discussion. The methods included solicitation by invitation, participant selection, meeting content, collaterals, focus group execution, recording, analysis, and discerning comparability among groups. Pharmacy focus group discussions centered on electronic prescribing, including the anticipated advantages: reducing handwriting interpretation errors, improving formulary compliance, improving communication with prescribers, increasing efficiency, and ensuring data accuracy. Disadvantages included: medication errors, inadequate training and knowledge of software applications, and inflated patient expectations. Pharmacists ranked e-prescribing as the highest priority feature of an electronic health system. Copyright © 2011 Elsevier Inc. All rights reserved.

Plantform Bioreactor for Mass Micropropagation of Date Palm.

PubMed

Almusawi, Abdulminam H A; Sayegh, Abdullah J; Alshanaw, Ansam M S; Griffis, John L

2017-01-01

A novel protocol for the commercial production of date palm through micropropagation is presented. This protocol includes the use of a semisolid medium alternation or in combination with a temporary immersion system (TIS, Plantform bioreactor) in date palm micropropagation. The use of the Plantform bioreactor for date palm results in an improved multiplication rate, reduced micropropagation time, and improved weaning success. It also reduces the cost of saleable units and thus improves economic return for commercial micropropagation. The use of the Plantform bioreactor successfully addresses other hindrances that can occur during the scale-up of date palm micropropagation, including asynchrony of somatic embryos, limited maturation of somatic embryos, and highly variable germination frequencies of embryos.

Academic/State/Federal collaborations and the improvement of practices in disaster mental health services and evaluation.

PubMed

Watson, Patricia J; Ruzek, Josef I

2009-05-01

Academic, state, and federal agencies collaborated over the last 9 years to improve disaster mental health services and evaluation. This process, which included literature reviews, a number of expert panels, and case studies, is described. The products resulting from this process have included the development of a systematic cross-site evaluation of the federally funded crisis counseling program and field guides for interventions aimed at providing services to distressed individuals in the immediate aftermath of disasters and to individuals needing resilience skills training weeks or months after the event. Future improvement of disaster mental health services calls for continued research, evaluation, training, and intervention development.

Immigrant workers in the United States: recent trends, vulnerable populations, and challenges for occupational health.

PubMed

McCauley, Linda A

2005-07-01

Immigrant workers are a rapidly growing segment of the U.S. work force, and these increasing numbers have resulted in a different ethnic mix in the work force than in previous decades. Immigrant workers are not a homogenous group, but are over-represented in low-paying occupations. Their diversity and vulnerability present distinct challenges for occupational health nurses. High-risk occupations in which a large proportion of immigrant workers are hired include agriculture, sweatshops, day laborers, and construction. Initiatives needed to improve the working conditions of this vulnerable population include improved surveillance and research, culturally competent care providers, improved health care access, advocacy, and changes in immigration and health policy.

Exercise improves cardiorespiratory fitness in people with depression: A meta-analysis of randomized control trials.

PubMed

Stubbs, Brendon; Rosenbaum, Simon; Vancampfort, Davy; Ward, Philip B; Schuch, Felipe B

2016-01-15

Cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular disease and all-cause mortality. CRF improves in response to exercise interventions, yet the effectiveness of such interventions to improve CRF among people with depression is unclear. We conducted a systematic review and meta-analysis to evaluate whether CRF improves in people with depression in exercise randomized control trials (RCTs). Three authors identified RCTs from a recent Cochrane review and conducted updated searches of major electronic databases. We included RCTs of exercise interventions in people with depression (including major depressive disorder (MDD) and above-threshold depressive symptoms) that reported CRF (defined as predicted maximal oxygen uptake (VO2max predicted) or peak oxygen uptake (VO2peak)) versus a control condition. A random effects meta-analysis was conducted. Seven unique RCTs including 8 aerobic exercise interventions for depression were eligible, including 293 people allocated to exercise (mean age=40.3 years, range=27.2-64.7 years and 35-100% female) and 205 allocated to control conditions. Across all studies exercise results in a significant increase in CRF (g=0.64, 95%CI=0.32-0.96, p<0.001) equating to a mean increase of 3.05 ml/kg/min. Results remained significant when restricted to MDD only (N=5, g=0.41, 95%CI=0.18-0.64, p<0.001) and in high quality studies (N=5, g=0.60, 95%CI=0.19-1.00, p=0.004). People with depression can achieve clinically relevant improvements in CRF in response to exercise interventions. Targeting 'fitness' rather than 'fatness' may be another feasible intervention strategy in this population. Copyright © 2015 Elsevier B.V. All rights reserved.

Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units.

PubMed

Render, Marta L; Freyberg, Ron W; Hasselbeck, Rachael; Hofer, Timothy P; Sales, Anne E; Deddens, James; Levesque, Odette; Almenoff, Peter L

2011-06-01

BACKGROUND Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership. METHODS Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices. Leaders prioritise measures based on quality improvement objectives. The electronic extraction is validated manually against the medical record, selecting hospitals whose data elements and measures fall at the extremes (10th, 90th percentile). results are depicted in graphic, narrative and tabular reports benchmarked by type and complexity of ICU. RESULTS The VA admits 103 689±1156 ICU patients/year. Variation in electronic business practices, data location and normal range of some laboratory tests affects data quality. A data management website captures data elements important to ICU performance and not available electronically. A dashboard manages the data overload (quarterly reports ranged 106-299 pages). More than 85% of ICU directors and nurse managers review their reports. Leadership interest is sustained by including ICU targets in executive performance contracts, identification of local improvement opportunities with analytic software, and focused reviews. CONCLUSION Lessons relevant to non-VA institutions include the: (1) need for ongoing data validation, (2) essential involvement of leadership at multiple levels, (3) supplementation of electronic data when key elements are absent, (4) utility of a good but not perfect electronic indicator to move practice while improving data elements and (5) value of a dashboard.

Strategy for the management of macular edema in retinal vein occlusion: the European VitreoRetinal Society macular edema study.

PubMed

Adelman, Ron A; Parnes, Aaron J; Bopp, Silvia; Saad Othman, Ihab; Ducournau, Didier

2015-01-01

To compare the efficacy of different therapies in the treatment of macular edema associated with retinal vein occlusion (RVO). This is a nonrandomized, multicenter collaborative study. 86 retina specialists from 29 countries provided clinical information, including choice of treatment and outcome, on 2,603 patients with macular edema including 738 cases of RVO. Reported data included the type and number of treatments performed, visual acuities, and other clinical and diagnostic findings. The mean increase in visual acuity and mean number of treatments performed. 358 cases of central retinal vein occlusion (CRVO) and 380 cases of branch retinal vein occlusion (BRVO) were included in this investigation. Taking all RVO cases together, pars plana vitrectomy with internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than other therapies. Those treated with intravitreal antivascular endothelial growth factor (anti-VEGF) injection alone showed the second greatest improvement in vision. Dexamethasone intravitreal implant alone and intravitreal triamcinolone alone both resulted in modest visual gains. In the treatment of macular edema in RVO, vitrectomy with ILM peeling may achieve visual improvement and may be a good option for certain cases. Anti-VEGF injection is the most effective of the nonsurgical treatments.

Idaho National Laboratory Integrated Safety Management System FY 2013 Effectiveness Review and Declaration Report

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

Hunt, Farren

2013-12-01

Idaho National Laboratory (INL) performed an Annual Effectiveness Review of the Integrated Safety Management System (ISMS), per 48 Code of Federal Regulations (CFR) 970.5223 1, “Integration of Environment, Safety and Health into Work Planning and Execution.” The annual review assessed Integrated Safety Management (ISM) effectiveness, provided feedback to maintain system integrity, and identified target areas for focused improvements and assessments for Fiscal Year (FY) 2014. Results of the FY 2013 annual effectiveness review demonstrate that the INL’s ISMS program is “Effective” and continually improving and shows signs of being significantly strengthened. Although there have been unacceptable serious events in themore » past, there has also been significant attention, dedication, and resources focused on improvement, lessons learned and future prevention. BEA’s strategy of focusing on these improvements includes extensive action and improvement plans that include PLN 4030, “INL Sustained Operational Improvement Plan, PLN 4058, “MFC Strategic Excellence Plan,” PLN 4141, “ATR Sustained Excellence Plan,” and PLN 4145, “Radiological Control Road to Excellence,” and the development of LWP 20000, “Conduct of Research.” As a result of these action plans, coupled with other assurance activities and metrics, significant improvement in operational performance, organizational competence, management oversight and a reduction in the number of operational events is being realized. In short, the realization of the fifth core function of ISMS (feedback and continuous improvement) and the associated benefits are apparent.« less

Translational educational research: a necessity for effective health-care improvement.

PubMed

McGaghie, William C; Issenberg, S Barry; Cohen, Elaine R; Barsuk, Jeffrey H; Wayne, Diane B

2012-11-01

Medical education research contributes to translational science (TS) when its outcomes not only impact educational settings, but also downstream results, including better patient-care practices and improved patient outcomes. Simulation-based medical education (SBME) has demonstrated its role in achieving such distal results. Effective TS also encompasses implementation science, the science of health-care delivery. Educational, clinical, quality, and safety goals can only be achieved by thematic, sustained, and cumulative research programs, not isolated studies. Components of an SBME TS research program include motivated learners, curriculum grounded in evidence-based learning theory, educational resources, evaluation of downstream results, a productive research team, rigorous research methods, research resources, and health-care system acceptance and implementation. National research priorities are served from translational educational research. National funding priorities should endorse the contribution and value of translational education research.

Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?

PubMed Central

2011-01-01

Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes. PMID:22185479

Optimization of the Switch Mechanism in a Circuit Breaker Using MBD Based Simulation

PubMed Central

Jang, Jin-Seok; Yoon, Chang-Gyu; Ryu, Chi-Young; Kim, Hyun-Woo; Bae, Byung-Tae; Yoo, Wan-Suk

2015-01-01

A circuit breaker is widely used to protect electric power system from fault currents or system errors; in particular, the opening mechanism in a circuit breaker is important to protect current overflow in the electric system. In this paper, multibody dynamic model of a circuit breaker including switch mechanism was developed including the electromagnetic actuator system. Since the opening mechanism operates sequentially, optimization of the switch mechanism was carried out to improve the current breaking time. In the optimization process, design parameters were selected from length and shape of each latch, which changes pivot points of bearings to shorten the breaking time. To validate optimization results, computational results were compared to physical tests with a high speed camera. Opening time of the optimized mechanism was decreased by 2.3 ms, which was proved by experiments. Switch mechanism design process can be improved including contact-latch system by using this process. PMID:25918740

Effectiveness of cognitive behavioral therapy supported by virtual reality in the treatment of body image in eating disorders: one year follow-up.

PubMed

Marco, José H; Perpiñá, Conxa; Botella, Cristina

2013-10-30

Body image disturbance is a significant maintenance and prognosis factor in eating disorders. Hence, existing eating disorder treatments can benefit from direct intervention in patients' body image. No controlled studies have yet compared eating disorder treatments with and without a treatment component centered on body image. This paper includes a controlled study comparing Cognitive Behavioral Treatment (CBT) for eating disorders with and without a component for body image treatment using Virtual Reality techniques. Thirty-four participants diagnosed with eating disorders were evaluated and treated. The clinical improvement was analyzed from statistical and clinical points of view. Results showed that the patients who received the component for body image treatment improved more than the group without this component. Furthermore, improvement was maintained in post-treatment and at one year follow-up. The results reveal the advantage of including a treatment component addressing body image disturbances in the protocol for general treatment of eating disorders. The implications and limitations of these results are discussed below. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

One hundred ampere-hour nickel-cadmium battery cells of improved design

NASA Technical Reports Server (NTRS)

Kantner, E.

1972-01-01

Nickel cadmium battery cells with 100 ampere hour capacity were developed. The design features, notably extension of the current collector tab to the full width of the battery plate, and the location of the cell terminals on the opposite ends, resulted in a reduction of internal impedance, and improved electrical performance with expected improvement in thermal performance. Tables of data and performance curves are included to support the theoretical considerations.

Continuous improvement in the Industrial and Management Systems Engineering programme at Kuwait University

NASA Astrophysics Data System (ADS)

Aldowaisan, Tariq; Allahverdi, Ali

2016-07-01

This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been applied to the results of four assessment tools and other data sources to improve performance. Important improvements include the need to reconsider two student outcomes as they were difficult to implement in courses. In addition, through benchmarking and the engagement of Alumni and Employers, key decisions were made to improve the curriculum and enhance employability.

Improving Rural Teachers' Attitudes towards Acceleration

ERIC Educational Resources Information Center

Olthouse, Jill M.

2015-01-01

Gifted students see both educational benefits and barriers as a result of living in rural communities. Benefits include increased individual attention and community engagement; barriers include limited curricular options (Lawrence, 2009). Acceleration is an option that has positive academic outcomes but is underused, especially in rural areas.…

Hybrid Power Management (HPM) Program Resulted in Several New Applications

NASA Technical Reports Server (NTRS)

Eichenberg, Dennis J.

2003-01-01

Hybrid Power Management (HPM) is the innovative integration of diverse, state-of-the-art power devices in an optimal configuration for space and terrestrial applications. The appropriate application and control of the various power devices significantly improves overall system performance and efficiency. The advanced power devices include ultracapacitors, fuel cells, and photovoltaics. HPM has extremely wide potential with applications from nanowatts to megawatts. Applications include power generation, transportation systems, biotechnology systems, and space power systems. HPM has the potential to significantly alleviate global energy concerns, improve the environment, and stimulate the economy.

Spirometry

MedlinePlus

... the bronchodilator improved your airflow. Results Key spirometry measurements include the following: Forced vital capacity (FVC). This is the largest amount of air that you can forcefully exhale after breathing in ...

Reinforcement learning algorithms for robotic navigation in dynamic environments.

PubMed

Yen, Gary G; Hickey, Travis W

2004-04-01

The purpose of this study was to examine improvements to reinforcement learning (RL) algorithms in order to successfully interact within dynamic environments. The scope of the research was that of RL algorithms as applied to robotic navigation. Proposed improvements include: addition of a forgetting mechanism, use of feature based state inputs, and hierarchical structuring of an RL agent. Simulations were performed to evaluate the individual merits and flaws of each proposal, to compare proposed methods to prior established methods, and to compare proposed methods to theoretically optimal solutions. Incorporation of a forgetting mechanism did considerably improve the learning times of RL agents in a dynamic environment. However, direct implementation of a feature-based RL agent did not result in any performance enhancements, as pure feature-based navigation results in a lack of positional awareness, and the inability of the agent to determine the location of the goal state. Inclusion of a hierarchical structure in an RL agent resulted in significantly improved performance, specifically when one layer of the hierarchy included a feature-based agent for obstacle avoidance, and a standard RL agent for global navigation. In summary, the inclusion of a forgetting mechanism, and the use of a hierarchically structured RL agent offer substantially increased performance when compared to traditional RL agents navigating in a dynamic environment.

Effects of sleep manipulation on cognitive functioning of adolescents: A systematic review.

PubMed

de Bruin, Eduard J; van Run, Chris; Staaks, Janneke; Meijer, Anne Marie

2017-04-01

Adolescents are considered to be at risk for deteriorated cognitive functioning due to insufficient sleep. This systematic review examined the effects of experimental sleep manipulation on adolescent cognitive functioning. Sleep manipulations consisted of total or partial sleep restriction, sleep extension, and sleep improvement. Only articles written in English, with participants' mean age between 10 and 19 y, using objective sleep measures and cognitive performance as outcomes were included. Based on these criteria 16 articles were included. The results showed that the sleep manipulations were successful. Partial sleep restriction had small or no effects on adolescent cognitive functioning. Sleep deprivation studies showed decrements in the psychomotor vigilance task as most consistent finding. Sleep extension and sleep improvement contributed to improvement of working memory. Sleep directly after learning improved memory consolidation. Due to the great diversity of tests and lack of coherent results, decisive conclusions could not be drawn about which domains in particular were influenced by sleep manipulation. Small number of participants, not accounting for the role of sleep quality, individual differences in sleep need, compensatory mechanisms in adolescent sleep and cognitive functioning, and the impurity problem of cognitive tests might explain the absence of more distinct results. Copyright © 2016 Elsevier Ltd. All rights reserved.

Revisiting the pole tide for and from satellite altimetry

NASA Astrophysics Data System (ADS)

Desai, Shailen; Wahr, John; Beckley, Brian

2015-12-01

Satellite altimeter sea surface height observations include the geocentric displacements caused by the pole tide, namely the response of the solid Earth and oceans to polar motion. Most users of these data remove these effects using a model that was developed more than 20 years ago. We describe two improvements to the pole tide model for satellite altimeter measurements. Firstly, we recommend an approach that improves the model for the response of the oceans by including the effects of self-gravitation, loading, and mass conservation. Our recommended approach also specifically includes the previously ignored displacement of the solid Earth due to the load of the ocean response, and includes the effects of geocenter motion. Altogether, this improvement amplifies the modeled geocentric pole tide by 15 %, or up to 2 mm of sea surface height displacement. We validate this improvement using two decades of satellite altimeter measurements. Secondly, we recommend that the altimetry pole tide model exclude geocentric sea surface displacements resulting from the long-term drift in polar motion. The response to this particular component of polar motion requires a more rigorous approach than is used by conventional models. We show that erroneously including the response to this component of polar motion in the pole tide model impacts interpretation of regional sea level rise by ± 0.25 mm/year.

The impact of second generation antipsychotics on insight in schizophrenia: Results from 14 randomized, placebo controlled trials.

PubMed

Mattila, Taina; Koeter, Maarten; Wohlfarth, Tamar; Storosum, Jitschak; van den Brink, Wim; Derks, Eske; Leufkens, Hubertus; Denys, Damiaan

2017-01-01

Despite the negative impact of lack of insight on the prognosis, general functioning and treatment adherence, the effect of antipsychotic medication on insight has been investigated only in small samples and uncontrolled studies. In this study we examine whether previously reported effects of antipsychotics on insight from uncontrolled studies can be confirmed in a database including 14 randomized, double-blind, placebo-controlled trials. The database contained placebo-controlled RCTs of five second-generation antipsychotics (SGAs: olanzapine, paliperidone, quetiapine, risperidone and sertindole) and included a total of 4243 patients with schizophrenia. Insight was assessed with item G12 of the Positive and Negative Syndrome Scale (PANSS) at baseline and at six weeks. Overall, SGA treatment resulted in a significantly larger improvement in insight than placebo (0.43 points versus 0.15 points; Hedge׳s g 0.23; p<0.001). However this difference in improvement in insight was largely explained by improvement in other symptoms. In the initial analysis, one of the compounds was significantly less effective in improving insight than the other SGAs, but this difference no longer persisted when improvement in other symptoms was taken into account. The effect of SGAs on improvement in insight was not moderated by geographic region, illness duration or drop-out. The present study showed that SGA treatment of patients with schizophrenia is associated with improved insight, but that this improvement is associated with SGA induced improvements in other symptoms, though the causal relationship may not be established. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

An improvement project within urological care.

PubMed

Khatami, Annelie; Rosengren, Kristina

2015-01-01

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. This study includes one team (six members, different health professionals) within the same urology department. Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

High-Speed Cycling Intervention Improves Rate-Dependent Mobility in Older Adults

PubMed Central

Bellumori, Maria; Uygur, Mehmet; Knight, Christopher A.

2016-01-01

PURPOSE The aim was to determine the feasibility of a six-week speed-based exercise program that could be used to initiate new exercise behaviors and improve rapid movement in older adults approaching frailty. METHODS The intervention group included 14 older adults (3 males, 11 females, mean (SD) age: 70 (7.6) years, height: 1.6 (.11) m, mass: 76.8 (12.0) kg, BMI: 27.7(4.7)). The control group included 12 older adults (6 males, 6 females, mean (SD) age: 69.2 (6.9) years, height: 1.7 (.09) m, mass: 78.2 (10.9) kg, BMI: 25.3 (2.7)). Subjects included active older adults, including regular exercisers, but none were engaged in sports or exercises with an emphasis on speed (e.g. cycling spin classes or tennis). Stationary recumbent cycling was selected to minimize fall risk and low pedaling resistance reduced musculoskeletal and cardiovascular load. Two weekly 30-minute exercise sessions consisted of interval training in which subjects pedaled at preferred cadence and performed ten 20-s fast cadence intervals separated by 40-s of active recovery at preferred cadence. RESULTS Significant Group by Time interactions (p<.05) supported a 2-s improvement in the timed up and go test and a 34% improvement in rapid isometric knee extension contractions in the exercise group but not in controls. Central neural adaptations are suggested because this lower extremity exercise program also elicited significant improvements in the untrained upper extremities of the exercise group (elbow extension RFD-SF and 9-Hole Peg Test, p<.05). CONCLUSION These results demonstrate that a relatively low dose of speed-based exercise can improve neuromuscular function and tests of mobility in older adults. Such a program serves as a sensible precursor to subsequent, more vigorous training or as an adjunct to a program where a velocity emphasis is lacking. PMID:27501360

Seeing the forests and the trees—innovative approaches to exploring heterogeneity in systematic reviews of complex interventions to enhance health system decision-making: a protocol

PubMed Central

2014-01-01

Background To improve quality of care and patient outcomes, health system decision-makers need to identify and implement effective interventions. An increasing number of systematic reviews document the effects of quality improvement programs to assist decision-makers in developing new initiatives. However, limitations in the reporting of primary studies and current meta-analysis methods (including approaches for exploring heterogeneity) reduce the utility of existing syntheses for health system decision-makers. This study will explore the role of innovative meta-analysis approaches and the added value of enriched and updated data for increasing the utility of systematic reviews of complex interventions. Methods/Design We will use the dataset from our recent systematic review of 142 randomized trials of diabetes quality improvement programs to evaluate novel approaches for exploring heterogeneity. These will include exploratory methods, such as multivariate meta-regression analyses and all-subsets combinatorial meta-analysis. We will then update our systematic review to include new trials and enrich the dataset by surveying authors of all included trials. In doing so, we will explore the impact of variables not, reported in previous publications, such as details of study context, on the effectiveness of the intervention. We will use innovative analytical methods on the enriched and updated dataset to identify key success factors in the implementation of quality improvement interventions for diabetes. Decision-makers will be involved throughout to help identify and prioritize variables to be explored and to aid in the interpretation and dissemination of results. Discussion This study will inform future systematic reviews of complex interventions and describe the value of enriching and updating data for exploring heterogeneity in meta-analysis. It will also result in an updated comprehensive systematic review of diabetes quality improvement interventions that will be useful to health system decision-makers in developing interventions to improve outcomes for people with diabetes. Systematic review registration PROSPERO registration no. CRD42013005165 PMID:25115289

Exercise and Pharmacological Treatment of Depressive Symptoms in Patients with Coronary Heart Disease: Results from the UPBEAT Study

PubMed Central

Blumenthal, James A.; Sherwood, Andrew; Babyak, Michael A.; Watkins, Lana L.; Smith, Patrick J.; Hoffman, Benson M.; O’Hayer, C. Virginia F.; Mabe, Stephanie; Johnson, Julie; Doraiswamy, P. Murali; Jiang, Wei

2012-01-01

OBJECTIVE To assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease (CHD). BACKGROUND Although there is good evidence that clinical depression is associated with poor prognosis, optimal therapeutic strategies are currently not well-defined. METHODS 101 outpatients with CHD and elevated depressive symptoms underwent assessment of depression including a psychiatric interview and the Hamilton Rating Scale for Depression (HAM-D). Participants were randomized to 4 months of aerobic exercise (3 times/week), sertraline (50-200 mg/day), or placebo. Additional assessments of cardiovascular biomarkers included measures of heart rate variability (HRV), endothelial function, baroreflex sensitivity, inflammation, and platelet function. RESULTS After 16 weeks, all groups showed improvement on HAM-D scores. Participants in both aerobic exercise (M= −7.5 [95% CI = −9.8, −5.0]) and sertraline (M= −6.1 [95% CI = −8.4, −3.9] achieved larger reductions in depressive symptoms compared to placebo (M= −4.5 [95% CI = −7.6, −1.5]; p = .034); exercise and sertraline were equally effective in reducing depressive symptoms (p = .607). Exercise and medication tended to result in greater improvements in HRV compared to placebo (p = .052); exercise tended to result in greater improvements in HRV compared to sertraline (p =.093) CONCLUSIONS Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in CHD patients. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as quality of life. PMID:22858387

The value of vital sign trends for detecting clinical deterioration on the wards

PubMed Central

Churpek, Matthew M; Adhikari, Richa; Edelson, Dana P

2016-01-01

Aim Early detection of clinical deterioration on the wards may improve outcomes, and most early warning scores only utilize a patient’s current vital signs. The added value of vital sign trends over time is poorly characterized. We investigated whether adding trends improves accuracy and which methods are optimal for modelling trends. Methods Patients admitted to five hospitals over a five-year period were included in this observational cohort study, with 60% of the data used for model derivation and 40% for validation. Vital signs were utilized to predict the combined outcome of cardiac arrest, intensive care unit transfer, and death. The accuracy of models utilizing both the current value and different trend methods were compared using the area under the receiver operating characteristic curve (AUC). Results A total of 269,999 patient admissions were included, which resulted in 16,452 outcomes. Overall, trends increased accuracy compared to a model containing only current vital signs (AUC 0.78 vs. 0.74; p<0.001). The methods that resulted in the greatest average increase in accuracy were the vital sign slope (AUC improvement 0.013) and minimum value (AUC improvement 0.012), while the change from the previous value resulted in an average worsening of the AUC (change in AUC −0.002). The AUC increased most for systolic blood pressure when trends were added (AUC improvement 0.05). Conclusion Vital sign trends increased the accuracy of models designed to detect critical illness on the wards. Our findings have important implications for clinicians at the bedside and for the development of early warning scores. PMID:26898412

Research Agenda for an Improved Novice Driver Program

DOT National Transportation Integrated Search

1994-05-31

This report documents previous NHTSA efforts in driver education. These include the results of a major demonstration evaluation that was conducted in DeKalb County Georgia and a summary of a workshop held last year that resulted in numerous recommend...

A continuous quality improvement approach to improving clinical practice in the areas of sedation, analgesia, and neuromuscular blockade.

PubMed

Arbour, Richard

2003-01-01

Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas. The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants. Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain. The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.

Combinatorial optimization problem solution based on improved genetic algorithm

NASA Astrophysics Data System (ADS)

Zhang, Peng

2017-08-01

Traveling salesman problem (TSP) is a classic combinatorial optimization problem. It is a simplified form of many complex problems. In the process of study and research, it is understood that the parameters that affect the performance of genetic algorithm mainly include the quality of initial population, the population size, and crossover probability and mutation probability values. As a result, an improved genetic algorithm for solving TSP problems is put forward. The population is graded according to individual similarity, and different operations are performed to different levels of individuals. In addition, elitist retention strategy is adopted at each level, and the crossover operator and mutation operator are improved. Several experiments are designed to verify the feasibility of the algorithm. Through the experimental results analysis, it is proved that the improved algorithm can improve the accuracy and efficiency of the solution.

Heart Failure Update: Chronic Disease Management Programs.

PubMed

Fountain, Lorna B

2016-03-01

With high mortality and readmission rates among patients with heart failure (HF), multiple disease management models have been and continue to be tested, with mixed results. Early postdischarge care improves outcomes for patients. Telemonitoring also can assist in reducing mortality and HF-related hospitalizations. Office-based team care improves patient outcomes, with important components including rapid access to physicians, partnerships with clinical pharmacists, education, monitoring, and support. Pay-for-performance measures developed for HF, primarily use of angiotensin-converting enzyme inhibitors and beta blockers, also improve patient outcomes, but the influence of adherence to other measures has been minimal. Evaluating comorbid conditions, including diabetes and hypertension, and making drug adjustments for patients with HF to include blood pressure control and use of metformin, when possible, can reduce mortality and morbidity. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Improving management of constipation in an inpatient setting using a care bundle.

PubMed

Linton, Andrew

2014-01-01

Constipation is a common occurrence on geriatric in-patient wards. It can result in delirium and other complications including bowel obstruction. Over treatment with laxatives can result in iatrogenic diahorrea, which can lead to dehydration, delirium, and the false positive labeling and unnecessary treatment of clostridium difficile carriers. This can result in increased morbidity and mortality, and a longer stay in hospital. This means that improving the assessment and treatment of constipation should improve patient outcomes and result in significant hospital cost savings. Multidisciplinary discussion and planning resulted in the delivery of our constipation project. This aimed to encourage the early assessment and treatment of constipation of inpatients on a geriatric rehabilitation ward. The goal was to prevent significant constipation by intervening early, improving the prescription of laxatives, and titrating them when the constipation has resolved. This involved educational sessions, non-pharmacological alternatives to laxatives (optimisation of hydration, exercise, and high fibre foods), laxative prescription guidance, and twice weekly laxative ward rounds. The profile of laxative prescription changed in keeping with our guidance. There was a reduction in overall laxative prescription by a third and the prescription of "PRN" laxatives was eliminated. This hopefully resulted in reduced morbidity for the patients and reduced length of stay. There was a cost savings on the laxative bill on average per day of the project, which when extrapolated to a 365 day year was £1226.40. This doesn't include potential savings gained from reduced complications of constipation and reduced length of stay, which are hard to accurately measure.

Development of the improved helicopter icing spray system (IHISS)

NASA Technical Reports Server (NTRS)

Peterson, Andrew A.; Jenks, Mark D.; Gaitskill, William H.

1989-01-01

Boeing Helicopters has been awarded a contract by the U.S. Army to design, fabricate and test a replacement for the existing Helicopter Icing Spray System (HISS). The Improved Hiss (IHISS), capable of deployment from any CH-47D helicopter, will include new icing spray nozzles and pneumatic pressure source, and a significantly larger water tank and spray boom. Results are presented for extensive bench and icing tunnel test programs used to select and modify an improved spray nozzle and validate spray boom aerodynamic characteristics. The resulting system will provide a significantly larger icing cloud with droplet characteristics closely matching natural icing conditions.

Improved treatment of global positioning system force parameters in precise orbit determination applications

NASA Technical Reports Server (NTRS)

Vigue, Y.; Lichten, S. M.; Muellerschoen, R. J.; Blewitt, G.; Heflin, M. B.

1993-01-01

Data collected from a worldwide 1992 experiment were processed at JPL to determine precise orbits for the satellites of the Global Positioning System (GPS). A filtering technique was tested to improve modeling of solar-radiation pressure force parameters for GPS satellites. The new approach improves orbit quality for eclipsing satellites by a factor of two, with typical results in the 25- to 50-cm range. The resultant GPS-based estimates for geocentric coordinates of the tracking sites, which include the three DSN sites, are accurate to 2 to 8 cm, roughly equivalent to 3 to 10 nrad of angular measure.

Improvement of the Davydov theory of bioenergy transport in protein molecular systems.

PubMed

Pang, X F

2000-11-01

The Hamiltonian and the wave function in the Davydov theory have simultaneously been improved and extended, based on some physical and biological grounds and on results from other models. The equations of motion for the improved Davydov model with a quasicoherent two-quanta state and a new interaction term in the Hamiltonian describe bioenergy transport along the molecular chains in protein molecules by a soliton mechanism. Some elementary properties of the soliton, including the nonlinear coupling energy and greatly increased binding energy of the soliton, are also given. The results obtained suggest that the model could be a candidate for a bioenergy transport mechanism in protein molecules.

Environmental implications of jatropha biofuel from a silvi-pastoral production system in central-west Brazil.

PubMed

Bailis, Rob; Kavlak, Goksin

2013-07-16

We present a life cycle assessment of synthetic paraffinic kerosene produced from Jatropha curcas. The feedstock is grown in an intercropping arrangement with pasture grasses so that Jatropha is coproduced with cattle. Additional innovations are introduced including hybrid seeds, detoxification of jatropha seedcake, and cogeneration. Two fuel pathways are examined including a newly developed catalytic decarboxylation process. Sensitivities are examined including higher planting density at the expense of cattle production as well as 50% lower yields. Intercropping with pasture and detoxifying seedcake yield coproducts that are expected to relieve pressure on Brazil's forests and indirectly reduce environmental impacts of biofuel production. Other innovations also reduce impacts. Results of the baseline assessment indicate that innovations would reduce impacts relative to the fossil fuel reference scenario in most categories including 62-75% reduction in greenhouse gas emissions, 64-82% reduction in release of ozone depleting chemicals, 33-52% reduction in smog-forming pollutants, 6-25% reduction in acidification, and 60-72% reduction in use of nonrenewable energy. System expansion, which explicitly accounts for avoided deforestation, results in larger improvements. Results are robust across allocation methodologies, improve with higher planting density, and persist if yield is reduced by half.

Optimal guidance law development for an advanced launch system

NASA Technical Reports Server (NTRS)

Calise, Anthony J.; Hodges, Dewey H.

1990-01-01

A regular perturbation analysis is presented. Closed-loop simulations were performed with a first order correction including all of the atmospheric terms. In addition, a method was developed for independently checking the accuracy of the analysis and the rather extensive programming required to implement the complete first order correction with all of the aerodynamic effects included. This amounted to developing an equivalent Hamiltonian computed from the first order analysis. A second order correction was also completed for the neglected spherical Earth and back-pressure effects. Finally, an analysis was begun on a method for dealing with control inequality constraints. The results on including higher order corrections do show some improvement for this application; however, it is not known at this stage if significant improvement will result when the aerodynamic forces are included. The weak formulation for solving optimal problems was extended in order to account for state inequality constraints. The formulation was tested on three example problems and numerical results were compared to the exact solutions. Development of a general purpose computational environment for the solution of a large class of optimal control problems is under way. An example, along with the necessary input and the output, is given.

A Teacher's Guide for Getting Serious about the System

ERIC Educational Resources Information Center

Cowan, D'Ette; Joyner, Stacey; Beckwith, Shirley

2012-01-01

It may take a village to raise a child, but it takes a community of educators to improve a school--a community that includes administrators and teachers in different, but equally important, roles. A district's changes can only show results once their improvements reach the classroom. At the same time, teachers need support from their districts to…

Improving Ascertainment of Risk Factors for HIV Infection: Results of a Group-Randomized Evaluation

ERIC Educational Resources Information Center

Harrison, Kathleen McDavid; Pals, Sherri L.; Sajak, Tammy; Chase, Jennifer; Kajese, Tebitha

2010-01-01

To allow appropriate allocation of prevention and care funding, HIV/AIDS surveillance data must include risk factor information, currently available for less than 70% of cases reported in the United States. The authors evaluated an intervention consisting of provider training and materials to improve risk factor reporting. Facilities were matched…

The CF6 jet engine performance improvement: New front mount

NASA Technical Reports Server (NTRS)

Fasching, W. A.

1979-01-01

The New Front Mount was evaluated in component tests including stress, deflection/distortion and fatigue tests. The test results demonstrated a performance improvement of 0.1% in cruise sfc, 16% in compressor stall margin and 10% in compressor stator angle margin. The New Front Mount hardware successfully completed 35,000 simulated flight cycles endurance testing.

Should Physical Activity Be Included in Nutrition Education? A Comparison of Nutrition Outcomes with and without In-Class Activities

ERIC Educational Resources Information Center

Palmer-Keenan, Debra M.; Corda, Kirsten

2014-01-01

Limited-resource adults' dietary intakes and nutrition behaviors improve as a result of Expanded Food and Nutrition Education Program (EFNEP)/Supplemental Nutrition Assistance Program Education (SNAP-Ed) participation; however, physical activity education is needed for improved health. The experimental study reported here assessed if spending time…

Toward an Innovative, Basic Program Model for the Improvement of Professional Instruction in Dental Education: A Review of the Literature.

ERIC Educational Resources Information Center

Wulf, Kathleen M.; And Others

1980-01-01

An analysis of the massive amount of literature pertaining to the improvement of professional instruction in dental education resulted in the formation of a comprehensive model of 10 categories, including Delphi technique; systems approach; agencies; workshops; multi-media, self-instruction; evaluation paradigms, measurement, courses, and…

Culturally Based Math Education as a Way to Improve Alaska Native Students' Math Performance.

ERIC Educational Resources Information Center

Lipka, Jerry; Adams, Barbara

2004-01-01

Culturally based instruction has long been touted as a preferred approach to improving the performance of American Indian and Alaska Native (AI/AN) students? academic performance. However, there has been scant research to support this conjecture, particularly when quantitative data and quasi-experimental designs are included. The results of this…

A Multicultural Awareness Program To Improve Language and Thinking Skills to a Group of Language Deficient Preschool Students.

ERIC Educational Resources Information Center

Altamura, Marilyn T.

This practicum project exposed seven preschool students with language deficiencies to multicultural experiences and strategies, resulting in improvements in both language and thinking skills. The children were included in a regular preschool program serving low-income families. The program was based on a multicultural awareness curriculum which…

76 FR 61150 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property at the VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

... intends to enter into an EUL on an 11.2- acre parcel of land and improvements to include renovating an...-term self-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise... for the provision of medical care and services would result in a demonstrable improvement of services...

Strain improvement of chymosin-producing strains of Aspergillus niger var. awamori using parasexual recombination.

PubMed

Bodie, E A; Armstrong, G L; Dunn-Coleman, N S

1994-05-01

Parasexual recombination was used to obtain improved chymosin-producing strains and to perform genetic analysis on existing strains. Chlorate resistance was used to select for a variety of spontaneous nitrate assimilation pathway mutations in strains previously improved for chymosin production using classical strain improvement methods including mutation and screening, and selection for 2-deoxyglucose resistance (dgr). Diploids of these improved strains were generated via parasexual recombination and were isolated on selective media by complementation of nitrate assimilation mutations. A preliminary genetic analysis of diploid and haploid segregants indicated that the dgr trait, resulting in overexpression of chymosin, was recessive. Also, mutations in two different dgr genes resulted in an increased level of chymosin production. When these mutations were combined via parasexual recombination, the resulting haploid segregants produced about 15% more chymosin than either parental strain. CHEF gel electrophoresis was used to determine the chromosomal location of the integrated chymosin DNA sequences, and to verify diploidy in one case where the chromosome composition of two haploid parents differed.

An improved algorithm for evaluating trellis phase codes

NASA Technical Reports Server (NTRS)

Mulligan, M. G.; Wilson, S. G.

1982-01-01

A method is described for evaluating the minimum distance parameters of trellis phase codes, including CPFSK, partial response FM, and more importantly, coded CPM (continuous phase modulation) schemes. The algorithm provides dramatically faster execution times and lesser memory requirements than previous algorithms. Results of sample calculations and timing comparisons are included.

An improved algorithm for evaluating trellis phase codes

NASA Technical Reports Server (NTRS)

Mulligan, M. G.; Wilson, S. G.

1984-01-01

A method is described for evaluating the minimum distance parameters of trellis phase codes, including CPFSK, partial response FM, and more importantly, coded CPM (continuous phase modulation) schemes. The algorithm provides dramatically faster execution times and lesser memory requirements than previous algorithms. Results of sample calculations and timing comparisons are included.

Technology-based self-care methods of improving antiretroviral adherence: a systematic review.

PubMed

Saberi, Parya; Johnson, Mallory O

2011-01-01

As HIV infection has shifted to a chronic condition, self-care practices have emerged as an important topic for HIV-positive individuals in maintaining an optimal level of health. Self-care refers to activities that patients undertake to maintain and improve health, such as strategies to achieve and maintain high levels of antiretroviral adherence. Technology-based methods are increasingly used to enhance antiretroviral adherence; therefore, we systematically reviewed the literature to examine technology-based self-care methods that HIV-positive individuals utilize to improve adherence. Seven electronic databases were searched from 1/1/1980 through 12/31/2010. We included quantitative and qualitative studies. Among quantitative studies, the primary outcomes included ARV adherence, viral load, and CD4+ cell count and secondary outcomes consisted of quality of life, adverse effects, and feasibility/acceptability data. For qualitative/descriptive studies, interview themes, reports of use, and perceptions of use were summarized. Thirty-six publications were included (24 quantitative and 12 qualitative/descriptive). Studies with exclusive utilization of medication reminder devices demonstrated less evidence of enhancing adherence in comparison to multi-component methods. This systematic review offers support for self-care technology-based approaches that may result in improved antiretroviral adherence. There was a clear pattern of results that favored individually-tailored, multi-function technologies, which allowed for periodic communication with health care providers rather than sole reliance on electronic reminder devices.

The Effects of Aerobic Exercise on the Recovery of Walking Ability and Neuroplasticity in People with Multiple Sclerosis: A Systematic Review of Animal and Clinical Studies

PubMed Central

2017-01-01

Introduction Walking is of high priority for people with multiple sclerosis (PwMS). It remains unclear whether aerobic exercise can improve walking ability and upregulate neurotrophins. This review aims to consolidate evidence to develop optimal aerobic training parameters to enhance walking outcomes and neuroplasticity in PwMS. Methods Clinical studies examining aerobic exercise for ≥3 weeks, having outcomes on walking with or without neurotrophic markers, were included. Studies utilizing animal models of MS were included if they employed aerobic exercise with outcomes on neurological recovery and neurotrophins. From a total of 1783 articles, 12 clinical and 5 animal studies were included. Results Eleven clinical studies reported improvements in walking ability. Only two clinical studies evaluated both walking and neurotrophins, and neither found an increase in neurotrophins despite improvements in walking. Patients with significant walking impairments were underrepresented. Long-term follow-up revealed mixed results. Two animal studies reported a positive change in both neurological recovery and neurotrophins. Conclusion Aerobic exercise improves walking ability in PwMS. Gains are not consistently maintained at 2- to 9-month follow-up. Studies examining levels of neurotrophins are inconclusive, necessitating further research. Aerobic exercise enhances both neurological recovery and neurotrophins in animal studies when started 2 weeks before induction of MS. PMID:29181199

Improved Operating Room Efficiency via Constraint Management: Experience of a Tertiary-Care Academic Medical Center.

PubMed

Kimbrough, Charles W; McMasters, Kelly M; Canary, Jeff; Jackson, Lisa; Farah, Ian; Boswell, Mark V; Kim, Daniel; Scoggins, Charles R

2015-07-01

Suboptimal operating room (OR) efficiency is a universal complaint among surgeons. Nonetheless, maximizing efficiency is critical to institutional success. Here, we report improvement achieved from low-cost, low-technology measures instituted within a tertiary-care academic medical center/Level I trauma center. Improvements in preadmission testing and OR scheduling, including appointing a senior nurse anesthetist to help direct OR use, were instituted in March 2012. A retrospective review of prospectively maintained OR case data was performed to evaluate time periods before and after program implementation, as well as to assess trends over time. Operating room performance metrics were compared using Mann-Whitney and chi-squared tests. Changes over time were analyzed using linear regression. Data including all surgical cases were available for a 36-month period; 10 months (6,581 cases) before program implementation and 26 months afterward (17,574 cases). Dramatic improvement was seen in first-case on-time starts, which increased from 39.3% to 83.8% (p < 0.0001). Additionally, the percent utilization of available OR time demonstrated a steady increase (p < 0.001). After an initial lag, case volume also improved, evident by an increase observed in the 12-month rolling average of cases per month (p < 0.001). The increase in case volume occurred during peak OR time (7 am to 5 pm), and did not result from adding cases after hours (5 pm to 11 pm). After many years of what seemed an insoluble problem, simple changes fostering collaboration among services, including active management of the OR schedule and transparent data, have resulted in substantial improvement in OR efficiency and case volume. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Results from the first 4 years of pay for performance.

PubMed

DeVore, Susan D

2010-01-01

Some of the lessons hospitals that have participated in the Hospital Quality Incentive Demonstration project have learned include: the need to tie in quality-of-care initiatives to the organization's strategic plan and to incentive plans for all employees, from executives on down; the value in allowing hospital physicians to "own" quality improvement initiatives; the importance of making results of the initiative available to all staff; the benefit of creating best-practice teams to address improvements in specific clinical areas.

Recent Development of Augmented Reality in Surgery: A Review

PubMed Central

Vávra, P.; Zonča, P.; Ihnát, P.; El-Gendi, A.

2017-01-01

Introduction The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. Methods We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms “augmented reality” and “surgery.” Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. Conclusions The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice. PMID:29065604

Evaluation of anthropogenic influence in probabilistic forecasting of coastal change

NASA Astrophysics Data System (ADS)

Hapke, C. J.; Wilson, K.; Adams, P. N.

2014-12-01

Prediction of large scale coastal behavior is especially challenging in areas of pervasive human activity. Many coastal zones on the Gulf and Atlantic coasts are moderately to highly modified through the use of soft sediment and hard stabilization techniques. These practices have the potential to alter sediment transport and availability, as well as reshape the beach profile, ultimately transforming the natural evolution of the coastal system. We present the results of a series of probabilistic models, designed to predict the observed geomorphic response to high wave events at Fire Island, New York. The island comprises a variety of land use types, including inhabited communities with modified beaches, where beach nourishment and artificial dune construction (scraping) occur, unmodified zones, and protected national seashore. This variation in land use presents an opportunity for comparison of model accuracy across highly modified and rarely modified stretches of coastline. Eight models with basic and expanded structures were developed, resulting in sixteen models, informed with observational data from Fire Island. The basic model type does not include anthropogenic modification. The expanded model includes records of nourishment and scraping, designed to quantify the improved accuracy when anthropogenic activity is represented. Modification was included as frequency of occurrence divided by the time since the most recent event, to distinguish between recent and historic events. All but one model reported improved predictive accuracy from the basic to expanded form. The addition of nourishment and scraping parameters resulted in a maximum reduction in predictive error of 36%. The seven improved models reported an average 23% reduction in error. These results indicate that it is advantageous to incorporate the human forcing into a coastal hazards probability model framework.

Development of an external ceramic insulation for the space shuttle orbiter. Part 2: Optimization

NASA Technical Reports Server (NTRS)

Tanzilli, R. A. (Editor)

1973-01-01

The basic insulation improvement study concentrated upon evaluating variables which could result in significant near-term gains in mechanical behavior and insulation effectiveness of the baseline system. The approaches undertaken included: evaluation of small diameter fibers, optimization of binder: slurry characteristics, evaluation of techniques for controlling fiber orientation, optimization of firing cycle, and the evaluation of methods for improving insulation efficiency. A detailed discussion of these basic insulation improvement studies is presented.

Improved retinal and visual function following panmacular subthreshold diode micropulse laser for retinitis pigmentosa.

PubMed

Luttrull, Jeffrey K

2018-06-01

To examine the effect of subthreshold diode micropulse laser (SDM) on pattern electroretinography (PERG) and visual function in retinitis pigmentosa (RP). The records of all patients (pts) undergoing SDM in a vitreoretinal subspecialty practice were reviewed. Inclusion criteria included the presence of RP evaluated before and after SDM by PERG. As a secondary outcome measure, the results of automated omnifield resolution perimetry (ORP) were also reviewed. All eyes undergoing SDM for RP were eligible study, including 26 eyes of 15 pts; seven male and eight female, aged 16-69 (avg. 47) years. Retinal function by PERG improved by all indices, with significant improvements in the 24° field signal latency measures; the MagD(µV)/ Mag(µV) ratio (P < 0.0001) and the MagD(µV) amplitude (P = 0.0003). ORP significantly improved by all indices (p = 0.02-0.002). Average best-corrected chart visual acuities improved from 0.6 to 0.4 logMAR units (p = 0.02). There were no adverse treatment effects. SDM significantly improved chart visual acuity, mesopic logMAR visual acuity perimetry, and retinal function by PERG in RP without adverse treatment effects. Treatment responses indicate a significant capacity for rescue of dysfunctional retina. These results suggest that early and periodic treatment with SDM might slow disease progression and reduce long-term vision loss.

Status of the Local Enforcement of Energy Efficiency Standards and Labeling Program in China

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

Zhou, Nan; Zheng, Nina; Fino-Chen, Cecilia

2011-09-26

As part of its commitment to promoting and improving the local enforcement of appliance energy efficiency standards and labeling, the China National Institute of Standardization (CNIS) launched the National and Local Enforcement of Energy Efficiency Standards and Labeling project on August 14, 2009. The project’s short-term goal is to expand the effort to improve enforcement of standards and labeling requirements to the entire country within three years, with a long-term goal of perfecting overall enforcement. For this project, Jiangsu, Shandong, Sichuan and Shanghai were selected as pilot locations. This report provides information on the local enforcement project’s recent background, activitiesmore » and results as well as comparison to previous rounds of check-testing in 2006 and 2007. In addition, the report also offers evaluation on the achievement and weaknesses in the local enforcement scheme and recommendations. The results demonstrate both improvement and some backsliding. Enforcement schemes are in place in all target cities and applicable national standards and regulations were followed as the basis for local check testing. Check testing results show in general high labeling compliance across regions with 100% compliance for five products, including full compliance for all three products tested in Jiangsu province and two out of three products tested in Shandong province. Program results also identified key weaknesses in labeling compliance in Sichuan as well as in the efficiency standards compliance levels for small and medium three-phase asynchronous motors and self-ballasted fluorescent lamps. For example, compliance for the same product ranged from as low as 40% to 100% with mixed results for products that had been tested in previous rounds. For refrigerators, in particular, the efficiency standards compliance rate exhibited a wider range of 50% to 100%, and the average rate across all tested models also dropped from 96% in 2007 to 63%, possibly due to the implementation of newly strengthened efficiency standards in 2009. Areas for improvement include: Greater awareness at the local level to ensure that all manufacturers register their products with the label certification project and to minimize their resistance to inspections; improvement of the product sampling methodology to include representative testing of both large and small manufacturers and greater standardization of testing tools and procedures; and continued improvement in local enforcement efforts.« less

Exploring Mechanisms for Effective Technology-Enhanced Simulation-based Education in Wilderness Medicine: A Systematic Review

PubMed Central

MacKinnon, Ralph; Humphries, Christopher

2015-01-01

Background: Technology-enhanced simulation is well-established in healthcare teaching curricula, including those regarding wilderness medicine. Compellingly, the evidence base for the value of this educational modality to improve learner competencies and patient outcomes are increasing. Aims: The aim was to systematically review the characteristics of technology-enhanced simulation presented in the wilderness medicine literature to date. Then, the secondary aim was to explore how this technology has been used and if the use of this technology has been associated with improved learner or patient outcomes. Methods: EMBASE and MEDLINE were systematically searched from 1946 to 2014, for articles on the provision of technology-enhanced simulation to teach wilderness medicine. Working independently, the team evaluated the information on the criteria of learners, setting, instructional design, content, and outcomes. Results: From a pool of 37 articles, 11 publications were eligible for systematic review. The majority of learners in the included publications were medical students, settings included both indoors and outdoors, and the main focus clinical content was initial trauma management with some including leadership skills. The most prevalent instructional design components were clinical variation and cognitive interactivity, with learner satisfaction as the main outcome. Conclusions: The results confirm that the current provision of wilderness medicine utilizing technology-enhanced simulation is aligned with instructional design characteristics that have been used to achieve effective learning. Future research should aim to demonstrate the translation of learning into the clinical field to produce improved learner outcomes and create improved patient outcomes. PMID:26824012

Robotics in Arthroplasty: A Comprehensive Review.

PubMed

Jacofsky, David J; Allen, Mark

2016-10-01

Robotic-assisted orthopedic surgery has been available clinically in some form for over 2 decades, claiming to improve total joint arthroplasty by enhancing the surgeon's ability to reproduce alignment and therefore better restore normal kinematics. Various current systems include a robotic arm, robotic-guided cutting jigs, and robotic milling systems with a diversity of different navigation strategies using active, semiactive, or passive control systems. Semiactive systems have become dominant, providing a haptic window through which the surgeon is able to consistently prepare an arthroplasty based on preoperative planning. A review of previous designs and clinical studies demonstrate that these robotic systems decrease variability and increase precision, primarily focusing on component positioning and alignment. Some early clinical results indicate decreased revision rates and improved patient satisfaction with robotic-assisted arthroplasty. The future design objectives include precise planning and even further improved consistent intraoperative execution. Despite this cautious optimism, many still wonder whether robotics will ultimately increase cost and operative time without objectively improving outcomes. Over the long term, every industry that has seen robotic technology be introduced, ultimately has shown an increase in production capacity, improved accuracy and precision, and lower cost. A new generation of robotic systems is now being introduced into the arthroplasty arena, and early results with unicompartmental knee arthroplasty and total hip arthroplasty have demonstrated improved accuracy of placement, improved satisfaction, and reduced complications. Further studies are needed to confirm the cost effectiveness of these technologies. Copyright © 2016 Elsevier Inc. All rights reserved.

Early treatment improves urodynamic prognosis in neurogenic voiding dysfunction: 20 years of experience.

PubMed

Costa Monteiro, Lucia M; Cruz, Glaura O; Fontes, Juliana M; Vieira, Eliane T R C; Santos, Eloá N; Araújo, Grace F; Ramos, Eloane G

To evaluate the association between early treatment and urodynamic improvement in pediatric and adolescent patients with neurogenic bladder. Retrospective longitudinal and observational study (between 1990 and 2013) including patients with neurogenic bladder and myelomeningocele treated based on urodynamic results. The authors evaluated the urodynamic follow-up (bladder compliance and maximum bladder capacity and pressure) considering the first urodynamic improvement in two years as the outcome variable and early referral as the exposure variable, using a descriptive and multivariate analysis with logistic regression model. Among 230 patients included, 52% had an early referral. The majority were diagnosed as overactive bladder with high bladder pressure (≥40cm H 2 O) and low bladder compliance (3mL/cmH 2 O) and were treated with oxybutynin and intermittent catheterization. Urodynamic follow-up results showed 68% of improvement at the second urodynamic examination decreasing bladder pressure and increasing bladder capacity and compliance. The percentage of incontinence and urinary tract infections decreased over treatment. Early referral (one-year old or less) increased by 3.5 the probability of urodynamic improvement in two years (95% CI: 1.81-6.77). Treatment onset within the first year of life improves urodynamic prognosis in patients with neurogenic bladder and triplicates the probability of urodynamic improvement in two years. The role of neonatologists and pediatricians in early referral is extremely important. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Short- and long-term effects of a lactose-restricted diet and probiotics in children with chronic abdominal pain: a retrospective study.

PubMed

Ockeloen, L E; Deckers-Kocken, J M

2012-05-01

To determine the short- and long-term effect of treatment in children with chronic abdominal pain (CAP). A database with the results of H(2) breath test of children with CAP was created. All children with an abnormal test result were included and classified as small intestinal bacterial overgrowth (SIBO) or lactose intolerant (LTI). SIBO was treated with probiotics and LTI with a lactose-restricted diet. CAP was evaluated 5 months and 15 months after the test. 37 children (41%) were included. 17 LTI children (94%) improved after 5 months and 11 children (61%) after 15 months (P<0.05). Seven SIBO children improved after 5 months and 4 children after 15 months. In the combination group all 4 children improved after 5 months and 3 children after 15 months. Children with CAP caused by LTI or SIBO had less CAP after 5 months. This positive effect persists only in half of the children. Copyright © 2011 Elsevier Ltd. All rights reserved.

Prior experience in micro-surgery may improve the surgeon's performance in robotic surgical training.

PubMed

Perez, Manuela; Perrenot, Cyril; Tran, Nguyen; Hossu, Gabriela; Felblinger, Jacques; Hubert, Jacques

2013-09-01

Robotic surgery has witnessed a huge expansion. Robotic simulators have proved to be of major interest in training. Some authors have suggested that prior experience in micro-surgery could improve robotic surgery training. To test micro-surgery as a new approach in training, we proposed a prospective study comparing the surgical performance of micro-surgeons with that of general surgeons on a robotic simulator. 49 surgeons were enrolled; 11 in the micro-surgery group (MSG); 38 n the control group (CG). Performance was evaluated based on five dV-Trainer® exercises. MSG achieved better results for all exercises including exercises requiring visual evaluation of force feed-back, economy of motion, instrument force and position. These results show that experience in micro-surgery could significantly improve surgeons' abilities and their performance in robotic training. So, as micro-surgery practice is relatively cheap, it could be easily included in basic robotic surgery training. Copyright © 2013 John Wiley & Sons, Ltd.

Buying results? Contracting for health service delivery in developing countries.

PubMed

Loevinsohn, Benjamin; Harding, April

To achieve the health-related Millennium Development Goals, the delivery of health services will need to improve. Contracting with non-state entities, including non-governmental organisations (NGOs), has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. These results were achieved in various settings and services. Many of the anticipated difficulties with contracting were either not observed in practice or did not compromise contracting's effectiveness. Seven of the nine cases with sufficient experience (greater than 3 years' elapsed experience) have been sustained and expanded. Provision of a package of basic services by contractors costs between roughly US3 dollars and US6 dollars per head per year in low-income countries. Contracting for health service delivery should be expanded and future efforts must include rigorous evaluations.

Nordic Pharmacy Schools’ Experience in Communication Skills Training

PubMed Central

Björnsdottir, Ingunn; Wallman, Andy; Sporrong, Sofia Kälvemark

2017-01-01

Objective. To assess communication skills training at Nordic pharmacy schools and explore ways for improvement. Methods. E-mail questionnaires were developed and distributed with the aim to explore current practice and course leaders’ opinions regarding teaching of patient communication skills at all the 11 master level Nordic (Denmark, Finland, Iceland, Norway and Sweden) pharmacy schools. The questionnaires contained both closed- and open-ended questions. Results. There was a variation of patient communication skills training among schools. In general, communication skills training was included in one to five courses (mode 1); varied in quantity (6-92 hours); had low use of experiential training methods; and had challenges regarding assessments and acquiring sufficient resources. However, some schools had more focus on such training. Conclusion. The results show room for improvement in patient communication skills training in most Nordic pharmacy schools and give insights into how to enhance communication skill building in pharmacy curricula. Suggestions for improving the training include: early training start, evidence-based frameworks, experiential training, and scaffolding. PMID:29302085

Simultaneous versus Sequential Accelerated Corneal Collagen Cross-Linking and Wave Front Guided PRK for Treatment of Keratoconus: Objective and Subjective Evaluation

PubMed Central

El Emam, Dalia Sabry; Farag, Rania Kamel; Abouelkheir, Hossam Youssef

2016-01-01

Aim. To compare objective and subjective outcome after simultaneous wave front guided (WFG) PRK and accelerated corneal cross-linking (CXL) in patients with progressive keratoconus versus sequential WFG PRK 6 months after CXL. Methods. 62 eyes with progressive keratoconus were divided into two groups; the first including 30 eyes underwent simultaneous WFG PRK with accelerated CXL. The second including 32 eyes underwent subsequent WFG PRK performed 6 months later after accelerated CXL. Visual, refractive, topographic, and aberrometric data were determined preoperatively and during 1-year follow-up period and the results compared in between the 2 studied groups. Results. All evaluated visual, refractive, and aberrometric parameters demonstrated highly significant improvement in both studied groups (all P < 0.001). A significant improvement was observed in keratometric and Q values. The improvement in all parameters was stable till the end of follow-up. Likewise, no significant difference was determined in between the 2 groups in any of recorded parameters. Subjective data revealed similarly significant improvement in both groups. Conclusions. WFG PRK and accelerated CXL is an effective and safe option to improve the vision in mild to moderate keratoconus. In one-year follow-up, there is no statistically significant difference between the simultaneous and sequential procedure. PMID:28127465

Simultaneous versus Sequential Accelerated Corneal Collagen Cross-Linking and Wave Front Guided PRK for Treatment of Keratoconus: Objective and Subjective Evaluation.

PubMed

Abou Samra, Waleed Ali; El Emam, Dalia Sabry; Farag, Rania Kamel; Abouelkheir, Hossam Youssef

2016-01-01

Aim . To compare objective and subjective outcome after simultaneous wave front guided (WFG) PRK and accelerated corneal cross-linking (CXL) in patients with progressive keratoconus versus sequential WFG PRK 6 months after CXL. Methods . 62 eyes with progressive keratoconus were divided into two groups; the first including 30 eyes underwent simultaneous WFG PRK with accelerated CXL. The second including 32 eyes underwent subsequent WFG PRK performed 6 months later after accelerated CXL. Visual, refractive, topographic, and aberrometric data were determined preoperatively and during 1-year follow-up period and the results compared in between the 2 studied groups. Results . All evaluated visual, refractive, and aberrometric parameters demonstrated highly significant improvement in both studied groups (all P < 0.001). A significant improvement was observed in keratometric and Q values. The improvement in all parameters was stable till the end of follow-up. Likewise, no significant difference was determined in between the 2 groups in any of recorded parameters. Subjective data revealed similarly significant improvement in both groups. Conclusions . WFG PRK and accelerated CXL is an effective and safe option to improve the vision in mild to moderate keratoconus. In one-year follow-up, there is no statistically significant difference between the simultaneous and sequential procedure.

Brain Jogging Training to Improve Motivation and Learning Result of Tennis Skills

NASA Astrophysics Data System (ADS)

Tafaqur, M.; Komarudin; Mulyana; Saputra, M. Y.

2017-03-01

This research is aimed to determine the effect of brain jogging towards improvement of motivation and learning result of tennis skills. The method used in this research is experimental method. The population of this research is 15 tennis athletes of Core Siliwangi Bandung Tennis Club. The sampling technique used in this research is purposive sampling technique. Sample of this research is the 10 tennis athletes of Core Siliwangi Bandung Tennis Club. Design used for this research is pretest-posttest group design. Data analysis technique used in this research is by doing Instrument T-test to measure motivation using The Sport Motivation Scale questionnaire (SMS-28) and Instrument to measure learning result of tennis skill by using tennis skills test, which include: (1) forehand test, (2) backhand test, and (3) service placement test. The result of this research showed that brain jogging significantly impact the improvement of motivation and learning result of tennis skills.

An improved weakly compressible SPH method for simulating free surface flows of viscous and viscoelastic fluids

NASA Astrophysics Data System (ADS)

Xu, Xiaoyang; Deng, Xiao-Long

2016-04-01

In this paper, an improved weakly compressible smoothed particle hydrodynamics (SPH) method is proposed to simulate transient free surface flows of viscous and viscoelastic fluids. The improved SPH algorithm includes the implementation of (i) the mixed symmetric correction of kernel gradient to improve the accuracy and stability of traditional SPH method and (ii) the Rusanov flux in the continuity equation for improving the computation of pressure distributions in the dynamics of liquids. To assess the effectiveness of the improved SPH algorithm, a number of numerical examples including the stretching of an initially circular water drop, dam breaking flow against a vertical wall, the impact of viscous and viscoelastic fluid drop with a rigid wall, and the extrudate swell of viscoelastic fluid have been presented and compared with available numerical and experimental data in literature. The convergent behavior of the improved SPH algorithm has also been studied by using different number of particles. All numerical results demonstrate that the improved SPH algorithm proposed here is capable of modeling free surface flows of viscous and viscoelastic fluids accurately and stably, and even more important, also computing an accurate and little oscillatory pressure field.

Supplement Analysis for the Watershed Management Program EIS, (DOE/EIS-0265/SA-69) - Improvement of Anadromous Fish Habitat and Passage in Omak Creek

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

Spiering, Colleen

2001-11-15

BPA proposes to fund a project with the Colville Confederated Tribes that will improve spawning and rearing specifically for summer steelhead in the Omak Creek Watershed. Efforts to achieve this objective include improved livestock and forestry management and barrier removal. These techniques include exclusionary fencing, spring developments, hardened-rock crossings, road decommissioning, culvert removal and placement, riparian vegetation planting and installation of instream structures. The result of implementing these techniques will reduce fine sediment delivered to the stream channel which will result in increased hatching success of summer steelhead. Also, reestablishing riparian vegetation will provide canopy and enclose the stream channelmore » resulting in reduced stream temperatures. Two “on-the-ground” projects are proposed for this year. One project consists of installing three instream structures and planting riparian vegetation to provide bank stability along approximately 200’ of privately owned stream bank of Omak Creek. Also a fence will be constructed to exclude the landowner’s horses. The second project consists of removal of an inadequate sized culvert (5’ diameter) and replacement with a larger bottomless arch (6’ x 12’). This project will also include seven instream structures to stabilize the stream bank both upstream and downstream of the culvert and direct flows through the center of the bottomless arch.« less

Behavior of fiber reinforced mortar joints in masonry walls subjected to in-plane shear and out-of-plane bending

NASA Astrophysics Data System (ADS)

Armwood, Catherine K.

In this project, 26 fiber-reinforced mortar (FRM) mixtures are evaluated for their workability and strength characteristics. The specimens tested include two control mixtures and 24 FRMs. The mixtures were made of two types of binders; Type N Portland cement lime (Type N-PCL) and Natural Hydrated Lime 5 (NHL5); and 6 fiber types (5 synthetic fibers and one organic). When tested in flexure, the results indicate that majority of the synthetic fiber mixtures enhanced the performance of the mortar and the nano-nylon and horse hair fibers were the least effective in improving the mortar's modulus of rupture, ductility, and energy absorption. Four FRMs that improved the mortar's mechanical properties most during the flexural strength test were then used to conduct additional experiments. The FRM's compressive strength, as well as flexural and shear bond strength with clay and concrete masonry units were determined. Those four mixtures included Type N-PCL as the binder and 4 synthetic fibers. They were evaluated at a standard laboratory flow rate of 110% +/- 5% and a practical field flow rate of 130% +/- 5%. Results indicate that the use of fibers decreases the compressive strength of the mortar most of the time. However, the bond strength test results were promising: 81% of the FRM mixtures increased the flexural bond strength of the prism. The mixtures at 110 +/- 5% flow rate bonded better with concrete bricks and those ate 130+/-5% flow rate bonded better with clay bricks. The results of the shear bond strength show 50% of the FRM mixtures improved the shear bond strength. The FRM mixtures at 110+/-5% flow rate bonded with clay units provided the most improvement in shear bond strength compared to control specimen results. Along with detailed discussions and derived conclusions of these experiments, this dissertation includes recommendations for the most feasible FRM for different applications.

The effectiveness of virtual reality interventions in improving balance in adults with impaired balance compared with standard or no treatment: a systematic review and meta-analysis.

PubMed

Booth, Vicky; Masud, Tahir; Connell, Louise; Bath-Hextall, Fiona

2014-05-01

To evaluate whether virtual reality interventions, including interactive gaming systems, are effective at improving balance in adults with impaired balance. Systematic review and meta-analysis of randomized control trials. Studies were identified from electronic databases (CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, PyschINFO, PyschBITE, OTseeker, Ei Compendex, and Inspec) searched to November 2011, and repeated in November 2012. Two reviewers selected studies meeting inclusion criteria and quality of included studies assessed using a Joanna Briggs Institute appraisal tool. Data was pooled and a meta-analysis completed. The systematic review was reported following guidance of the PRISMA statement. A total of 251 articles were screened. Eight randomized control trials were included. These studies presented the results of 239 participants, with various aetiologies, and used a variety of virtual reality systems. The number of falls was documented in only one included study. Meta-analysis was completed on data from the Berg Balance Scale, walking speed, 30 second sit-to-stand test, and Timed Up and Go Test, and favoured standard therapy when compared with standard plus virtual reality interventions. There was a notable inconsistency in the outcome measures, experimental, and control interventions used within the included studies. The pooled results of the studies showed no significant difference. Therefore this review cannot support nor refute the use of virtual reality interventions, rather than conventional physiotherapy, to improve balance in adults with impaired balance.

Therapeutic Uses of Active Videogames: A Systematic Review

PubMed Central

Flynn, Rachel

2014-01-01

Abstract Background: Active videogames (AVGs) may be useful for promoting physical activity for therapeutic uses, including for balance, rehabilitation, and management of illness or disease. The literature from 64 peer-reviewed publications that assessed health outcomes of AVGs for therapeutic purposes was synthesized. Materials and Methods: PubMed, Medline, and PyschInfo were queried for original studies related to the use of AVGs to improve physical outcomes in patients who were ill or undergoing rehabilitation related to balance, burn treatment, cancer, cerebral palsy, Down's syndrome, extremity dysfunction or amputation, hospitalization, lupus, Parkinson's disease, spinal injury, or stroke. The following inclusion criteria were used: (1) human subjects; (2) English language; (3) not duplicates; (4) new empirical data; and (5) tests an AVG, including commercially available or custom-designed. Studies were included regardless of participants' age or the study design. Results and Limitations: Overall, the vast majority of studies demonstrated promising results for improved health outcomes related to therapy, including significantly greater or comparable effects of AVG play versus usual care. However, many studies were pilot trials with small, homogeneous samples, and many studies lacked a control or comparison group. Some trials tested multiweek or multimonth interventions, although many used a single bout of gameplay, and few included follow-up assessments to test sustainability of improved health. Conclusions and Implications: AVGs were acceptable and enjoyable to the populations examined and appear as a promising tool for balance, rehabilitation, and illness management. Future research directions and implications for clinicians are discussed. PMID:26192642

Interventions to Improve Parental Communication About Sex: A Systematic Review

PubMed Central

Holland, Cynthia L.; Bost, James

2011-01-01

CONTEXT: The relative effectiveness of interventions to improve parental communication with adolescents about sex is not known. OBJECTIVE: To compare the effectiveness and methodologic quality of interventions for improving parental communication with adolescents about sex. METHODS: We searched 6 databases: OVID/Medline, PsychInfo, ERIC, Cochrane Review, Communication and Mass Media, and the Cumulative Index to Nursing and Allied Health Literature. We included studies published between 1980 and July 2010 in peer-reviewed English-language journals that targeted US parents of adolescents aged 11 to 18 years, used an experimental or quasi-experimental design, included a control group, and had a pretest/posttest design. We abstracted data on multiple communication outcomes defined by the integrative conceptual model (communication frequency, content, skills, intentions, self-efficacy, perceived environmental barriers/facilitators, perceived social norms, attitudes, outcome expectations, knowledge, and beliefs). Methodologic quality was assessed using the 11-item methodologic quality score. RESULTS: Twelve studies met inclusion criteria. Compared with controls, parents who participated in these interventions experienced improvements in multiple communication domains including the frequency, quality, intentions, comfort, and self-efficacy for communicating. We noted no effects on parental attitudes toward communicating or the outcomes they expected to occur as a result of communicating. Four studies were of high quality, 7 were of medium quality, and 1 was of lower quality. CONCLUSIONS: Our review was limited by the lack of standardized measures for assessing parental communication. Still, interventions for improving parent-adolescent sex communication are well designed and have some targeted effects. Wider dissemination could augment efforts by schools, clinicians, and health educators. PMID:21321027

Positive effects of massage therapy on a patient with narcolepsy.

PubMed

Hill, Robyn; Baskwill, Amanda

2013-01-01

The purpose of this case report was to investigate the effects of massage therapy on the sleep patterns of a woman with narcolepsy. The 23-year-old woman's primary symptoms included excessive daytime sleepiness and periodic leg movements (PLM), which were associated with her diagnoses of both narcolepsy and cataplexy. Five 45-minute massage therapy treatments were administered over a five-week period. The patient's sleep patterns were recorded each week before the treatment. A final measurement was recorded in the sixth week. The sleep patterns were monitored using the Leeds Sleep Evaluation Questionnaire, which included ten visual analogue scales. The results of this case report included an improvement in getting to sleep by 148%, an improvement in quality of sleep by 1100%, an improvement in awake following sleep by 121%, and an improvement in behaviour following wakening by 28% using the Leeds Sleep Evaluation Questionnaire. This case report suggests that massage therapy had a positive effect on this patient with narcolepsy. Further research is needed to investigate the effects of massage therapy on narcolepsy and sleep patterns.

Tropospheric Airborne Meteorological Data Reporting (TAMDAR) Sensor Development

NASA Technical Reports Server (NTRS)

Daniels, Taumi S.; Tsoucalas, George; Anderson, Mark; Mulally, Daniel; Moninger, William; Mamrosh, Richard

2004-01-01

One of the recommendations of the National Aviation Weather Program Council was to expand and institutionalize the generation, dissemination, and use of automated pilot reports (PIREPS) to the full spectrum of the aviation community, including general aviation. In response to this and other similar recommendations, NASA initiated cooperative research into the development of an electronic pilot reporting capability (Daniels 2002). The ultimate goal is to develop a small low-cost sensor, collect useful meteorological observations below 25,000 ft., downlink the data in near real time, and use the data to improve weather forecasts. Primary users of the data include pilots, who are one targeted audience for the improved weather information that will result from the TAMDAR data. The weather data will be disseminated and used to improve aviation safety by providing pilots with enhanced weather situational awareness. In addition, the data will be used to improve the accuracy and timeliness of weather forecasts. Other users include air traffic controllers, flight service stations, and airline weather centers. Additionally, the meteorological data collected by TAMDAR is expected to have a significant positive impact on forecast accuracy for ground based applications.

Improving response rate and quality of survey data with a scratch lottery ticket incentive

PubMed Central

2012-01-01

Background The quality of data collected in survey research is usually indicated by the response rate; the representativeness of the sample, and; the rate of completed questions (item-response). In attempting to improve a generally declining response rate in surveys considerable efforts are being made through follow-up mailings and various types of incentives. This study examines effects of including a scratch lottery ticket in the invitation letter to a survey. Method Questionnaires concerning oral health were mailed to a random sample of 2,400 adults. A systematically selected half of the sample (1,200 adults) received a questionnaire including a scratch lottery ticket. One reminder without the incentive was sent. Results The incentive increased the response rate and improved representativeness by reaching more respondents with lower education. Furthermore, it reduced item nonresponse. The initial incentive had no effect on the propensity to respond after the reminder. Conclusion When attempting to improve survey data, three issues become important: response rate, representativeness, and item-response. This study shows that including a scratch lottery ticket in the invitation letter performs well on all the three. PMID:22515335

Salzburg Global Seminar Session 565—‘Better Health Care: how do we learn about improvement?’

PubMed Central

Massoud, M Rashad; Kimble, Leighann E; Goldmann, Don; Ovretveit, John; Dixon, Nancy

2018-01-01

Abstract A fundamental question for the field of healthcare improvement is the extent to which the results achieved can be attributed to the changes that were implemented and whether or not these changes are generalizable. Answering these questions is particularly challenging because the healthcare context is complex, and the interventions themselves tend to be complex and multi-dimensional. The Salzburg Global Seminar Session 565—‘Better Health Care: How do we learn about improvement?’ was convened to address questions of attribution, generalizability and rigor, and to think through how to approach these concerns in the field of quality improvement. The Salzburg Global Seminar Session 565 brought together 61 leaders in improvement from 22 countries, including researchers, evaluators and improvers. The primary conclusion that resulted from the session was the need for evaluation to be embedded as an integral part of the improvement. We have invited participants of the seminar to contribute to writing this supplement, which consists of eight articles reflecting insights and learning from the Salzburg Global Seminar. This editorial serves as an introduction to the supplement. The supplement explains results and insights from Salzburg Global Seminar Session 565. PMID:29462415

Potential benefits of magnetic suspension and balance systems

NASA Technical Reports Server (NTRS)

Lawing, Pierce L.; Dress, David A.; Kilgore, Robert A.

1987-01-01

The potential of Magnetic Suspension and Balance Systems (MSBS) to improve conventional wind tunnel testing techniques is discussed. Topics include: elimination of model geometry distortion and support interference to improve the measurement accuracy of aerodynamic coefficients; removal of testing restrictions due to supports; improved dynamic stability data; and stores separation testing. Substantial increases in wind tunnel productivity are anticipated due to the coalescence of these improvements. Specific improvements in testing methods for missiles, helicopters, fighter aircraft, twin fuselage transports and bombers, state separation, water tunnels, and automobiles are also forecast. In a more speculative vein, new wind tunnel test techniques are envisioned as a result of applying MSBS, including free-flight computer trajectories in the test section, pilot-in-the-loop and designer-in-the-loop testing, shipboard missile launch simulation, and optimization of hybrid hypersonic configurations. Also addressed are potential applications of MSBS to such diverse technologies as medical research and practice, industrial robotics, space weaponry, and ore processing in space.

Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.

PubMed

Boggan, Joel C; Swaminathan, Aparna; Thomas, Samantha; Simel, David L; Zaas, Aimee K; Bae, Jonathan G

2017-04-01

Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities. This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics. We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback. Residents performed audits of ambulatory patients requiring laboratory or radiologic testing by means of a shared online interface. The intervention consisted of an educational module viewed with initial audits, development of a personalized improvement plan after Phase 1, and repeated real-time feedback of individual relative performance compared at clinic and program levels. Outcomes included results communicated within 14 days and prespecified "significant" results communicated within 72 hours. A total of 76 of 86 eligible residents (88%) reviewed 1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed 1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating results within 14 days and significant results within 72 hours (85% versus 78%, P  < .001; and 82% versus 70%, P  = .002, respectively). Communication of "significant" results was more likely to occur via telephone, compared with communication of nonsignificant results. Participation in a shared audit and feedback quality improvement project can improve rates of resident follow-up and communication of results, although communication gaps remained.

Clackamas/Hood River Habitat Enhancement Program, 1987 Annual Report.

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

MacDonald, Ken; Cain, Thomas C.; Heller, David A.

1988-03-01

Fisheries habitat improvement work is being done on priority drainages in the Clackamas and Rood River sub-basins under program measure 704(c), Action Item 4.2 of the Northwest Power Planning Council's Columbia River Basin Fish and Wildlife Program. This report describes the work completed in 1987 for Bonneville Power Administration (BPA) project number 84-11, the Clackamas/Hood River Habitat Enhancement Program. The program is composed of six projects: Collawash River Habitat Improvement Project; Collawash River Falls Passage Improvement Project, Oak Grove Fork Habitat Improvement Project; Lake Branch/West Fork Hood River Habitat Improvement Project; Fifteenmile Creek Habitat Improvement Project; and Abundance, Behavior, andmore » Habitat Utilization by Coho Salmon and Steelhead Trout in Fish Creek, Oregon, As Influenced by Habitat Enhancement. This ongoing program was initiated in 1984, although some of the projects were begun with BPA funding support as early as 1983. The projects are complemented by a variety of habitat improvement and management activities funded from a variety of Forest Service sources. This report describes the activities implemented for five of the six projects. A separate annual report on the 1987 habitat improvement and monitoring/evaluation efforts in the Fish Creek drainage has been prepared. Species for management emphasis include spring chinook and coho salmon, and summer and winter steelhead trout. Project work in 1987 primarily focused on increasing the quantity and quality of available rearing habitat, and improving access at passage barriers. The underlying theme of the improvement work has been to increase habitat diversity through the introduction of ''structure''. Structure provided by logs and boulders serves to deflect, pond, or otherwise disrupt flow patterns within a stream channel. This alteration of flow patterns results in formation of an increased number of habitat niches (i.e. pools, glides, alcoves, etc. ) in which a variety of species and age group: of salmon and trout can rear. It also results in the sorting of gravel, rubble, and boulders being transported downstream, creating high quality spawning and rearing habitats, and food producing areas. In 1987, a total of 11.0 miles of stream were treated; 334 log structures (Including: ''deflector'', ''digger'', ''sill'', and ''cover'' logs) and 141 boulder structures (including: single boulder placement, ''berms'', ''alcoves'', and ''clusters'') were completed to meet habitat improvement objectives. In addition to these direct habitat improvement activities, BPA and the Forest Service financed a number of project and program assessment activities that have improved the efficiency and effectiveness of the Forest's fisheries management program. Notable findings relate to the durability of habitat improvement structures, the associated changes in physical habitat, and biological response to the improvement activities. A discussion of the 1987 habitat monitoring and evaluation program results can be found in the supplemental document, Appendix: Monitoring and Evaluation of Mt. Hood National Forest Stream Habitat Improvement and Rehabilitation Projects: 1987 Annual Report (Forsgren, Heller, and Ober, 1988).« less

Visual feedback training using WII Fit improves balance in Parkinson's disease.

PubMed

Zalecki, Tomasz; Gorecka-Mazur, Agnieszka; Pietraszko, Wojciech; Surowka, Artur D; Novak, Pawel; Moskala, Marek; Krygowska-Wajs, Anna

2013-01-01

Postural instability including imbalance is the most disabling long term problem in Parkinson's disease (PD) that does not respond to pharmacotherapy. This study aimed at investigating the effectiveness of a novel visual-feedback training method, using Wii Fit balance board in improving balance in patients with PD. Twenty four patients with moderate PD were included in the study which comprised of a 6-week home-based balance training program using Nintendo Wii Fit and balance board. The PD patients significantly improved their results in Berg Balance Scale, Tinnet's Performance-Oriented Mobility Assessment, Timed Up-and-Go, Sit-to-stand test, 10-Meter Walk test and Activities-specific Balance Confidence scale at the end of the programme. This study suggests that visual feedback training using Wii-Fit with balance board could improve dynamic and functional balance as well as motor disability in PD patients.

Quality Early Education and Child Care From Birth to Kindergarten.

PubMed

Donoghue, Elaine A

2017-08-01

High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels. Copyright © 2017 by the American Academy of Pediatrics.

Improving Factor Score Estimation Through the Use of Observed Background Characteristics

PubMed Central

Curran, Patrick J.; Cole, Veronica; Bauer, Daniel J.; Hussong, Andrea M.; Gottfredson, Nisha

2016-01-01

A challenge facing nearly all studies in the psychological sciences is how to best combine multiple items into a valid and reliable score to be used in subsequent modelling. The most ubiquitous method is to compute a mean of items, but more contemporary approaches use various forms of latent score estimation. Regardless of approach, outside of large-scale testing applications, scoring models rarely include background characteristics to improve score quality. The current paper used a Monte Carlo simulation design to study score quality for different psychometric models that did and did not include covariates across levels of sample size, number of items, and degree of measurement invariance. The inclusion of covariates improved score quality for nearly all design factors, and in no case did the covariates degrade score quality relative to not considering the influences at all. Results suggest that the inclusion of observed covariates can improve factor score estimation. PMID:28757790

Upgrades for the CMS simulation

DOE PAGES

Lange, D. J.; Hildreth, M.; Ivantchenko, V. N.; ...

2015-05-22

Over the past several years, the CMS experiment has made significant changes to its detector simulation application. The geometry has been generalized to include modifications being made to the CMS detector for 2015 operations, as well as model improvements to the simulation geometry of the current CMS detector and the implementation of a number of approved and possible future detector configurations. These include both completely new tracker and calorimetry systems. We have completed the transition to Geant4 version 10, we have made significant progress in reducing the CPU resources required to run our Geant4 simulation. These have been achieved throughmore » both technical improvements and through numerical techniques. Substantial speed improvements have been achieved without changing the physics validation benchmarks that the experiment uses to validate our simulation application for use in production. As a result, we will discuss the methods that we implemented and the corresponding demonstrated performance improvements deployed for our 2015 simulation application.« less

Organizational Wellness Program Implementation and Evaluation: A Holistic Approach to Improve the Wellbeing of Middle Managers.

PubMed

Medina, Maria Del Consuelo; Calderon, Angelica; Blunk, Dan I; Mills, Brandy W; Leiner, Marie

2018-06-01

: Employee wellness programs can provide benefits to institutions as well as employees and their families. Despite the attempts of some organizations to implement programs that take a holistic approach to improve physical, mental, and social wellness, the most common programs are exclusively comprised of physical and nutritional components. In this study, we implemented a wellness program intervention, including training using a holistic approach to improve the wellbeing of middle managers in several multinational organizations. We included control and experimental groups to measure wellness and teamwork with two repeated measures. Our results indicated that employees receiving the intervention had improved measures of wellness and teamwork. A positive relationship was found between wellness and teamwork in the experimental group when compared with the control group. Taken together, the data suggest that implementation of these programs would provide valuable outcomes for both employees and organizations.

Review of Quantitative Ultrasound: Envelope Statistics and Backscatter Coefficient Imaging and Contributions to Diagnostic Ultrasound.

PubMed

Oelze, Michael L; Mamou, Jonathan

2016-02-01

Conventional medical imaging technologies, including ultrasound, have continued to improve over the years. For example, in oncology, medical imaging is characterized by high sensitivity, i.e., the ability to detect anomalous tissue features, but the ability to classify these tissue features from images often lacks specificity. As a result, a large number of biopsies of tissues with suspicious image findings are performed each year with a vast majority of these biopsies resulting in a negative finding. To improve specificity of cancer imaging, quantitative imaging techniques can play an important role. Conventional ultrasound B-mode imaging is mainly qualitative in nature. However, quantitative ultrasound (QUS) imaging can provide specific numbers related to tissue features that can increase the specificity of image findings leading to improvements in diagnostic ultrasound. QUS imaging can encompass a wide variety of techniques including spectral-based parameterization, elastography, shear wave imaging, flow estimation, and envelope statistics. Currently, spectral-based parameterization and envelope statistics are not available on most conventional clinical ultrasound machines. However, in recent years, QUS techniques involving spectral-based parameterization and envelope statistics have demonstrated success in many applications, providing additional diagnostic capabilities. Spectral-based techniques include the estimation of the backscatter coefficient (BSC), estimation of attenuation, and estimation of scatterer properties such as the correlation length associated with an effective scatterer diameter (ESD) and the effective acoustic concentration (EAC) of scatterers. Envelope statistics include the estimation of the number density of scatterers and quantification of coherent to incoherent signals produced from the tissue. Challenges for clinical application include correctly accounting for attenuation effects and transmission losses and implementation of QUS on clinical devices. Successful clinical and preclinical applications demonstrating the ability of QUS to improve medical diagnostics include characterization of the myocardium during the cardiac cycle, cancer detection, classification of solid tumors and lymph nodes, detection and quantification of fatty liver disease, and monitoring and assessment of therapy.

Review of quantitative ultrasound: envelope statistics and backscatter coefficient imaging and contributions to diagnostic ultrasound

PubMed Central

Oelze, Michael L.; Mamou, Jonathan

2017-01-01

Conventional medical imaging technologies, including ultrasound, have continued to improve over the years. For example, in oncology, medical imaging is characterized by high sensitivity, i.e., the ability to detect anomalous tissue features, but the ability to classify these tissue features from images often lacks specificity. As a result, a large number of biopsies of tissues with suspicious image findings are performed each year with a vast majority of these biopsies resulting in a negative finding. To improve specificity of cancer imaging, quantitative imaging techniques can play an important role. Conventional ultrasound B-mode imaging is mainly qualitative in nature. However, quantitative ultrasound (QUS) imaging can provide specific numbers related to tissue features that can increase the specificity of image findings leading to improvements in diagnostic ultrasound. QUS imaging techniques can encompass a wide variety of techniques including spectral-based parameterization, elastography, shear wave imaging, flow estimation and envelope statistics. Currently, spectral-based parameterization and envelope statistics are not available on most conventional clinical ultrasound machines. However, in recent years QUS techniques involving spectral-based parameterization and envelope statistics have demonstrated success in many applications, providing additional diagnostic capabilities. Spectral-based techniques include the estimation of the backscatter coefficient, estimation of attenuation, and estimation of scatterer properties such as the correlation length associated with an effective scatterer diameter and the effective acoustic concentration of scatterers. Envelope statistics include the estimation of the number density of scatterers and quantification of coherent to incoherent signals produced from the tissue. Challenges for clinical application include correctly accounting for attenuation effects and transmission losses and implementation of QUS on clinical devices. Successful clinical and pre-clinical applications demonstrating the ability of QUS to improve medical diagnostics include characterization of the myocardium during the cardiac cycle, cancer detection, classification of solid tumors and lymph nodes, detection and quantification of fatty liver disease, and monitoring and assessment of therapy. PMID:26761606

NFIRE Survey of Rural Education Needs.

ERIC Educational Resources Information Center

Jongeward, Ray

Tabulated results of a 1976 National Federation for the Improvement of Rural Education (NFIRE) survey soliciting 140 opinions (a 43% return on 322 survey forms) re: rural education priorities are presented in this paper. These results include the total number of persons responding to each item and the resultant ranking of all items in the survey.…

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

PubMed

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

2011-06-01

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

The development of efficient coding for an electronic mail system

NASA Technical Reports Server (NTRS)

Rice, R. F.

1983-01-01

Techniques for efficiently representing scanned electronic documents were investigated. Major results include the definition and preliminary performance results of a Universal System for Efficient Electronic Mail (USEEM), offering a potential order of magnitude improvement over standard facsimile techniques for representing textual material.

Use of a Surgical Safety Checklist to Improve Team Communication.

PubMed

Cabral, Richard A; Eggenberger, Terry; Keller, Kathryn; Gallison, Barry S; Newman, David

2016-09-01

To improve surgical team communication, a team at Broward Health Imperial Point Hospital, Ft Lauderdale, Florida, implemented a program for process improvement using a locally adapted World Health Organization Surgical Safety Checklist. This program included a standardized, comprehensive time out and a briefing/debriefing process. Postimplementation responses to the Safety Attitudes Questionnaire revealed a significant increase in the surgical team's perception of communication compared with that reported on the pretest (6% improvement resulting in t79 = -1.72, P < .05, d = 0.39). Perceptions of communication increased significantly for nurses (12% increase, P = .002), although the increase for surgeons and surgical technologists was lower (4% for surgeons, P = .15 and 2.3% for surgical technologists, P = .06). As a result of this program, we have observed improved surgical teamwork behaviors and an enhanced culture of safety in the OR. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Surface Stabilized InP/GaP/ZnS Quantum Dots with Mg Ions for WLED Application.

PubMed

Park, Joong Pill; Kim, Sang-Wook

2016-05-01

One of the most highlighted cadmium-free quantum dots (QDs), InP-based QDs, have improved their optical properties. However, InP-based QDs have some practical drawbacks, for example, stability, compared with CdSe-based QDs. Poor stability of InP-based QDs yields critical problems, such as agglomeration and photoluminescence quenching in light emitting diode (LED). It has to be solved for applications and most research has focused on thick outer shells as an effective solution. We introduced magnesium cations for improving stability of InP-based QDs. We applied very small amounts of Mg cations as surface stabilizers, as a result, stability of QDs is clearly improved. Then, QD based LED chips also yield improved values including RA of 84.4, CCT of 3799 K, and luminous efficiency of 129.57 Im/W, which are highly improved data compared with our previous results.

Coal liquefaction process

DOEpatents

Skinner, Ronald W.; Tao, John C.; Znaimer, Samuel

1985-01-01

This invention relates to an improved process for the production of liquid carbonaceous fuels and solvents from carbonaceous solid fuels, especially coal. The claimed improved process includes the hydrocracking of the light SRC mixed with a suitable hydrocracker solvent. The recycle of the resulting hydrocracked product, after separation and distillation, is used to produce a solvent for the hydrocracking of the light solvent refined coal.

Using the Results of Teaching Evaluations to Improve Teaching: A Case Study of a New Systematic Process

ERIC Educational Resources Information Center

Malouff, John M.; Reid, Jackie; Wilkes, Janelle; Emmerton, Ashley J.

2015-01-01

This article describes a new 14-step process for using student evaluations of teaching to improve teaching. The new process includes examination of student evaluations in the context of instructor goals, student evaluations of the same course completed in prior terms, and evaluations of similar courses taught by other instructors. The process has…

Improving 10th Graders' English Communicative Competence through the Implementation of the Task-Based Learning Approach

ERIC Educational Resources Information Center

Buitrago Campo, Ana Carolina

2016-01-01

This article reports the results of an action-research project focused on improving students' communicative competence in English through the task-based learning approach. This study was conducted in a co-educational public school in Medellín (Colombia) with thirty-four tenth graders. Actions implemented include the development of a series of…

Engineered Structured Sorbents for the Adsorption of Carbon Dioxide and Water Vapor from Manned Spacecraft Atmospheres: Applications and Testing 2008/2009

NASA Technical Reports Server (NTRS)

Howard, David F.; Perry, Jay L.; Knox, James C.; Junaedi, Christian

2009-01-01

This paper describes efforts to improve on typical packed beds of sorbent pellets by making use of structured sorbents and alternate bed configurations to improve system efficiency and reliability. The benefits of the alternate configurations include increased structural stability gained by eliminating clay bound zeolite pellets that tend to fluidize and erode, and better thermal control during sorption to increase process efficiency. Test results that demonstrate such improvements are described and presented.

Differential absorption and Raman lidar for water vapor profile measurements - A review

NASA Technical Reports Server (NTRS)

Grant, William B.

1991-01-01

Differential absorption lidar and Raman lidar have been applied to the range-resolved measurements of water vapor density for more than 20 years. Results have been obtained using both lidar techniques that have led to improved understanding of water vapor distributions in the atmosphere. This paper reviews the theory of the measurements, including the sources of systematic and random error; the progress in lidar technology and techniques during that period, including a brief look at some of the lidar systems in development or proposed; and the steps being taken to improve such lidar systems.

Small UAV Research and Evolution in Long Endurance Electric Powered Vehicles

NASA Technical Reports Server (NTRS)

Logan, Michael J.; Chu, Julio; Motter, Mark A.; Carter, Dennis L.; Ol, Michael; Zeune, Cale

2007-01-01

This paper describes recent research into the advancement of small, electric powered unmanned aerial vehicle (UAV) capabilities. Specifically, topics include the improvements made in battery technology, design methodologies, avionics architectures and algorithms, materials and structural concepts, propulsion system performance prediction, and others. The results of prototype vehicle designs and flight tests are discussed in the context of their usefulness in defining and validating progress in the various technology areas. Further areas of research need are also identified. These include the need for more robust operating regimes (wind, gust, etc.), and continued improvement in payload fraction vs. endurance.

A common evaluation framework for the African Health Initiative

PubMed Central

2013-01-01

Background The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. Methods This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. Results and conclusions The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results. PMID:23819778

A common evaluation framework for the African Health Initiative.

PubMed

Bryce, Jennifer; Requejo, Jennifer Harris; Moulton, Lawrence H; Ram, Malathi; Black, Robert E

2013-01-01

The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results.

Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol.

PubMed

Dahm, Maria R; Georgiou, Andrew; Westbrook, Johanna I; Greenfield, David; Horvath, Andrea R; Wakefield, Denis; Li, Ling; Hillman, Ken; Bolton, Patrick; Brown, Anthony; Jones, Graham; Herkes, Robert; Lindeman, Robert; Legg, Michael; Makeham, Meredith; Moses, Daniel; Badmus, Dauda; Campbell, Craig; Hardie, Rae-Anne; Li, Julie; McCaughey, Euan; Sezgin, Gorkem; Thomas, Judith; Wabe, Nasir

2018-02-15

The failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability; (2) harness health information technology (IT) to inform and monitor test-result management; (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems. This convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia.Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions.Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes.Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings. Ethical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Io's Magnetospheric Interaction: An MHD Model with Day-Night Asymmetry

NASA Technical Reports Server (NTRS)

Kabin, K.; Combi, M. R.; Gombosi, T. I.; DeZeeuw, D. L.; Hansen, K. C.; Powell, K. G.

2001-01-01

In this paper we present the results of all improved three-dimensional MHD model for Io's interaction with Jupiter's magnetosphere. We have included the day-night asymmetry into the spatial distribution of our mass-loading, which allowed us to reproduce several smaller features or the Galileo December 1995 data set. The calculation is performed using our newly modified description of the pick-up processes that accounts for the effects of the corotational electric field existing in the Jovian magnetosphere. This change in the formulation of the source terms for the MHD equations resulted in significant improvements in the comparison with the Galileo measurements. We briefly discuss the limitations of our model and possible future improvements.

Replacing revolving door: a collaborative approach to treating individuals in crisis.

PubMed

Lauer, Michelle; Brownstein, Rose

2008-06-01

The Crisis Assessment and Psychiatric Emergency Services (CAPES) unit was designed to improve the quality of psychiatric treatment, contain costs, and provide relief to overburdened psychiatric inpatient and emergency services in Delaware. This innovative program is the result of collaboration between public and private agencies to treat individuals in crisis. The myriad factors that contributed to a broken system and instigated Delaware's search for a solution are discussed in this article. The CAPES unit has resulted in improved communication among providers, decreased committal rates, better linkage to appropriate levels of care, increased safety, and improved coordination of services. Clinical implications for nursing practice include providing more holistic care in a safer environment.

Improved Monkey-King Genetic Algorithm for Solving Large Winner Determination in Combinatorial Auction

NASA Astrophysics Data System (ADS)

Li, Yuzhong

Using GA solve the winner determination problem (WDP) with large bids and items, run under different distribution, because the search space is large, constraint complex and it may easy to produce infeasible solution, would affect the efficiency and quality of algorithm. This paper present improved MKGA, including three operator: preprocessing, insert bid and exchange recombination, and use Monkey-king elite preservation strategy. Experimental results show that improved MKGA is better than SGA in population size and computation. The problem that traditional branch and bound algorithm hard to solve, improved MKGA can solve and achieve better effect.

SPAR improved structural-fluid dynamic analysis capability

NASA Technical Reports Server (NTRS)

Pearson, M. L.

1985-01-01

The results of a study whose objective was to improve the operation of the SPAR computer code by improving efficiency, user features, and documentation is presented. Additional capability was added to the SPAR arithmetic utility system, including trigonometric functions, numerical integration, interpolation, and matrix combinations. Improvements were made in the EIG processor. A processor was created to compute and store principal stresses in table-format data sets. An additional capability was developed and incorporated into the plot processor which permits plotting directly from table-format data sets. Documentation of all these features is provided in the form of updates to the SPAR users manual.

Demonstration of the Health Literacy Universal Precautions Toolkit: Lessons for Quality Improvement.

PubMed

Mabachi, Natabhona M; Cifuentes, Maribel; Barnard, Juliana; Brega, Angela G; Albright, Karen; Weiss, Barry D; Brach, Cindy; West, David

2016-01-01

The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements.

GEOS S2S-2_1: GMAO's New High Resolution Seasonal Prediction System

NASA Technical Reports Server (NTRS)

Molod, Andrea; Akella, Santha; Andrews, Lauren; Barahona, Donifan; Borovikov, Anna; Chang, Yehui; Cullather, Richard; Hackert, Eric; Kovach, Robin; Koster, Randal;

[Concept analysis of medication adherence in patients with chronic disease].

PubMed

Huang, Jen-Ying; Chen, Hsing-Mei

2014-06-01

Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her / his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice.

Cardiovascular exercise training extends influenza vaccine seroprotection in sedentary older adults: the immune function intervention trial.

PubMed

Woods, Jeffrey A; Keylock, K Todd; Lowder, Thomas; Vieira, Victoria J; Zelkovich, William; Dumich, Sara; Colantuano, Kim; Lyons, Kristin; Leifheit, Kurt; Cook, Marc; Chapman-Novakofski, Karen; McAuley, Edward

2009-12-01

To determine whether cardiovascular exercise training resulted in improved antibody responses to influenza vaccination in sedentary elderly people who exhibited poor vaccine responses. Single-site randomized parallel-arm 10-month controlled trial. University of Illinois at Urbana-Champaign. One hundred forty-four sedentary, healthy older (69.9 +/- 0.4) adults. Moderate (60-70% maximal oxygen uptake) cardiovascular exercise was compared with flexibility and balance training. The primary outcome was influenza vaccine response, as measured according to hemagglutination inhibition (HI) anti-influenza antibody titer and seroprotective responses (HI titer > or =40). Secondary measures included cardiovascular fitness and body composition. Of the 160 participants enrolled, 144 (90%) completed the 10-month intervention with excellent compliance ( approximately 83%). Cardiovascular, but not flexibility, exercise intervention resulted in improvements in indices of cardiovascular fitness, including maximal oxygen uptake. Although not affecting peak (e.g., 3 and 6 weeks) postvaccine anti-influenza HI titers, cardiovascular exercise resulted in a significant increase in seroprotection 24 weeks after vaccination (30-100% dependent on vaccine variant), whereas flexibility training did not. Participants randomized to cardiovascular exercise experienced improvements in influenza seroprotection throughout the entire influenza season, whereas those in the balance and flexibility intervention did not. Although there were no differences in reported respiratory tract infections, the exercise group exhibited reduced overall illness severity and sleep disturbance. These data support the hypothesis that regular endurance exercise improves influenza vaccine responses.

Changes in Non-Diabetic Comorbid Disease Status Following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) Procedures: a Systematic Review of Randomized Controlled Trials.

PubMed

Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Memon, Breda; Memon, Muhammed Ashraf

2017-05-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this systematic review was to study the peer review literature regarding postoperative nondiabetic comorbid disease resolution or improvement reported from randomized controlled trials (RCTs) comparing LVSG and LRYGB procedures. RCTs comparing postoperative comorbid disease resolution such as hypertension, dyslipidemia, obstructive sleep apnea, joint and musculoskeletal conditions, gastroesophageal reflux disease, and menstrual irregularities following LVSG and LRYGB were included for analysis. The studies were selected from PubMed, Medline, EMBASE, Science Citation Index, Current Contents, and the Cochrane database and reported on at least one comorbidity resolution or improvement. The present work was undertaken according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA). The Jadad method for assessment of methodological quality was applied to the included studies. Six RCTs performed between 2005 and 2015 involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on the resolution or improvement of comorbid disease following LVSG and LRYGB procedures. Both bariatric procedures provide effective and almost comparable results in improving or resolving these comorbidities. This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative nondiabetic comorbid diseases in obese patients. While results are not conclusive at this time, LRYGB may provide superior results compared to LVSG in mediating the remission and/or improvement in some conditions such as dyslipidemia and arthritis.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004–2012

PubMed Central

Hamel, Donald J.; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D.; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T.; Okonkwo, Prosper; Kanki, Phyllis J.

2015-01-01

Introduction From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Methods Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Results Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Conclusions Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings. PMID:26900573

Toward Improved Fidelity of Thermal Explosion Simulations

NASA Astrophysics Data System (ADS)

Nichols, Albert; Becker, Richard; Burnham, Alan; Howard, W. Michael; Knap, Jarek; Wemhoff, Aaron

2009-06-01

We present results of an improved thermal/chemical/mechanical model of HMX based explosives like LX04 and LX10 for thermal cook-off. The original HMX model and analysis scheme were developed by Yoh et.al. for use in the ALE3D modeling framework. The improvements were concentrated in four areas. First, we added porosity to the chemical material model framework in ALE3D used to model HMX explosive formulations to handle the roughly 2% porosity in solid explosives. Second, we improved the HMX reaction network, which included the addition of a reactive phase change model base on work by Henson et.al. Third, we added early decomposition gas species to the CHEETAH material database to improve equations of state for gaseous intermediates and products. Finally, we improved the implicit mechanics module in ALE3D to more naturally handle the long time scales associated with thermal cookoff. The application of the resulting framework to the analysis of the Scaled Thermal Explosion (STEX) experiments will be discussed.

Improvements in emotion regulation following repetitive transcranial magnetic stimulation for generalized anxiety disorder.

PubMed

Diefenbach, Gretchen J; Assaf, Michal; Goethe, John W; Gueorguieva, Ralitza; Tolin, David F

2016-10-01

Generalized anxiety disorder (GAD) is characterized by emotion regulation difficulties, which are associated with abnormalities in neural circuits encompassing fronto-limbic regions including the dorsolateral prefrontal cortex (DLPFC). The aim of this study was to determine whether DLPFC neuromodulation improves emotion regulation in patients with GAD. This is a secondary analysis from a randomized-controlled trial comparing 30 sessions of low-frequency right-sided active (n=13) versus sham (n=12, sham coil) repetitive transcranial magnetic stimulation (rTMS) at the right DLPFC in patients with GAD. Results indicated statistically significant improvements in self-reported emotion regulation difficulties at posttreatment and 3-month follow-up in the active group only. Improvements were found primarily in the domains of goal-directed behaviors and impulse control and were significantly associated with a global clinician rating of improvement. These preliminary results support rTMS as a treatment for GAD and suggest improved emotion regulation as a possible mechanism of change. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

Effect of shoulder girdle strengthening on trunk alignment in patients with stroke.

PubMed

Awad, Amina; Shaker, Hussien; Shendy, Wael; Fahmy, Manal

2015-07-01

[Purpose] This study investigated the effect of shoulder girdle strengthening, particularly the scapular muscles, on poststroke trunk alignment. [Subjects and Methods] The study involved 30 patients with residual hemiparesis following cerebrovascular stroke. Patient assessment included measuring shoulder muscle peak torque, scapular muscles peak force, spinal lateral deviation angle, and motor functional performance. Patients were randomly allocated either to the control group or the study group and received an 18-session strengthening program including active resisted exercises for shoulder abductors and external rotators in addition to trunk control exercises. The study group received additional strengthening exercises for the scapular muscles. [Results] The two groups showed significant improvement in strength of all shoulder and scapular muscles, with higher improvement in the study group. Similarly, the lateral spinal deviation angles significantly improved in both groups, with significantly higher improvement in the study group. Transfer activity, sitting balance, upper limb functions, and hand movements significantly improved in the two groups, with higher improvement in the latter two functions in the study group. [Conclusion] Strengthening of shoulder girdle muscles, particularly scapular muscles, can significantly contribute to improving the postural alignment of the trunk in patients with poststroke hemiparesis.

Improving Access to Emergency Contraception Pills through Strengthening Service Delivery and Demand Generation: A Systematic Review of Current Evidence in Low and Middle-Income Countries

PubMed Central

Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

2014-01-01

Objectives Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. Methods A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Findings Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. Conclusion There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP. PMID:25285438

Team-Based Learning in US Colleges and Schools of Pharmacy

PubMed Central

Copeland, Jeffrey; Franks, Andrea S.; Karimi, Reza; McCollum, Marianne; Riese, David J.; Lin, Anne Y.F.

2013-01-01

Objective. To characterize the use of team-based learning (TBL) in US colleges and schools of pharmacy, including factors that may affect implementation and perceptions of faculty members regarding the impact of TBL on educational outcomes. Methods. Respondents identified factors that inhibit or enable TBL use and its impact on student learning. Results were stratified by type of institution (public/private), class size, and TBL experience. Results. Sixty-nine of 100 faculty members (69%) representing 43 (86%) institutions responded. Major factors considered to enable TBL implementation included a single campus and student and administration buy-in. Inhibiting factors included distant campuses, faculty resistance, and lack of training. Compared with traditional lectures, TBL is perceived to enhance student engagement, improve students’ preparation for class, and promote achievement of course outcomes. In addition, TBL is perceived to be more effective than lectures at fostering learning in all 6 domains of Bloom’s Taxonomy. Conclusions. Despite potential implementation challenges, faculty members perceive that TBL improves student engagement and learning. PMID:23966718

Sleep education with self-help treatment and sleep health promotion for mental and physical wellness in Japan.

PubMed

Tanaka, Hideki; Tamura, Norihisa

The purpose of this article was to provide an overview of the effects of the sleep education with self-help treatment for student, teacher, and local resident and sleep health promotion for mental and physical wellness for elderly with actual examples of public health from the community and schools. Sleep education with self-help treatment in schools revealed that delayed or irregular sleep/wake patterns were significantly improved. Also, it was effective for improving sleep-onset latency, sleep satisfaction, mood during the morning, and daytime sleepiness. The strategy of this sleep education included the acquisition of the correct knowledge about sleep and the sleep-related behaviors that are important for improving sleep. Sleep health promotion that included short naps and exercise in the evening (Sleep health class) was effective in promoting sleep and mental health with elderly people. The interventions demonstrated that the proper awakening maintenance, keeping proper arousal level during the evening was effective in improving sleep quality. Furthermore, sleep management that included sleep education and cognitive-behavioral interventions improved sleep-related habits and the quality of sleep. In this study, a sleep educational program using minimal cognitive-behavioral modification techniques was developed. Mental and physical health was also improved with better sleep in the elderly. These results suggest that sleep health promotion is effective for mental and physical wellness for the elderly.

Improved (ERTS) information and its impact on U.S. markets for agricultural commodities: A quantitiative economic investigation of production, distribution and net export effects

NASA Technical Reports Server (NTRS)

1974-01-01

An econometric investigation into the markets for agricultural commodities is summarized. An overview of the effort including the objectives, scope, and architecture of the analysis and the estimation strategy employed is presented. The major empirical results and policy conclusions are set forth. These results and conclusions focus on the economic importance of improved crop forecasts, U.S. exports, and government policy operations. A number of promising avenues of further investigation are suggested.

New advances in the partial-reflection-drifts experiment using microprocessors

NASA Technical Reports Server (NTRS)

Ruggerio, R. L.; Bowhill, S. A.

1982-01-01

Improvements to the partial reflection drifts experiment are completed. The results of the improvements include real time processing and simultaneous measurements of the D region with coherent scatter. Preliminary results indicate a positive correlation between drift velocities calculated by both methods during a two day interval. The possibility now exists for extended observations between partial reflection and coherent scatter. In addition, preliminary measurements could be performed between partial reflection and meteor radar to complete a comparison of methods used to determine velocities in the D region.

Does pedometer goal setting improve physical activity among Native elders? Results from a randomized pilot study.

PubMed

Sawchuk, Craig N; Russo, Joan E; Charles, Steve; Goldberg, Jack; Forquera, Ralph; Roy-Byrne, Peter; Buchwald, Dedra

2011-01-01

We examined if step-count goal setting resulted in increases in physical activity and walking compared to only monitoring step counts with pedometers among American Indian/Alaska Native elders. Outcomes included step counts, self-reported physical activity and well-being, and performance on the 6-minute walk test. Although no significant between-group differences were found, within-group analyses indicated that elders significantly improved on the majority of step count, physical activity, health-related quality of life, and 6-minute walk outcomes.

How can we improve the environmental sustainability of poultry production?

PubMed

Leinonen, Ilkka; Kyriazakis, Ilias

2016-08-01

The review presents results of recent life cycle assessment studies aiming to quantify and improve the environmental performance of UK poultry production systems, including broiler meat, egg and turkey meat production. Although poultry production has been found to be relatively environmentally friendly compared with the production of other livestock commodities, it still contributes to environmental impacts, such as global warming, eutrophication and acidification. Amongst different sub-processes, feed production and transport contributes about 70 % to the global warming potential of poultry systems, whereas manure management contributes about 40-60 % to their eutrophication potential and acidification potential, respectively. All these impacts can be reduced by improving the feed efficiency, either by changing the birds through genetic selection or by making the feed more digestible (e.g. by using additives such as enzymes). However, although genetic selection has the potential to reduce the resources needed for broiler production (including feed consumption), the changing need of certain feed ingredients, most notably protein sources as a result of changes in bird requirements may limit the benefits of this strategy. The use of alternative feed ingredients, such as locally grown protein crops and agricultural by-products, as a replacement of South American grown soya, can potentially also lead to improvements in several environmental impact categories, as long as such feeding strategies have no negative effect on bird performance. Other management options, such as improving poultry housing and new strategies for manure management have also the potential to further improve the environmental sustainability of the poultry industries in Europe.

Obesity Prevention Programs for Children and Youth: Why Are Their Results so Modest?

ERIC Educational Resources Information Center

Thomas, Helen

2006-01-01

The purpose of this paper is to critically reflect upon the mixed/modest results of the primary studies related to the effectiveness of physical activity enhancement and improving nutritional intake in obesity prevention programs for children and youth. The results of a recent review of this topic that included 57 randomized controlled trials…

Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis.

PubMed

Tang, Kai; Si, Jun-Kang; Guo, Da-Dong; Cui, Yan; Du, Yu-Xiang; Pan, Xue-Mei; Bi, Hong-Sheng

2015-01-01

To compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV). A systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis. Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study. IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.

Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates.

PubMed

Memon, M; Kay, J; Ginsberg, L; Simunovic, N; Bak, K; Lapner, P; Ayeni, O R

2018-01-01

The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure. Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist. In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures. While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder. Level IV, systematic review of level II to IV studies.

We need to include bystander first aid in trauma research.

PubMed

Bakke, Håkon Kvåle; Wisborg, Torben

2017-03-23

The chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystander first aid has resulted in improved outcome. Whereas, in trauma research the first link of the chain of survival is almost ignored. In OHCA, cardiopulmonary resuscitation (CPR) from bystanders has been subject of a vast amount of research, as well as measures and programs to raise the rate of bystander CPR to cardiac arrest victims. These efforts have resulted in improved survival. The research effort has been well grounded in the research community, as demonstrated by its natural inclusion in the uniform reporting template (Utstein) for the treatment of OHCA. In trauma the bystander may contribute by providing an open airway, staunch bleedings, or prevent hypothermia. In trauma however, while the chain of survival has been adopted along with it distinct links, including bystander first aid, the consensus-based uniform reporting template for trauma (the Utstein template) does not include the bystander first aid efforts. There is extremely little research on what first aid measures bystanders provide to trauma victims, and on what impact such measures have on outcome. An important step to improve research on bystander first aid in trauma would be to include this as part of the uniform reporting template for trauma CONCLUSION: The lack of research on bystander first aid makes the first link in the trauma chain of survival the weakest link. We, the trauma research community, should either improve our research and knowledge in this area, or remove the link from the chain of survival.

Green supply chain management in China

NASA Astrophysics Data System (ADS)

Zhu, Qinghua; Sarkis, Joseph

2004-02-01

Globalization results in both pressure and drivers for Chinese enterprise to improve their environmental performance. As a developing country, China has to balance economic and environmental performance. Green supply chain management (GSCM) is emerging to be an important approach for Chinese enterprises to improve performance, possibly on both these dimensions. Using empirical results from 89 respondents on GSCM practice in Chinese manufacturing enterprises, we examine the relationships between pressures, practice and performance. The results will look at multiple dimensions of GSCM practice and performance, as well as various pressures they face. Discussion of the results will include practical implications for organizations, not only in China, but internationally who face similar pressures and seek to implement similar programs.

Method and apparatus for producing cryogenic targets

DOEpatents

Murphy, James T.; Miller, John R.

1984-01-01

An improved method and apparatus are given for producing cryogenic inertially driven fusion targets in the fast isothermal freezing (FIF) method. Improved coupling efficiency and greater availability of volume near the target for diagnostic purposes and for fusion driver beam propagation result. Other embodiments include a new electrical switch and a new explosive detonator, all embodiments making use of a purposeful heating by means of optical fibers.

The validation of ozone measurements from the improved stratospheric and mesospheric sounder

NASA Technical Reports Server (NTRS)

Connor, Brian J.; Scheuer, Christopher J.; Chu, D. A.; Remedios, John J.; Marks, C. J.; Rodgers, Clive D.; Taylor, Fredric W.

1994-01-01

We present preliminary results of the validation of ozone measurements from the Improved Stratospheric and Mesospheric Sounder (ISAMS). The indications are that the ISAMS provides ozone data which generally agrees with other experiments and climatological values, except in regions of large thermal gradients or high aerosol loading. Corrections for these effects will be included in future reprocessing of the data.

Improving Human Milk and Breastfeeding Practices in the NICU.

PubMed

Fugate, Karen; Hernandez, Ivonne; Ashmeade, Terri; Miladinovic, Branko; Spatz, Diane L

2015-01-01

To determine if systematic implementation of the Spatz Ten Steps for Promoting and Protecting Breastfeeding for Vulnerable Infants (Ten Steps) would result in an improvement in the percentage of infants receiving mother's own milk (MOM) at initiation of feedings and at hospital discharge. Continuous quality improvement (QI) process. Urban, 82-bed, Level-III NICU. Very- low-birth-weight (VLBW) infants weighing fewer than 1500 grams. The Ten Step method was implemented during a 3-year period. Process measurements included percentage of VLBW infants receiving MOM at initiation of feeds, number of mothers of VLBW infants with hospital-grade electric breast pump at hospital discharge, and number of mothers of VLBW infants initiating pumping within 6 hours of delivery. Outcome measurements included percentage of VLBW infants with any human milk at discharge to home and parent satisfaction with nurses' support of mother's efforts to breastfeed. Balancing measurements included percentage of VLBW infants at less than the third percentile for growth on the Fenton growth chart at discharge and receiving pasteurized donor milk (PDM). Significant improvements were achieved in the percentages of mothers expressing their milk within 6 hours of delivery, infants receiving MOM at initiation of feeds, and mothers with a hospital-grade pump at discharge. Improvements in these processes resulted in increased parent satisfaction with nurses' support of breastfeeding and a 3.1-fold greater odds of the VLBW infant receiving MOM at discharge in 2013 compared to 2010 (odds ratio [OR]= 3.01, 95% confidence interval [CI] [1.75, 5.17], p < .001). Despite an increase in the use of MOM, there was not a significant increase in VLBW infants discharged at less than the third percentile for growth, and initiation of PDM did not negatively affect the percentage of VLBW infants with any human milk at discharge. Implementation of the Ten Steps method using QI methodology resulted in significantly improved rates of use of MOM at initiation of feeds and at hospital discharge. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Application of ALOS and Envisat Data in Improving Multi-Temporal InSAR Methods for Monitoring Damavand Volcano and Landslide Deformation in the Center of Alborz Mountains, North Iran

NASA Astrophysics Data System (ADS)

Vajedian, S.; Motagh, M.; Nilfouroushan, F.

2013-09-01

InSAR capacity to detect slow deformation over terrain areas is limited by temporal and geometric decorrelations. Multitemporal InSAR techniques involving Persistent Scatterer (Ps-InSAR) and Small Baseline (SBAS) are recently developed to compensate the decorrelation problems. Geometric decorrelation in mountainous areas especially for Envisat images makes phase unwrapping process difficult. To improve this unwrapping problem, we first modified phase filtering to make the wrapped phase image as smooth as possible. In addition, in order to improve unwrapping results, a modified unwrapping method has been developed. This method includes removing possible orbital and tropospheric effects. Topographic correction is done within three-dimensional unwrapping, Orbital and tropospheric corrections are done after unwrapping process. To evaluate the effectiveness of our improved method we tested the proposed algorithm by Envisat and ALOS dataset and compared our results with recently developed PS software (StaMAPS). In addition we used GPS observations for evaluating the modified method. The results indicate that our method improves the estimated deformation significantly.

The value of vital sign trends for detecting clinical deterioration on the wards.

PubMed

Churpek, Matthew M; Adhikari, Richa; Edelson, Dana P

2016-05-01

Early detection of clinical deterioration on the wards may improve outcomes, and most early warning scores only utilize a patient's current vital signs. The added value of vital sign trends over time is poorly characterized. We investigated whether adding trends improves accuracy and which methods are optimal for modelling trends. Patients admitted to five hospitals over a five-year period were included in this observational cohort study, with 60% of the data used for model derivation and 40% for validation. Vital signs were utilized to predict the combined outcome of cardiac arrest, intensive care unit transfer, and death. The accuracy of models utilizing both the current value and different trend methods were compared using the area under the receiver operating characteristic curve (AUC). A total of 269,999 patient admissions were included, which resulted in 16,452 outcomes. Overall, trends increased accuracy compared to a model containing only current vital signs (AUC 0.78 vs. 0.74; p<0.001). The methods that resulted in the greatest average increase in accuracy were the vital sign slope (AUC improvement 0.013) and minimum value (AUC improvement 0.012), while the change from the previous value resulted in an average worsening of the AUC (change in AUC -0.002). The AUC increased most for systolic blood pressure when trends were added (AUC improvement 0.05). Vital sign trends increased the accuracy of models designed to detect critical illness on the wards. Our findings have important implications for clinicians at the bedside and for the development of early warning scores. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Dissemination of performance information and continuous improvement: A narrative systematic review.

PubMed

Lemire, Marc; Demers-Payette, Olivier; Jefferson-Falardeau, Justin

2013-01-01

Developing a performance measure and reporting the results to support decision making at an individual level has yielded poor results in many health systems. The purpose of this paper is to highlight the factors associated with the dissemination of performance information that generate and support continuous improvement in health organizations. A systematic data collection strategy that includes empirical and theoretical research published from 1980 to 2010, both qualitative and quantitative, was performed on Web of Science, Current Contents, EMBASE and MEDLINE. A narrative synthesis method was used to iteratively detail explicative processes that underlie the intervention. A classification and synthesis framework was developed, drawing on knowledge transfer and exchange (KTE) literature. The sample consisted of 114 articles, including seven systematic or exhaustive reviews. Results showed that dissemination in itself is not enough to produce improvement initiatives. Successful dissemination depends on various factors, which influence the way collective actors react to performance information such as the clarity of objectives, the relationships between stakeholders, the system's governance and the available incentives. This review was limited to the process of knowledge dissemination in health systems and its utilization by users at the health organization level. Issues related to improvement initiatives deserve more attention. Knowledge dissemination goes beyond better communication and should be considered as carefully as the measurement of performance. Choices pertaining to intervention should be continuously prompted by the concern to support organizational action. While considerable attention was paid to the public reporting of performance information, this review sheds some light on a more promising avenue for changes and improvements, notably in public health systems.

Systematic Review of Model-Based Economic Evaluations of Treatments for Alzheimer's Disease.

PubMed

Hernandez, Luis; Ozen, Asli; DosSantos, Rodrigo; Getsios, Denis

2016-07-01

Numerous economic evaluations using decision-analytic models have assessed the cost effectiveness of treatments for Alzheimer's disease (AD) in the last two decades. It is important to understand the methods used in the existing models of AD and how they could impact results, as they could inform new model-based economic evaluations of treatments for AD. The aim of this systematic review was to provide a detailed description on the relevant aspects and components of existing decision-analytic models of AD, identifying areas for improvement and future development, and to conduct a quality assessment of the included studies. We performed a systematic and comprehensive review of cost-effectiveness studies of pharmacological treatments for AD published in the last decade (January 2005 to February 2015) that used decision-analytic models, also including studies considering patients with mild cognitive impairment (MCI). The background information of the included studies and specific information on the decision-analytic models, including their approach and components, assumptions, data sources, analyses, and results, were obtained from each study. A description of how the modeling approaches and assumptions differ across studies, identifying areas for improvement and future development, is provided. At the end, we present our own view of the potential future directions of decision-analytic models of AD and the challenges they might face. The included studies present a variety of different approaches, assumptions, and scope of decision-analytic models used in the economic evaluation of pharmacological treatments of AD. The major areas for improvement in future models of AD are to include domains of cognition, function, and behavior, rather than cognition alone; include a detailed description of how data used to model the natural course of disease progression were derived; state and justify the economic model selected and structural assumptions and limitations; provide a detailed (rather than high-level) description of the cost components included in the model; and report on the face-, internal-, and cross-validity of the model to strengthen the credibility and confidence in model results. The quality scores of most studies were rated as fair to good (average 87.5, range 69.5-100, in a scale of 0-100). Despite the advancements in decision-analytic models of AD, there remain several areas of improvement that are necessary to more appropriately and realistically capture the broad nature of AD and the potential benefits of treatments in future models of AD.

Importance of Ambipolar Electric Field in the Ion Loss from Mars- Results from a Multi-fluid MHD Model with the Electron Pressure Equation Included

NASA Astrophysics Data System (ADS)

Ma, Y.; Dong, C.; van der Holst, B.; Nagy, A. F.; Bougher, S. W.; Toth, G.; Cravens, T.; Yelle, R. V.; Jakosky, B. M.

2017-12-01

The multi-fluid (MF) magnetohydrodynamic (MHD) model of Mars is further improved by solving an additional electron pressure equation. Through the electron pressure equation, the electron temperature is calculated based on the effects from various electrons related heating and cooling processes (e.g. photo-electron heating, electron-neutral collision and electron-ion collision), and thus the improved model is able to calculate the electron temperature and the electron pressure force self-consistently. Electron thermal conductivity is also considered in the calculation. Model results of a normal case with electron pressure equation included (MFPe) are compared in detail to an identical case using the regular MF model to identify the effect of the improved physics. We found that when the electron pressure equation is included, the general interaction patterns are similar to that of the case with no electron pressure equation. The model with electron pressure equation predicts that electron temperature is much larger than the ion temperature in the ionosphere, consistent with both Viking and MAVEN observations. The inclusion of electron pressure equation significantly increases the total escape fluxes predicted by the model, indicating the importance of the ambipolar electric field(electron pressure gradient) in driving the ion loss from Mars.

How small is small enough? Role of robotics in paediatric urology

PubMed Central

Ganpule, Arvind P.; Sripathi, Venkat

2015-01-01

The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series. PMID:25598599

How small is small enough? Role of robotics in paediatric urology.

PubMed

Ganpule, Arvind P; Sripathi, Venkat

2015-01-01

The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series.

Cultural competence in mental health care: a review of model evaluations

PubMed Central

Bhui, Kamaldeep; Warfa, Nasir; Edonya, Patricia; McKenzie, Kwame; Bhugra, Dinesh

2007-01-01

Background Cultural competency is now a core requirement for mental health professionals working with culturally diverse patient groups. Cultural competency training may improve the quality of mental health care for ethnic groups. Methods A systematic review that included evaluated models of professional education or service delivery. Results Of 109 potential papers, only 9 included an evaluation of the model to improve the cultural competency practice and service delivery. All 9 studies were located in North America. Cultural competency included modification of clinical practice and organizational performance. Few studies published their teaching and learning methods. Only three studies used quantitative outcomes. One of these showed a change in attitudes and skills of staff following training. The cultural consultation model showed evidence of significant satisfaction by clinicians using the service. No studies investigated service user experiences and outcomes. Conclusion There is limited evidence on the effectiveness of cultural competency training and service delivery. Further work is required to evaluate improvement in service users' experiences and outcomes. PMID:17266765

The affordable care act and long-term care: comprehensive reform or just tinkering around the edges?

PubMed

Miller, Edward Alan

2012-01-01

The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system. But just how effective is the ACA likely to be in addressing these challenges? Will it result in meaningful or marginal reform? This special issue of Journal of Aging & Social Policy seeks to answer these questions. The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms. There are also elements that seek to improve workforce recruitment and retention, in addition to benefit improvements and spending reductions under Medicare. This article reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them. It also includes a brief overview of issue content.

An additional k-means clustering step improves the biological features of WGCNA gene co-expression networks.

PubMed

Botía, Juan A; Vandrovcova, Jana; Forabosco, Paola; Guelfi, Sebastian; D'Sa, Karishma; Hardy, John; Lewis, Cathryn M; Ryten, Mina; Weale, Michael E

2017-04-12

Weighted Gene Co-expression Network Analysis (WGCNA) is a widely used R software package for the generation of gene co-expression networks (GCN). WGCNA generates both a GCN and a derived partitioning of clusters of genes (modules). We propose k-means clustering as an additional processing step to conventional WGCNA, which we have implemented in the R package km2gcn (k-means to gene co-expression network, https://github.com/juanbot/km2gcn ). We assessed our method on networks created from UKBEC data (10 different human brain tissues), on networks created from GTEx data (42 human tissues, including 13 brain tissues), and on simulated networks derived from GTEx data. We observed substantially improved module properties, including: (1) few or zero misplaced genes; (2) increased counts of replicable clusters in alternate tissues (x3.1 on average); (3) improved enrichment of Gene Ontology terms (seen in 48/52 GCNs) (4) improved cell type enrichment signals (seen in 21/23 brain GCNs); and (5) more accurate partitions in simulated data according to a range of similarity indices. The results obtained from our investigations indicate that our k-means method, applied as an adjunct to standard WGCNA, results in better network partitions. These improved partitions enable more fruitful downstream analyses, as gene modules are more biologically meaningful.

Does hippotherapy effect use of sensory information for balance in people with multiple sclerosis?

PubMed

Lindroth, Jodi L; Sullivan, Jessica L; Silkwood-Sherer, Debbie

2015-01-01

This case-series study aimed to determine if there were observable changes in sensory processing for postural control in individuals with multiple sclerosis (MS) following physical therapy using hippotherapy (HPOT), or changes in balance and functional gait. This pre-test non-randomized design study, with follow-up assessment at 6 weeks, included two females and one male (age range 37-60 years) with diagnoses of relapse-remitting or progressive MS. The intervention consisted of twelve 40-min physical therapy sessions which included HPOT twice a week for 6 weeks. Sensory organization and balance were assessed by the Sensory Organization Test (SOT) and Berg Balance Scale (BBS). Gait was assessed using the Functional Gait Assessment (FGA). Following the intervention period, all three participants showed improvements in SOT (range 1-8 points), BBS (range 2-6 points), and FGA (average 4 points) scores. These improvements were maintained or continued to improve at follow-up assessment. Two of the three participants no longer over-relied on vision and/or somatosensory information as the primary sensory input for postural control, suggesting improved use of sensory information for balance. The results indicate that HPOT may be a beneficial physical therapy treatment strategy to improve balance, functional gait, and enhance how some individuals with MS process sensory cues for postural control. Randomized clinical trials will be necessary to validate results of this study.

Windfalls for wilderness: land protection and land value in the Green Mountains

Treesearch

Spencer Phillips

2000-01-01

Land is a composite good, the price of which varies with its characteristics, including proximity to amenities. Using data from sales of land near Green Mountain National Forest wilderness areas in a hedonic price model, a positive relationship between proximity to protected wilderness and market values is revealed. The applications of this result include improved...

Simulation center training as a means to improve resident performance in percutaneous noncontinuous CT-guided fluoroscopic procedures with dose reduction.

PubMed

Mendiratta-Lala, Mishal; Williams, Todd R; Mendiratta, Vivek; Ahmed, Hafeez; Bonnett, John W

2015-04-01

The purpose of this study was to evaluate the effectiveness of a multifaceted simulation-based resident training for CT-guided fluoroscopic procedures by measuring procedural and technical skills, radiation dose, and procedure times before and after simulation training. A prospective analysis included 40 radiology residents and eight staff radiologists. Residents took an online pretest to assess baseline procedural knowledge. Second-through fourth-year residents' baseline technical skills with a procedural phantom were evaluated. First-through third-year residents then underwent formal didactic and simulation-based procedural and technical training with one of two interventional radiologists and followed the training with 1 month of supervised phantom-based practice. Thereafter, residents underwent final written and practical examinations. The practical examination included essential items from a 20-point checklist, including site and side marking, consent, time-out, and sterile technique along with a technical skills portion assessing pedal steps, radiation dose, needle redirects, and procedure time. The results indicated statistically significant improvement in procedural and technical skills after simulation training. For residents, the median number of pedal steps decreased by three (p=0.001), median dose decreased by 15.4 mGy (p<0.001), median procedure time decreased by 4.0 minutes (p<0.001), median number of needle redirects decreased by 1.0 (p=0.005), and median number of 20-point checklist items successfully completed increased by three (p<0.001). The results suggest that procedural skills can be acquired and improved by simulation-based training of residents, regardless of experience. CT simulation training decreases procedural time, decreases radiation dose, and improves resident efficiency and confidence, which may transfer to clinical practice with improved patient care and safety.

A Natural Language Processing System That Links Medical Terms in Electronic Health Record Notes to Lay Definitions: System Development Using Physician Reviews

PubMed Central

Druhl, Emily; Polepalli Ramesh, Balaji; Houston, Thomas K; Brandt, Cynthia A; Zulman, Donna M; Vimalananda, Varsha G; Malkani, Samir; Yu, Hong

2018-01-01

Background Many health care systems now allow patients to access their electronic health record (EHR) notes online through patient portals. Medical jargon in EHR notes can confuse patients, which may interfere with potential benefits of patient access to EHR notes. Objective The aim of this study was to develop and evaluate the usability and content quality of NoteAid, a Web-based natural language processing system that links medical terms in EHR notes to lay definitions, that is, definitions easily understood by lay people. Methods NoteAid incorporates two core components: CoDeMed, a lexical resource of lay definitions for medical terms, and MedLink, a computational unit that links medical terms to lay definitions. We developed innovative computational methods, including an adapted distant supervision algorithm to prioritize medical terms important for EHR comprehension to facilitate the effort of building CoDeMed. Ten physician domain experts evaluated the user interface and content quality of NoteAid. The evaluation protocol included a cognitive walkthrough session and a postsession questionnaire. Physician feedback sessions were audio-recorded. We used standard content analysis methods to analyze qualitative data from these sessions. Results Physician feedback was mixed. Positive feedback on NoteAid included (1) Easy to use, (2) Good visual display, (3) Satisfactory system speed, and (4) Adequate lay definitions. Opportunities for improvement arising from evaluation sessions and feedback included (1) improving the display of definitions for partially matched terms, (2) including more medical terms in CoDeMed, (3) improving the handling of terms whose definitions vary depending on different contexts, and (4) standardizing the scope of definitions for medicines. On the basis of these results, we have improved NoteAid’s user interface and a number of definitions, and added 4502 more definitions in CoDeMed. Conclusions Physician evaluation yielded useful feedback for content validation and refinement of this innovative tool that has the potential to improve patient EHR comprehension and experience using patient portals. Future ongoing work will develop algorithms to handle ambiguous medical terms and test and evaluate NoteAid with patients. PMID:29358159

Real-Time Data Processing Onboard Remote Sensor Platforms: Annual Review #3 Data Package

NASA Technical Reports Server (NTRS)

Cook, Sid; Harsanyi, Joe

2003-01-01

The current program status reviewed by this viewgraph presentation includes: 1) New Evaluation Results; 2) Algorithm Improvement Investigations; 3) Electronic Hardware Design; 4) Software Hardware Interface Design.

Assessment of a Comprehensive Anti-Aging Neck Cream.

PubMed

Saxena, Subhash J; Duque, Deysi; Schirripa, Michael J

2015-09-01

With many effective anti-aging solutions for the face, consumer focus is now turning to other parts of the body including the delicate skin on the neck. This study investigates the effect of a new neck cream on the appearance of texture, fine lines and wrinkles, laxity, and hydration. 85 adult females ages 35-65 with Fitzpatrick skin types I through IV applied the test neck cream twice daily for a 3-month study period. Screening was conducted at Baseline, 2, 30, 60, and 90 days via a virtual trial. Subjects rated satisfaction in each of 4 anti-aging categories including hydration, texture, appearance of wrinkles, and appearance of laxity as well as three product attributes including application, feel, and smell. Improvement was statistically significant for all measured categories (hydration, texture, appearance of wrinkles, and appearance of laxity) with 94% of study subjects noting improvement in one or more of the measured categories. Further, the quantity of "Satisfied" and "Highly Satisfied" assessments increased 8-fold from baseline with a 94x increase in the quantity of "Highly Satisfied" assessments. The results demonstrate the product's rapid and continuing ability to improve the self-perceived signs of aging in the neck area including improvement in skin texture on the neck and a reduction in the appearance of wrinkles and laxity along the jawline. Future studies are recommended to determine the primary action mechanisms and to assess the degree of improvement by blinded physician assessment.

Solar-System Tests of Gravitational Theories

NASA Technical Reports Server (NTRS)

Shapiro, Irwin

1997-01-01

We are engaged in testing gravitational theory by means of observations of objects in the solar system. These tests include an examination of the Principle Of Equivalence (POE), the Shapiro delay, the advances of planetary perihelia, the possibility of a secular variation G in the "gravitational constant" G, and the rate of the de Sitter (geodetic) precession of the Earth-Moon system. These results are consistent with our preliminary results focusing on the contribution of Lunar Laser Ranging (LLR), which were presented at the seventh Marcel Grossmann meeting on general relativity. The largest improvement over previous results comes in the uncertainty for (eta): a factor of five better than our previous value. This improvement reflects the increasing strength of the LLR data. A similar analysis presented at the same meeting by a group at the Jet Propulsion Laboratory gave a similar result for (eta). Our value for (beta) represents our first such result determined simultaneously with the solar quadrupole moment from the dynamical data set. These results are being prepared for publication. We have shown how positions determined from different planetary ephemerides can be compared and how the combination of VLBI and pulse timing information can yield a direct tie between planetary and radio frames. We have continued to include new data in our analysis as they became available. Finally, we have made improvement in our analysis software (PEP) and ported it to a network of modern workstations from its former home on a "mainframe" computer.

The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

PubMed

Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

2014-12-01

We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

Improved image quality in pinhole SPECT by accurate modeling of the point spread function in low magnification systems

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

Pino, Francisco; Roé, Nuria; Aguiar, Pablo, E-mail: pablo.aguiar.fernandez@sergas.es

2015-02-15

Purpose: Single photon emission computed tomography (SPECT) has become an important noninvasive imaging technique in small-animal research. Due to the high resolution required in small-animal SPECT systems, the spatially variant system response needs to be included in the reconstruction algorithm. Accurate modeling of the system response should result in a major improvement in the quality of reconstructed images. The aim of this study was to quantitatively assess the impact that an accurate modeling of spatially variant collimator/detector response has on image-quality parameters, using a low magnification SPECT system equipped with a pinhole collimator and a small gamma camera. Methods: Threemore » methods were used to model the point spread function (PSF). For the first, only the geometrical pinhole aperture was included in the PSF. For the second, the septal penetration through the pinhole collimator was added. In the third method, the measured intrinsic detector response was incorporated. Tomographic spatial resolution was evaluated and contrast, recovery coefficients, contrast-to-noise ratio, and noise were quantified using a custom-built NEMA NU 4–2008 image-quality phantom. Results: A high correlation was found between the experimental data corresponding to intrinsic detector response and the fitted values obtained by means of an asymmetric Gaussian distribution. For all PSF models, resolution improved as the distance from the point source to the center of the field of view increased and when the acquisition radius diminished. An improvement of resolution was observed after a minimum of five iterations when the PSF modeling included more corrections. Contrast, recovery coefficients, and contrast-to-noise ratio were better for the same level of noise in the image when more accurate models were included. Ring-type artifacts were observed when the number of iterations exceeded 12. Conclusions: Accurate modeling of the PSF improves resolution, contrast, and recovery coefficients in the reconstructed images. To avoid the appearance of ring-type artifacts, the number of iterations should be limited. In low magnification systems, the intrinsic detector PSF plays a major role in improvement of the image-quality parameters.« less

Some economic benefits of a synchronous earth observatory satellite

NASA Technical Reports Server (NTRS)

Battacharyya, R. K.; Greenberg, J. S.; Lowe, D. S.; Sattinger, I. J.

1974-01-01

An analysis was made of the economic benefits which might be derived from reduced forecasting errors made possible by data obtained from a synchronous satellite system which can collect earth observation and meteorological data continuously and on demand. User costs directly associated with achieving benefits are included. In the analysis, benefits were evaluated which might be obtained as a result of improved thunderstorm forecasting, frost warning, and grain harvest forecasting capabilities. The anticipated system capabilities were used to arrive at realistic estimates of system performance on which to base the benefit analysis. Emphasis was placed on the benefits which result from system forecasting accuracies. Benefits from improved thunderstorm forecasts are indicated for the construction, air transportation, and agricultural industries. The effects of improved frost warning capability on the citrus crop are determined. The benefits from improved grain forecasting capability are evaluated in terms of both U.S. benefits resulting from domestic grain distribution and U.S. benefits from international grain distribution.

Change in functional balance after an exercise program with Nintendo Wii in Latino patients with cerebral palsy: a case series.

PubMed

Gatica-Rojas, Valeska; Cartes-Velásquez, Ricardo; Méndez-Rebolledo, Guillermo; Olave-Godoy, Felipe; Villalobos-Rebolledo, David

2016-08-01

[Purpose] This study aimed to explore the possibility of improving functional balance using an exercise program with Nintendo and the Balance Board peripheral in subjects with cerebral palsy. [Subjects and Methods] This study included 4 male outpatients of a neurological center. All participants received an exercise program based on the use of Nintendo with the Balance Board peripheral. Training consisted of three 25-min sessions per week for 6 weeks. Each session was guided by a physical therapist. Timed up-and-go and one-leg standing tests were conducted before and after the intervention. [Results] All subjects showed significant improvements in the results of the timed up-and-go test. However, there were no significant changes in the results of the one-leg standing test. [Conclusion] The exercise protocol involving Nintendo with the Balance Board peripheral appears to improve functional dynamic balance in patients with cerebral palsy. However, static functional balance does not improve after 6 weeks of training.

Change in functional balance after an exercise program with Nintendo Wii in Latino patients with cerebral palsy: a case series

PubMed Central

Gatica-Rojas, Valeska; Cartes-Velásquez, Ricardo; Méndez-Rebolledo, Guillermo; Olave-Godoy, Felipe; Villalobos-Rebolledo, David

2016-01-01

[Purpose] This study aimed to explore the possibility of improving functional balance using an exercise program with Nintendo and the Balance Board peripheral in subjects with cerebral palsy. [Subjects and Methods] This study included 4 male outpatients of a neurological center. All participants received an exercise program based on the use of Nintendo with the Balance Board peripheral. Training consisted of three 25-min sessions per week for 6 weeks. Each session was guided by a physical therapist. Timed up-and-go and one-leg standing tests were conducted before and after the intervention. [Results] All subjects showed significant improvements in the results of the timed up-and-go test. However, there were no significant changes in the results of the one-leg standing test. [Conclusion] The exercise protocol involving Nintendo with the Balance Board peripheral appears to improve functional dynamic balance in patients with cerebral palsy. However, static functional balance does not improve after 6 weeks of training. PMID:27630446

Simulation development and evaluation of an improved longitudinal velocity vector control wheel steering mode and electronic display format

NASA Technical Reports Server (NTRS)

Steinmetz, G. G.

1980-01-01

Using simulation, an improved longitudinal velocity vector control wheel steering mode and an improved electronic display format for an advanced flight system were developed and tested. Guidelines for the development phase were provided by test pilot critique summaries of the previous system. The results include performances from computer generated step column inputs across the full airplane speed and configuration envelope, as well as piloted performance results taken from a reference line tracking task and an approach to landing task conducted under various environmental conditions. The analysis of the results for the reference line tracking and approach to landing tasks indicates clearly detectable improvement in pilot tracking accuracy with a reduction in physical workload. The original objectives of upgrading the longitudinal axis of the velocity vector control wheel steering mode were successfully met when measured against the test pilot critique summaries and the original purpose outlined for this type of augment control mode.

Improving the physico-chemical and sensory characteristics of camel meat burger patties using ginger extract and papain.

PubMed

Abdel-Naeem, Heba H S; Mohamed, Hussein M H

2016-08-01

The objective of the current study was to include tenderizing agents in the formulation of camel meat burger patties to improve the physico-chemical and sensory characteristics of the product. Camel meat burger patties were processed with addition of ginger extract (7%), papain (0.01%) and mixture of ginger extract (5%) and papain (0.005%) in addition to control. Addition of ginger, papain and their mixture resulted in significant (P<0.05) increase of the collagen solubility and sensory scores (juiciness, tenderness and overall acceptability) with significant (P<0.05) reduction of the shear force values. Ginger extract resulted in extensive fragmentation of myofibrils; however, papain extract caused noticeable destructive effect on connective tissue. Moreover, ginger and papain resulted in improvement of the lipid stability of treated burger patties during storage. Therefore, addition of ginger extract and papain powder during formulation of camel burger patties can improve their physico-chemical and sensory properties. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrating improvement learning into a family medicine residency curriculum.

PubMed

Pensa, Mellisa; Frew, Patty; Gelmon, Sherril B

2013-06-01

Knowledge of improvement practices is a critical skill for family medicine residents who will lead patient-centered medical homes. The Accreditation Council for Graduate Medical Education includes systems-based practice and improvement knowledge as a core competency for residency education. The objective of this report is to describe the 6-year implementation and development of our practice-based improvement curriculum in a family medicine residency. In 2006, Oregon Health and Science University Family Medicine Residency implemented an improvement curriculum that focused on clinic-based improvement and involved longitudinal didactics. Over the course of 6 years, the curriculum has been refined to include longitudinal instruction of improvement principles according to the levels of training and clinic-based didactics and experientials that are team oriented. Residents complete ambulatory improvement projects over the cycle of 12 months and present outcomes each year. Residents evaluated their knowledge, experience, confidence, and satisfaction at the end of the academic year. Ninety percent of residents designed and lead improvement projects upon graduation from residency in 2011. Resident confidence to make a change in local health care settings at the end of the curriculum was high and improved from 2009/2010 to 2010/2011. Upon graduation from the program, 100% of residents reported competence or proficiency in their ability to apply knowledge to an improvement project and present results. We describe a longitudinal, practical, developmental, and clinically based experiential improvement curriculum that has been successfully integrated into a family medicine residency program.

Strategies to improve the quality of life of persons post-stroke: protocol of a systematic review.

PubMed

Munce, Sarah E P; Perrier, Laure; Shin, Saeha; Adhihetty, Chamila; Pitzul, Kristen; Nelson, Michelle L A; Bayley, Mark T

2017-09-07

While many outcomes post-stroke (e.g., depression) have been previously investigated, there is no complete data on the impact of a variety of quality improvement strategies on the quality of life and physical and psychological well-being of individuals post-stroke. The current paper outlines a systematic review protocol on the impact of quality improvement strategies on quality of life as well as physical and psychological well-being of individuals with stroke. MEDLINE, CINAHL, EMBASE, and PsycINFO databases will be searched. Two independent reviewers will conduct all levels of screening, data abstraction, and quality appraisal. Only randomized controlled trials that report on the impact of quality improvement strategies on quality of life outcomes in people with stroke will be included. The secondary outcomes will be physical and psychological well-being. Quality improvement strategies include audit and feedback, case management, team changes, electronic patient registries, clinician education, clinical reminders, facilitated relay of clinical information to clinicians, patient education, (promotion of) self-management, patient reminder systems, and continuous quality improvement. Studies published since 2000 will be included to increase the relevancy of findings. Results will be grouped according to the target group of the varying quality improvement strategies (i.e., health system, health care professionals, or patients) and/or by any other noteworthy grouping variables, such as etiology of stroke or by sex. This systematic review will identify those quality improvement strategies aimed at the health system, health care professionals, and patients that impact the quality of life of individuals with stroke. Improving awareness and utilization of such strategies may enhance uptake of stroke best practices and reduce inappropriate health care utilization costs. PROSPERO, CRD42017064141.

Airfoil structure

DOEpatents

Frey, Gary A.; Twardochleb, Christopher Z.

1998-01-01

Past airfoil configurations have been used to improve aerodynamic performance and engine efficiencies. The present airfoil configuration further increases component life and reduces maintenance by reducing internal stress within the airfoil itself. The airfoil includes a chord and a span. Each of the chord and the span has a bow being summed to form a generally "C" configuration of the airfoil. The generally "C" configuration includes a compound bow in which internal stresses resulting from a thermal temperature gradient are reduced. The structural configuration reduces internal stresses resulting from thermal expansion.

Airfoil structure

DOEpatents

Frey, G.A.; Twardochleb, C.Z.

1998-01-13

Past airfoil configurations have been used to improve aerodynamic performance and engine efficiencies. The present airfoil configuration further increases component life and reduces maintenance by reducing internal stress within the airfoil itself. The airfoil includes a chord and a span. Each of the chord and the span has a bow being summed to form a generally ``C`` configuration of the airfoil. The generally ``C`` configuration includes a compound bow in which internal stresses resulting from a thermal temperature gradient are reduced. The structural configuration reduces internal stresses resulting from thermal expansion. 6 figs.

Solutions of the Dirac Equation with the Shifted DENG-FAN Potential Including Yukawa-Like Tensor Interaction

NASA Astrophysics Data System (ADS)

Yahya, W. A.; Falaye, B. J.; Oluwadare, O. J.; Oyewumi, K. J.

2013-08-01

By using the Nikiforov-Uvarov method, we give the approximate analytical solutions of the Dirac equation with the shifted Deng-Fan potential including the Yukawa-like tensor interaction under the spin and pseudospin symmetry conditions. After using an improved approximation scheme, we solved the resulting schr\\"{o}dinger-like equation analytically. Numerical results of the energy eigenvalues are also obtained, as expected, the tensor interaction removes degeneracies between spin and pseudospin doublets.

The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

PubMed

Sales, Anne E; Bostrom, Anne-Marie; Bucknall, Tracey; Draper, Kellie; Fraser, Kimberly; Schalm, Corinne; Warren, Sharon

2012-02-01

Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. The most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Quality improvement: the nurse's role.

PubMed

Moran, M J; Johnson, J E

1992-06-01

Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers participate in reshaping the health care environment. The professional nurse plays a vital role in the quality improvement of health care services. However, nurses cannot make these improvements in a vacuum; they must include other professionals and ancillary personnel in their efforts. Total quality commitment must include all levels of an organization's structure. Quality patient care services will be achieved as the result of positive interactions among departments working together to build a dynamic mechanism that continuously improves the processes and outcomes of health care services.

Increasing children's physical activity through a teaching-assistant led extracurricular intervention: process evaluation of the action 3:30 randomised feasibility trial.

PubMed

Jago, Russell; Sebire, Simon J; Davies, Ben; Wood, Lesley; Banfield, Kathryn; Edwards, Mark J; Powell, Jane E; Montgomery, Alan A; Thompson, Janice L; Fox, Kenneth R

2015-02-18

Many children do not engage in recommended levels of physical activity (PA), highlighting the need to find ways to increase children's PA. Process evaluations play an important role in improving the science of randomised controlled trials. We recently reported the results of the Action 3:30 cluster randomised feasibility trial illustrating higher levels of moderate to vigorous intensity PA among boys but not girls. The aim of this paper is to report the process evaluation results including intervention fidelity, implementation, context and how intervention components and trial design could be improved before proceeding to a definitive RCT. Children's session enjoyment was assessed every two weeks. Reasons for non-attendance were provided by questionnaire at the end of the intervention. Post intervention interviews were held with participating teaching assistants (TAs) and school key contacts (KCs), and focus groups were conducted with children in all 10 intervention schools. Interviews and focus groups examined how recruitment and session attendance might be improved and established which elements of the programme that were and were not well received. Data indicated good intervention fidelity with TA's adopting enjoyment-focussed teaching styles and the sessions improving children's skills and self-esteem. Several positive aspects of implementation were identified, including high session variety, the opportunity to work in teams, the child-led sessions and the engaging leader style. In terms of context there was evidence that TA's faced difficulties managing challenging behaviour and that further training in this area was needed. TAs and KCs felt that recruitment could be improved by providing taster sessions during PE lessons and clarifying the days that the clubs would run at the point of recruitment. The programme could be improved to enhance interest for girls, by including training for managing disruptive behaviour and making some activities more age-group appropriate. Action 3.30 showed promise but could be improved by ensuring age appropriate activities, providing more appeal to girls and improving recruitment through taster sessions and early establishment of days of the week it is to be offered on. ISRCTN58502739.

Validation of Spectral Unmixing Results from Informed Non-Negative Matrix Factorization (INMF) of Hyperspectral Imagery

NASA Astrophysics Data System (ADS)

Wright, L.; Coddington, O.; Pilewskie, P.

2017-12-01

Hyperspectral instruments are a growing class of Earth observing sensors designed to improve remote sensing capabilities beyond discrete multi-band sensors by providing tens to hundreds of continuous spectral channels. Improved spectral resolution, range and radiometric accuracy allow the collection of large amounts of spectral data, facilitating thorough characterization of both atmospheric and surface properties. We describe the development of an Informed Non-Negative Matrix Factorization (INMF) spectral unmixing method to exploit this spectral information and separate atmospheric and surface signals based on their physical sources. INMF offers marked benefits over other commonly employed techniques including non-negativity, which avoids physically impossible results; and adaptability, which tailors the method to hyperspectral source separation. The INMF algorithm is adapted to separate contributions from physically distinct sources using constraints on spectral and spatial variability, and library spectra to improve the initial guess. Using this INMF algorithm we decompose hyperspectral imagery from the NASA Hyperspectral Imager for the Coastal Ocean (HICO), with a focus on separating surface and atmospheric signal contributions. HICO's coastal ocean focus provides a dataset with a wide range of atmospheric and surface conditions. These include atmospheres with varying aerosol optical thicknesses and cloud cover. HICO images also provide a range of surface conditions including deep ocean regions, with only minor contributions from the ocean surfaces; and more complex shallow coastal regions with contributions from the seafloor or suspended sediments. We provide extensive comparison of INMF decomposition results against independent measurements of physical properties. These include comparison against traditional model-based retrievals of water-leaving, aerosol, and molecular scattering radiances and other satellite products, such as aerosol optical thickness from the Moderate Resolution Imaging Spectroradiometer (MODIS).

Effect of coenzyme Q10 supplementation on heart failure: a meta-analysis123

PubMed Central

Thompson-Paul, Angela M; Bazzano, Lydia A

2013-01-01

Background: Coenzyme Q10 (CoQ10; also called ubiquinone) is an antioxidant that has been postulated to improve functional status in congestive heart failure (CHF). Several randomized controlled trials have examined the effects of CoQ10 on CHF with inconclusive results. Objective: The objective of this meta-analysis was to evaluate the impact of CoQ10 supplementation on the ejection fraction (EF) and New York Heart Association (NYHA) functional classification in patients with CHF. Design: A systematic review of the literature was conducted by using databases including MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and manual examination of references from selected studies. Studies included were randomized controlled trials of CoQ10 supplementation that reported the EF or NYHA functional class as a primary outcome. Information on participant characteristics, trial design and duration, treatment, dose, control, EF, and NYHA classification were extracted by using a standardized protocol. Results: Supplementation with CoQ10 resulted in a pooled mean net change of 3.67% (95% CI: 1.60%, 5.74%) in the EF and −0.30 (95% CI: −0.66, 0.06) in the NYHA functional class. Subgroup analyses showed significant improvement in EF for crossover trials, trials with treatment duration ≤12 wk in length, studies published before 1994, and studies with a dose ≤100 mg CoQ10/d and in patients with less severe CHF. These subgroup analyses should be interpreted cautiously because of the small number of studies and patients included in each subgroup. Conclusions: Pooled analyses of available randomized controlled trials suggest that CoQ10 may improve the EF in patients with CHF. Additional well-designed studies that include more diverse populations are needed. PMID:23221577

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres

PubMed Central

2010-01-01

Background Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Methods Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. Results We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations. Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. Conclusions The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals. PMID:20807408

Computation of turbulent boundary layer flows with an algebraic stress turbulence model

NASA Technical Reports Server (NTRS)

Kim, Sang-Wook; Chen, Yen-Sen

1986-01-01

An algebraic stress turbulence model is presented, characterized by the following: (1) the eddy viscosity expression is derived from the Reynolds stress turbulence model; (2) the turbulent kinetic energy dissipation rate equation is improved by including a production range time scale; and (3) the diffusion coefficients for turbulence equations are adjusted so that the kinetic energy profile extends further into the free stream region found in most experimental data. The turbulent flow equations were solved using a finite element method. Examples include: fully developed channel flow, fully developed pipe flow, flat plate boundary layer flow, plane jet exhausting into a moving stream, circular jet exhausting into a moving stream, and wall jet flow. Computational results compare favorably with experimental data for most of the examples considered. Significantly improved results were obtained for the plane jet flow, the circular jet flow, and the wall jet flow; whereas the remainder are comparable to those obtained by finite difference methods using the standard kappa-epsilon turbulence model. The latter seems to be promising with further improvement of the expression for the eddy viscosity coefficient.

Effect of square stepping exercise for older adults to prevent fall and injury related to fall: systematic review and meta-analysis of current evidences.

PubMed

Fisseha, Berihu; Janakiraman, Balamurugan; Yitayeh, Asmare; Ravichandran, Hariharasudhan

2017-02-01

Falls and fall related injuries become an emerging health problem among older adults. As a result a review of the recent evidences is needed to design a prevention strategy. The aim of this review was to determine the effect of square stepping exercise (SSE) for fall down injury among older adults compared with walking training or other exercises. An electronic database search for relevant randomized control trials published in English from 2005 to 2016 was conducted. Articles with outcome measures of functional reach, perceived health status, fear of fall were included. Quality of the included articles was rated using Physiotherapy Evidence Database (PEDro) scale and the pooled effect of SSE was obtained by Review Manager (RevMan5) software. Significant effect of SSE was detected over walking or no treatment to improve balance as well to prevent fear of fall and improve perceived health status. The results of this systematic review proposed that SSE significantly better than walking or no treatment to prevent fall, prevent fear of fall and improve perceived health status.

Mobile health: a synopsis and comment on "Increasing physical activity with mobile devices: a meta-analysis".

PubMed

Johnston, Winter; Hoffman, Sara; Thornton, Louise

2014-03-01

We offer a synopsis and commentary on J. Fanning and colleagues' article "Increasing Physical Activity with Mobile Devices: A Meta-Analysis" published in the Journal of Medical Internet Research. Although regular physical activity has a range of benefits, very few adults in the USA meet recommended guidelines for daily physical activity. The meta-analysis of Fanning et al. (2012) aimed to synthesize the results of research using mobile devices to increase physical activity. Their review identified 11 studies that used mobile technologies, including short message service (SMS), apps, or personal digital assistant (PDA) to improve physical activity behaviors among participants. Fanning et al. conclude that while literature in this area is limited to date, there is initial support for the efficacy of mobile-based interventions for improving physical activity. Included studies varied greatly, and the majority used only SMS to influence physical behaviors, meaning generalization of results to other forms of mobile technologies may be premature. This review does, however, provide a foundation for understanding how mobile-based interventions may be used efficaciously for the development of future interventions to improve health behaviors.

Characteristics of Forests in Western Sayani Mountains, Siberia from SAR Data

NASA Technical Reports Server (NTRS)

Ranson, K. Jon; Sun, Guoqing; Kharuk, V. I.; Kovacs, Katalin

1998-01-01

This paper investigated the possibility of using spaceborne radar data to map forest types and logging in the mountainous Western Sayani area in Siberia. L and C band HH, HV, and VV polarized images from the Shuttle Imaging Radar-C instrument were used in the study. Techniques to reduce topographic effects in the radar images were investigated. These included radiometric correction using illumination angle inferred from a digital elevation model, and reducing apparent effects of topography through band ratios. Forest classification was performed after terrain correction utilizing typical supervised techniques and principal component analyses. An ancillary data set of local elevations was also used to improve the forest classification. Map accuracy for each technique was estimated for training sites based on Russian forestry maps, satellite imagery and field measurements. The results indicate that it is necessary to correct for topography when attempting to classify forests in mountainous terrain. Radiometric correction based on a DEM (Digital Elevation Model) improved classification results but required reducing the SAR (Synthetic Aperture Radar) resolution to match the DEM. Using ratios of SAR channels that include cross-polarization improved classification and

Conceptual model for heart failure disease management.

PubMed

Andrikopoulou, Efstathia; Abbate, Kariann; Whellan, David J

2014-03-01

The objective of this review is to propose a conceptual model for heart failure (HF) disease management (HFDM) and to define the components of an efficient HFDM plan in reference to this model. Articles that evaluated 1 or more of the following aspects of HFDM were reviewed: (1) outpatient clinic follow-up; (2) self-care interventions to enhance patient skills; and (3) remote evaluation of worsening HF either using structured telephone support (STS) or by monitoring device data (telemonitoring). The success of programs in reducing readmissions and mortality were mixed. Outpatient follow-up programs generally resulted in improved outcomes, including decreased readmissions. Based on 1 meta-analysis, specialty clinics improved outcomes and nonspecialty clinics did not. Results from self-care programs were inconsistent and might have been affected by patient cognitive status and educational level, and intervention intensity. Telemonitoring, despite initially promising meta-analyses demonstrating a decrease in the number and duration of HF-related readmissions and all-cause mortality rates at follow-up, has not been shown in randomized trials to consistently reduce readmissions or mortality. However, evidence from device monitoring trials in particular might have been influenced by technology and design issues that might be rectified in future trials. Results from the literature suggest that the ideal HFDM plan would include outpatient follow-up at an HF specialty clinic and continuous education to improve patient self-care. The end result of this plan would lead to better understanding on the part of the patient and improved patient ability to recognize and respond to signs of decompensation. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Problem-based learning in the NICU.

PubMed

Pilcher, Jobeth

2014-01-01

Problem-based learning (PBL) is an educational strategy that provides learners with the opportunity to investigate and solve realistic problem situations. It is also referred to as project-based learning or work-based learning. PBL combines several learning strategies including the use of case studies coupled with collaborative, facilitated, and self-directed learning. Research has demonstrated that use of PBL can result in learners having improved problem-solving skills, increased breadth and analysis of complex data, higher-level thinking skills, and improved collaboration. This article will include background information and a description of PBL, followed by examples of how this strategy can be used for learning in neonatal settings.

Modulated Source Interferometry with Combined Amplitude and Frequency Modulation

NASA Technical Reports Server (NTRS)

Gutierrez, Roman C. (Inventor)

1998-01-01

An improved interferometer is produced by modifying a conventional interferometer to include amplitude and/or frequency modulation of a coherent light source at radio or higher frequencies. The phase of the modulation signal can be detected in an interfering beam from an interferometer and can be used to determine the actual optical phase of the beam. As such, this improvement can be adapted to virtually any two-beam interferometer, including: Michelson, Mach-Zehnder, and Sagnac interferometers. The use of an amplitude modulated coherent tight source results in an interferometer that combines the wide range advantages of coherent interferometry with the precise distance measurement advantages of white light interferometry.

Nanoparticle-based targeted therapeutics in head-and-neck cancer.

PubMed

Wu, Ting-Ting; Zhou, Shui-Hong

2015-01-01

Head-and-neck cancer is a major form of the disease worldwide. Treatment consists of surgery, radiation therapy and chemotherapy, but these have not resulted in improved survival rates over the past few decades. Versatile nanoparticles, with selective tumor targeting, are considered to have the potential to improve these poor outcomes. Application of nanoparticle-based targeted therapeutics has extended into many areas, including gene silencing, chemotherapeutic drug delivery, radiosensitization, photothermal therapy, and has shown much promise. In this review, we discuss recent advances in the field of nanoparticle-mediated targeted therapeutics for head-and-neck cancer, with an emphasis on the description of targeting points, including future perspectives.

Cavitation-resistant inducer

DOEpatents

Dunn, Charlton; Subbaraman, Maria R.

1989-01-01

An improvement in an inducer for a pump wherein the inducer includes a hub, a plurality of radially extending substantially helical blades and a wall member extending about and encompassing an outer periphery of the blades. The improvement comprises forming adjacent pairs of blades and the hub to provide a substantially rectangular cross-sectional flow area which cross-sectional flow area decreases from the inlet end of the inducer to a discharge end of the inducer, resulting in increased inducer efficiency improved suction performance, reduced susceptibility to cavitation, reduced susceptibility to hub separation and reduced fabrication costs.

Induction plasma tube

DOEpatents

Hull, D.E.

1982-07-02

An induction plasma tube having a segmented, fluid-cooled internal radiation shield is disclosed. The individual segments are thick in cross-section such that the shield occupies a substantial fraction of the internal volume of the plasma enclosure, resulting in improved performance and higher sustainable plasma temperatures. The individual segments of the shield are preferably cooled by means of a counterflow fluid cooling system wherein each segment includes a central bore and a fluid supply tube extending into the bore. The counterflow cooling system results in improved cooling of the individual segments and also permits use of relatively larger shield segments which permit improved electromagnetic coupling between the induction coil and a plasma located inside the shield. Four embodiments of the invention, each having particular advantages, are disclosed.

Induction plasma tube

DOEpatents

Hull, Donald E.

1984-01-01

An induction plasma tube having a segmented, fluid-cooled internal radiation shield is disclosed. The individual segments are thick in cross-section such that the shield occupies a substantial fraction of the internal volume of the plasma enclosure, resulting in improved performance and higher sustainable plasma temperatures. The individual segments of the shield are preferably cooled by means of a counterflow fluid cooling system wherein each segment includes a central bore and a fluid supply tube extending into the bore. The counterflow cooling system results in improved cooling of the individual segments and also permits use of relatively larger shield segments which permit improved electromagnetic coupling between the induction coil and a plasma located inside the shield. Four embodiments of the invention, each having particular advantages, are disclosed.

Improvement of an algorithm for recognition of liveness using perspiration in fingerprint devices

NASA Astrophysics Data System (ADS)

Parthasaradhi, Sujan T.; Derakhshani, Reza; Hornak, Lawrence A.; Schuckers, Stephanie C.

2004-08-01

Previous work in our laboratory and others have demonstrated that spoof fingers made of a variety of materials including silicon, Play-Doh, clay, and gelatin (gummy finger) can be scanned and verified when compared to a live enrolled finger. Liveness, i.e. to determine whether the introduced biometric is coming from a live source, has been suggested as a means to circumvent attacks using spoof fingers. We developed a new liveness method based on perspiration changes in the fingerprint image. Recent results showed approximately 90% classification rate using different classification methods for various technologies including optical, electro-optical, and capacitive DC, a shorter time window and a diverse dataset. This paper focuses on improvement of the live classification rate by using a weight decay method during the training phase in order to improve the generalization and reduce the variance of the neural network based classifier. The dataset included fingerprint images from 33 live subjects, 33 spoofs created with dental impression material and Play-Doh, and fourteen cadaver fingers. 100% live classification was achieved with 81.8 to 100% spoof classification, depending on the device technology. The weight-decay method improves upon past reports by increasing the live and spoof classification rate.

Elevated body temperature in ischemic stroke associated with neurological improvement.

PubMed

Khanevski, A N; Naess, H; Thomassen, L; Waje-Andreassen, U; Nacu, A; Kvistad, C E

2017-11-01

Some studies suggest that high body temperature within the first few hours of ischemic stroke onset is associated with improved outcome. We hypothesized an association between high body temperature on admission and detectable improvement within 6-9 hours of stroke onset. Consecutive ischemic stroke patients with NIHSS scores obtained within 3 hours and in the interval 6-9 hours after stroke onset were included. Body temperature was measured on admission. A total of 315 patients with ischemic stroke were included. Median NIHSS score on admission was 6. Linear regression showed that NIHSS score 6-9 hours after stroke onset was inversely associated with body temperature on admission after adjusting for confounders including NIHSS score <3 hours after stroke onset (P<.001). The same result was found in patients with proximal middle cerebral occlusion on admission. We found an inverse association between admission body temperature and neurological improvement within few hours after admission. This finding may be limited to patients with documented proximal middle cerebral artery occlusion on admission and suggests a beneficial effect of higher body temperature on clot lysis within the first three hours. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Crossing the Barriers: An Analysis of Permitting Barriers to Geothermal Development and Potential Improvement Scenarios

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

Levine, Aaron L; Young, Katherine R

Developers have identified many non-technical barriers to geothermal power development, including permitting. Activities required for permitting, such as the associated environmental reviews, can take a considerable amount of time and delay project development. This paper discusses the impacts to geothermal development timelines due to the permitting challenges, including the regulatory framework, environmental review process, and ancillary permits. We identified barriers that have the potential to prevent geothermal development or delay timelines and defined improvement scenarios that could assist in expediting geothermal development and permitting timelines and lead to the deployment of additional geothermal resources by 2030 and 2050: (1) themore » creation of a centralized federal geothermal permitting office and utilization of state permit coordination offices as well as (2) an expansion of existing categorical exclusions applicable to geothermal development on Bureau of Land Management public lands to include the oil and gas categorical exclusions passed as part of the Energy Policy Act of 2005. We utilized the Regional Energy Deployment System (ReEDS) and the Geothermal Electricity Technology Evaluation Model (GETEM) to forecast baseline geothermal deployment based on previous analysis of geothermal project development and permitting timelines. The model results forecast that reductions in geothermal project timelines can have a significant impact on geothermal deployment. For example, using the ReEDS model, we estimated that reducing timelines by two years, perhaps due to the creation of a centralized federal geothermal permitting office and utilization of state permit coordination offices, could result in deployment of an additional 204 MW by 2030 and 768 MW by 2050 - a 13% improvement when compared to the business as usual scenario. The model results forecast that a timeline improvement of four years - for example with an expansion of existing categorical exclusions coupled with the creation of a centralized federal geothermal permitting office and utilization of state permit coordination offices - could result in deployment of an additional 2,529 MW of geothermal capacity by 2030 and 6,917 MW of geothermal capacity by 2050 - an improvement of 116% when compared to the business as usual scenario. These results suggest that reducing development timelines could be a large driver in the deployment of geothermal resources.« less

Literature Review and Meta-Analysis of Transcutaneous Electrical Nerve Stimulation in Treating Chronic Back Pain

PubMed Central

Wu, Lien-Chen; Weng, Pei-Wei; Chen, Chia-Hsien; Huang, Yi-You; Tsuang, Yang-Hwei; Chiang, Chang-Jung

2018-01-01

Background and Objectives This study is a meta-analysis of randomized controlled trials comparing the efficacy of transcutaneous electrical nerve stimulation (TENS) to a control and to other nerve stimulation therapies (NSTs) for the treatment of chronic back pain. Methods Citations were identified in MEDLINE, the Cochrane Library, Google Scholar, and ClinicalTrials.gov through June 2014 using the following keywords: nerve stimulation therapy, transcutaneous electrical nerve stimulation, back pain, chronic pain. Control treatments included sham, placebo, or medication only. Other NSTs included electroacupuncture, percutaneous electrical nerve stimulation, and percutaneous neuromodulation therapy. Results Twelve randomized controlled trials including 700 patients were included in the analysis. The efficacy of TENS was similar to that of control treatment for providing pain relief (standardized difference in means [SDM] = −0.20; 95% confidence interval [CI], −0.58 to 0.18; P = 0.293). Other types of NSTs were more effective than TENS in providing pain relief (SDM = 0.86; 95% CI, 0.15–1.57; P = 0.017). Transcutaneous electrical nerve stimulation was more effective than control treatment in improving functional disability only in patients with follow-up of less than 6 weeks (SDM = −1.24; 95% CI, −1.83 to −0.65; P < 0.001). There was no difference in functional disability outcomes between TENS and other NSTs. Conclusions These results suggest that TENS does not improve symptoms of lower back pain, but may offer short-term improvement of functional disability. PMID:29394211

The VIIRS Ocean Data Simulator Enhancements and Results

NASA Technical Reports Server (NTRS)

Robinson, Wayne D.; Patt, Fredrick S.; Franz, Bryan A.; Turpie, Kevin R.; McClain, Charles R.

2011-01-01

The VIIRS Ocean Science Team (VOST) has been developing an Ocean Data Simulator to create realistic VIIRS SDR datasets based on MODIS water-leaving radiances. The simulator is helping to assess instrument performance and scientific processing algorithms. Several changes were made in the last two years to complete the simulator and broaden its usefulness. The simulator is now fully functional and includes all sensor characteristics measured during prelaunch testing, including electronic and optical crosstalk influences, polarization sensitivity, and relative spectral response. Also included is the simulation of cloud and land radiances to make more realistic data sets and to understand their important influence on nearby ocean color data. The atmospheric tables used in the processing, including aerosol and Rayleigh reflectance coefficients, have been modeled using VIIRS relative spectral responses. The capabilities of the simulator were expanded to work in an unaggregated sample mode and to produce scans with additional samples beyond the standard scan. These features improve the capability to realistically add artifacts which act upon individual instrument samples prior to aggregation and which may originate from beyond the actual scan boundaries. The simulator was expanded to simulate all 16 M-bands and the EDR processing was improved to use these bands to make an SST product. The simulator is being used to generate global VIIRS data from and in parallel with the MODIS Aqua data stream. Studies have been conducted using the simulator to investigate the impact of instrument artifacts. This paper discusses the simulator improvements and results from the artifact impact studies.

The VIIRS ocean data simulator enhancements and results

NASA Astrophysics Data System (ADS)

Robinson, Wayne D.; Patt, Frederick S.; Franz, Bryan A.; Turpie, Kevin R.; McClain, Charles R.

2011-10-01

The VIIRS Ocean Science Team (VOST) has been developing an Ocean Data Simulator to create realistic VIIRS SDR datasets based on MODIS water-leaving radiances. The simulator is helping to assess instrument performance and scientific processing algorithms. Several changes were made in the last two years to complete the simulator and broaden its usefulness. The simulator is now fully functional and includes all sensor characteristics measured during prelaunch testing, including electronic and optical crosstalk influences, polarization sensitivity, and relative spectral response. Also included is the simulation of cloud and land radiances to make more realistic data sets and to understand their important influence on nearby ocean color data. The atmospheric tables used in the processing, including aerosol and Rayleigh reflectance coefficients, have been modeled using VIIRS relative spectral responses. The capabilities of the simulator were expanded to work in an unaggregated sample mode and to produce scans with additional samples beyond the standard scan. These features improve the capability to realistically add artifacts which act upon individual instrument samples prior to aggregation and which may originate from beyond the actual scan boundaries. The simulator was expanded to simulate all 16 M-bands and the EDR processing was improved to use these bands to make an SST product. The simulator is being used to generate global VIIRS data from and in parallel with the MODIS Aqua data stream. Studies have been conducted using the simulator to investigate the impact of instrument artifacts. This paper discusses the simulator improvements and results from the artifact impact studies.

Improving the accuracy of energy baseline models for commercial buildings with occupancy data

DOE PAGES

Liang, Xin; Hong, Tianzhen; Shen, Geoffrey Qiping

2016-07-07

More than 80% of energy is consumed during operation phase of a building's life cycle, so energy efficiency retrofit for existing buildings is considered a promising way to reduce energy use in buildings. The investment strategies of retrofit depend on the ability to quantify energy savings by “measurement and verification” (M&V), which compares actual energy consumption to how much energy would have been used without retrofit (called the “baseline” of energy use). Although numerous models exist for predicting baseline of energy use, a critical limitation is that occupancy has not been included as a variable. However, occupancy rate is essentialmore » for energy consumption and was emphasized by previous studies. This study develops a new baseline model which is built upon the Lawrence Berkeley National Laboratory (LBNL) model but includes the use of building occupancy data. The study also proposes metrics to quantify the accuracy of prediction and the impacts of variables. However, the results show that including occupancy data does not significantly improve the accuracy of the baseline model, especially for HVAC load. The reasons are discussed further. In addition, sensitivity analysis is conducted to show the influence of parameters in baseline models. To conclude, the results from this study can help us understand the influence of occupancy on energy use, improve energy baseline prediction by including the occupancy factor, reduce risks of M&V and facilitate investment strategies of energy efficiency retrofit.« less

A Review on the Assessment of the Efficacy of Common Treatments in Polycystic Ovarian Syndrome on Prevention of Diabetes Mellitus

PubMed Central

Dashti, Sareh; Latiff, Latiffah Abdul; Zulkefli, Nor Afiah Binti Mohd; Baharom, Anisah Binti; Minhat, Halimatus Sakdiah; Hamid, Habibah Abdul; Ismail, Maimunah; Jafarzadeh Esfehani, Ali; Abu Bakar, Azrin Shah; Binti Sabri, Nur Amirah Inani

2017-01-01

Objective: Polycystic ovarian syndrome (PCOS) is a common condition amongst women of reproductive age that can result in increased mortality and morbidity in women due to increased risk of diabetes mellitus and cardiovascular diseases. The aim of this systematic review was to assess the effectiveness of common treatments of PCOS on the predictors of diabetes in non-diabetic PCOS women. Materials and methods: An extensive search was performed on the publications in three medical databases including pubmed, scopus and google scholar from 1995 till 2017. The articles were screened based on their quality and included in this systematic review. A total of 25 articles including cohort, randomised controlled trial, review and meta-analysis were included in the review. Results: This systematic review revealed that the effect of lifestyle modification might be low in PCOS subjects due to high drop-out rate while the benefits of this intervention including weight and fat reduction may not be achieved by medical interventions. Metformin treatment may result in improvements in insulin sensitivity while its weight reduction effect is still not documented in PCOS subjects. Thiazolidendiones might be tolerated by the PCOS subjects and may result in similar effects as metformin but this effect should be documented by further studies. Conclusion: Combination of lifestyle modification with metformin or thiazolidinedions might improve the outcome of the prevention strategies. On the other hand this study revealed a different response to treatments in non-obese compared with obese PCOS subjects. PMID:29282412

Insights, Pearls, and Guidance on Successfully Producing and Publishing Educational Research

PubMed Central

Romanelli, Frank

2016-01-01

It is the collaborative responsibility of authors, reviewers, and editors to produce high-quality manuscripts that advance knowledge and educational practice. Experience with manuscript submissions to the American Journal of Pharmaceutical Education reveal several areas for improvement that authors can make to increase their submission success rate during the review process. These improvements include research question justification, improved clarity and details regarding methodology, concise data and results, and a discussion that frames research findings in the context of what is already known. This paper summarizes common flaws we see in submitted manuscripts and makes suggestions on how to address these areas and improve publication success. PMID:27402978

Shuttle waste management system design improvements and flight evaluation

NASA Technical Reports Server (NTRS)

Winkler, H. Eugene; Goodman, Jerry R.; Murray, Robert W.; Mcintosh, Mathew E.

1986-01-01

The Space Shuttle waste management system has undergone a variety of design changes to improve performance and man-machine interface. These design improvements have resulted in more reliable operation and hygienic usage. Design enhancements include individual urinals, increased urine collection airflows, increased solids storage capacity, easier access to personal hygiene items, and additional wet trash stowage. The development and flight evaluation of these improvements are described herein. The Space Shuttle Orbiter has proved to be an invaluable test bed for development and in-flight evaluation of life support and habitability concepts which involve transport or separation of solids, liquids, and gases in a zero-g environment.

Improved control strategy for wind-powered refrigerated storage of apples

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

Baldwin, J.D.C.; Vaughan, D.H.

1981-01-01

A refrigerated apple storage facility was constructed at the VPI and SU Horticultural Research Farm in Blacksburg, Virginia and began operation in March 1978. The system included a 10-kW electric wind generator, electrical battery storage, thermal (ice) storage, and auxiliary power. The need for an improved control system for the VPI and SU system was determined from tests on the individual components and in situ performance tests. The results of these tests formed the basis for an improved control strategy to improve the utilization of available wind energy and reduce the need for auxiliary power while maintaining an adequate applemore » storage environment.« less

Utilizing Wisconsin Afterschool Programs to Increase Physical Activity in Youth.

PubMed

Cavanagh, Bradley D; Meinen, Amy

2015-10-01

Approximately 31.7% of children in the United States are overweight or obese. Interventions in the afterschool setting may help combat childhood obesity. Research exists on interventions in school settings, but a few data exist for interventions about afterschool programs. This study investigates increasing physical activity (PA) in Wisconsin afterschool programs. A literature review was used to develop key informant interviews. Utilizing a constant comparative method, interview data were coded and themes were identified. The themes, literature review, and expert opinions were used to formulate recommendations for improving PA in afterschool programs. Programs had success in utilizing different resources to improve PA. Key barriers to improving PA included grant-imposed academic restrictions, the need for provider education, fears of conflict and competitiveness, and a lack of understanding between health and sedentariness. There is a clear need for additional exploration into improving PA in Wisconsin afterschool programs. This study resulted in specific recommendations to increase PA in afterschool programming, including utilizing school wellness policies and staff professional development to improve PA in afterschool programs. © 2015, American School Health Association.

Improving family satisfaction and participation in decision making in an intensive care unit.

PubMed

Huffines, Meredith; Johnson, Karen L; Smitz Naranjo, Linda L; Lissauer, Matthew E; Fishel, Marmie Ann-Michelle; D'Angelo Howes, Susan M; Pannullo, Diane; Ralls, Mindy; Smith, Ruth

2013-10-01

Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients' families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families' satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = -2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = -2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit's team works together.

Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare.

PubMed

Van Spall, Harriette; Kassam, Alisha; Tollefson, Travis T

2015-08-01

Near-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs. Near-miss analysis is routine and systematic in HROs such as aviation. Strategies implemented in aviation include the Commercial Aviation Safety Team, which undertakes systematic analyses of near-misses, so that findings can be incorporated into Standard Operating Procedures (SOPs). Other strategies resulting from incident analyses include Crew Resource Management (CRM) for enhanced communication, situational awareness training, adoption of checklists during operations, and built-in redundancy within systems. Health care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

PubMed Central

Meyer, Johanna C.; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research. PMID:29163151

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study.

PubMed

Meyer, Johanna C; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research.

Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair : Laparoscopic approach for inguinodynia.

PubMed

Ramshaw, Bruce; Vetrano, Vincent; Jagadish, Mayuri; Forman, Brandie; Heidel, Eric; Mancini, Matthew

2017-12-01

Traditional methods of clinical research may not be adequate to improve the value of care for patients with complex medical problems such as chronic pain after inguinal hernia repair. This problem is very complex with many potential factors contributing to the development of this complication. We have implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain (inguinodynia) after inguinal hernia repair. Between April 2011 and June 2016, there were 93 patients who underwent 94 operations in an attempt to relieve pain (1 patient had two separate unilateral procedures). Patients who had prior laparoscopic inguinal hernia repair (26) had their procedure completed laparoscopically. Patients who had open inguinal hernia repair (68) had a combination of a laparoscopic and open procedure in an attempt to relieve pain. Initiatives to attempt to improve measurement and outcomes during this period included the administration of pre-operative bilateral transversus abdominis plane and intra-operative inguinal nerve blocks using long-acting local anesthetic as a part of a multimodal regimen, the introduction of a low pressure pneumoperitoneum system, and the expansion of a pre-operative questionnaire to assess emotional health pre-operatively. The results included the assessment of how much improvement was achieved after recovery from the operation. Forty-five patients (48%) reported significant improvement, 39 patients (41%) reported moderate improvement, and 10 patients (11%) reported little or no improvement. There were 3 (3%) complications, 13 (11%) hernia recurrences, and 15 patients (13%) developed a new pain in the inguinal region after the initial pain had resolved. The principles of CQI can be applied to a group of patients suffering from chronic pain after inguinal hernia repair. Based on these results additional process improvement ideas will be implemented in an attempt to improve outcomes.

Improved Discrete Ordinate Solutions in the Presence of an Anisotropically Reflecting Lower Boundary: Upgrades of the DISORT Computational Tool

NASA Technical Reports Server (NTRS)

Lin, Z.; Stamnes, S.; Jin, Z.; Laszlo, I.; Tsay, S. C.; Wiscombe, W. J.; Stamnes, K.

2015-01-01

A successor version 3 of DISORT (DISORT3) is presented with important upgrades that improve the accuracy, efficiency, and stability of the algorithm. Compared with version 2 (DISORT2 released in 2000) these upgrades include (a) a redesigned BRDF computation that improves both speed and accuracy, (b) a revised treatment of the single scattering correction, and (c) additional efficiency and stability upgrades for beam sources. In DISORT3 the BRDF computation is improved in the following three ways: (i) the Fourier decomposition is prepared "off-line", thus avoiding the repeated internal computations done in DISORT2; (ii) a large enough number of terms in the Fourier expansion of the BRDF is employed to guarantee accurate values of the expansion coefficients (default is 200 instead of 50 in DISORT2); (iii) in the post processing step the reflection of the direct attenuated beam from the lower boundary is included resulting in a more accurate single scattering correction. These improvements in the treatment of the BRDF have led to improved accuracy and a several-fold increase in speed. In addition, the stability of beam sources has been improved by removing a singularity occurring when the cosine of the incident beam angle is too close to the reciprocal of any of the eigenvalues. The efficiency for beam sources has been further improved from reducing by a factor of 2 (compared to DISORT2) the dimension of the linear system of equations that must be solved to obtain the particular solutions, and by replacing the LINPAK routines used in DISORT2 by LAPACK 3.5 in DISORT3. These beam source stability and efficiency upgrades bring enhanced stability and an additional 5-7% improvement in speed. Numerical results are provided to demonstrate and quantify the improvements in accuracy and efficiency of DISORT3 compared to DISORT2.

Does ownership of improved dairy cow breeds improve child nutrition? A pathway analysis for Uganda.

PubMed

Kabunga, Nassul S; Ghosh, Shibani; Webb, Patrick

2017-01-01

The promotion of livestock production is widely believed to support enhanced diet quality and child nutrition, but the empirical evidence for this causal linkage remains narrow and ambiguous. This study examines whether adoption of improved dairy cow breeds is linked to farm-level outcomes that translate into household-level benefits including improved child nutrition outcomes in Uganda. Using nationwide data from Uganda's National Panel Survey, propensity score matching is used to create an unbiased counterfactual, based on observed characteristics, to assess the net impacts of improved dairy cow adoption. All estimates were tested for robustness and sensitivity to variations in observable and unobservable confounders. Results based on the matched samples showed that households adopting improved dairy cows significantly increased milk yield-by over 200% on average. This resulted in higher milk sales and milk intakes, demonstrating the potential of this agricultural technology to both integrate households into modern value chains and increase households' access to animal source foods. Use of improved dairy cows increased household food expenditures by about 16%. Although undernutrition was widely prevalent in the study sample and in matched households, the adoption of improved dairy cows was associated with lower child stunting in adopter household. In scale terms, results also showed that holding larger farms tends to support adoption, but that this also stimulates the household's ability to achieve gains from adoption, which can translate into enhanced nutrition.

The Sea of Simulation: Improving Naval Shiphandling Training and Readiness through Game-Based Learning

DTIC Science & Technology

2012-03-01

Officer SWOI Surface Warfare Officer Introduction SWOS Surface Warfare Officers School xvii TFT Thin Film Transistor ULTRA Unit Level Training...designed the experiment , including participants, procedures, facilities selection, and materials. Chapter IV: Results and Discussion. This chapter...contains the results of experimentation and an interpretation of those results . Chapter V: Conclusions. This chapter provides an overall assessment

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

COMPREHENSIVE REVIEW OF GOLF-RELATED OCULAR INJURIES.

PubMed

Crane, Elliot S; Kolomeyer, Anton M; Kim, Eliott; Chu, David S

2016-07-01

The authors aimed to analyze the causes and outcomes of golf-related ocular injuries in this retrospective meta-analysis, literature review, and original case series. Forty-one articles identified by PubMed search resulted in 11 included studies yielding 102 subjects. Included articles described all ocular golf injuries that presented to an institution during a determined period. Eight factors were analyzed: age, sex, location and mechanism of injury, protective eyewear use, resulting open-globe injury, resulting enucleation, and visual acuity changes. No subjects wore adequate protective eyewear. Significantly more subjects were injured by golf balls (72%) than golf clubs (27%) or foreign body (1%) (P < 0.0001). The ratio of golf ball to club injuries was significantly higher in adults (92%) than in children (23%) (P < 0.0001). Forty-seven of 93 (51%) injuries resulted in an open globe, whereas 27/82 (33%) injuries resulted in enucleation. The mean ± SD logMAR visual acuity improved by -0.641 ± 0.745 after treatment (>6 lines of improvement; P = 0.0001). Reported ocular golf injuries occur less frequently than other ocular sports injuries, but may result in devastating outcomes. Supervision of children using golf equipment should be encouraged.

California Water Resources Development.

DTIC Science & Technology

1977-01-01

does not remain on the ground below 4,000 feet. The zone of heavy snowfall is from 7,000 to 8,000 feet. Melting of the normally deep snowpack in these...advanced cargoCaiornia has abundant water, metal , nonmetallic min- handling schniques indicate that major improvements erals, fuel and forestry resources...conceived by the De - California includes improvement and maintenance of bris Commission as a result of studies directed by all major coastal harbors in

The Pre-Blast Concept for use on Armour Materials

DTIC Science & Technology

2016-02-01

to improve blast resistance Repeated blast test results (up to 7 times) of candidate armour materials showed that the greatest deformation...may be used to increase blast resistance of steels. To test this, the ‘pre-blast’ concept test program includes hardening of materials by sheet charge...steels with hardness 450 HV or higher (up to 650 HV). In general, the improvement in deformation resistance is associated with increases in

OAO battery data analysis

NASA Technical Reports Server (NTRS)

Gaston, S.; Wertheim, M.; Orourke, J. A.

1973-01-01

Summary, consolidation and analysis of specifications, manufacturing process and test controls, and performance results for OAO-2 and OAO-3 lot 20 Amp-Hr sealed nickel cadmium cells and batteries are reported. Correlation of improvements in control requirements with performance is a key feature. Updates for a cell/battery computer model to improve performance prediction capability are included. Applicability of regression analysis computer techniques to relate process controls to performance is checked.

Achieving revenue integrity in hospitals and health systems.

PubMed

Schoen, Marianne; Najera, Michael

2012-09-01

The Bellevue Hospital sought to improve its performance in three areas-days in accounts receivable (A/R), denials, and charge capture-to enhance revenue integrity. Results included the following: A 30-percent reduction in days in A/R. A nearly 200 percent increase in bad debt collections. A more than $1.6 million reduction in denials write-offs. An improvement in net revenue of more than $1 million.

Method and apparatus for producing cryogenic targets

DOEpatents

Murphy, J.T.; Miller, J.R.

1984-08-07

An improved method and apparatus are given for producing cryogenic inertially driven fusion targets in the fast isothermal freezing (FIF) method. Improved coupling efficiency and greater availability of volume near the target for diagnostic purposes and for fusion driver beam propagation result. Other embodiments include a new electrical switch and a new explosive detonator, all embodiments making use of a purposeful heating by means of optical fibers. 6 figs.

Longitudinal Study Transformed Onboarding Nurse Graduates.

PubMed

Slate, Kimberly A; Stavarski, Debra H; Romig, Barbara J; Thacker, Karen S

The outcomes of a longitudinal research study on a nurse residency program indicated improvement in the onboarding experience for new graduate nurses. Practice changes and implications for nursing professional development practitioners resulting from the study include the number and orientation of preceptors, program length standardization, and improvement of emergency clinical response education. Additional research studies were implemented to further explore issues novice nurses and their proficient registered nurse colleagues experience throughout the organization.

Design Improvement for Airplane-Engine Nacelles

NASA Technical Reports Server (NTRS)

Vernon, D. F.; Page, G. S.; Welge, H. R.

1987-01-01

Advanced three-dimensional transonic design routine for wingmounted engine nacelles modified to include effects of propellers and wing sweep. Resulting new nacelle shapes introduce less airflow disturbance and less drag. Improvement consists of introduction of boundary conditions in form of nonuniform onset flow in area of wing washed by propeller slipstream. Routine generates nacelle shape as series of cross sections swept, relatively to unperturbed flow, as function of wing shape.

Teaching Science Writing in an Introductory Lab Course

PubMed Central

Holstein, Sarah E.; Mickley Steinmetz, Katherine R.; Miles, John D.

2015-01-01

One challenge that many neuroscience instructors face is how to teach students to communicate within the field. The goal of this project was to improve students’ scientific writing in an introductory psychology laboratory course that serves as a feeder course into the neuroscience curriculum. This course included a scaffolded approach - breaking assignments into different sections that build upon each other to allow for more direction and feedback on each section. Students were also provided with examples of scientific writing, given direction on finding and reading journal articles, and were taught how to effectively peer review a paper. Research papers were assessed before (Year 1) and after (Year 2) this scaffolded approach was instituted. The assessment included measures of “Genre Knowledge” for each section of a research paper (abstract, introduction, method, results, discussion) as well as measures of “Writing Elements” (grammar, formatting, clarity, transitions, building to the hypothesis, using evidence). The results indicated that there was an improvement for Genre Knowledge scores when comparing Year 1 to Year 2. However, there was no systematic improvement in Writing Elements. This suggests that this teaching technique was most effective in improving students’ ability to write within the scientific genre. The logistics of implementing such an approach are discussed. PMID:25838801

Use of Clinical Anatomy Resources by Musculoskeletal Outpatient Physiotherapists in Australian Public Hospitals: A Cross-Sectional Study

PubMed Central

Davies, Tilman M.; Cornwall, Jon

2015-01-01

ABSTRACT Purpose: To investigate how musculoskeletal outpatient physiotherapists in public hospitals interact with and perceive clinical anatomy resources in the workplace. Method: This cross-sectional study used a postal survey sent to musculoskeletal outpatient physiotherapists in 64 Australian public hospitals. Survey questions examined demographics, qualifications, experience, types of resources used, whether resources meet requirements, and what improvements could be made to current resources. Results: A total of 193 physiotherapists responded (75% response rate; 60% female), of whom 49% were age 35 years or younger; 67% had only an undergraduate qualification, and 37% had practised for 5 years or less. More experienced physiotherapists used resources significantly less frequently ([odds ratio]=1.35; 95% CI, 1.17–1.57), and we found no significant associations between preference for online versus printed resources and age, sex, qualifications, or experience. Trends included less experienced physiotherapists identifying the absence of online access as a barrier to resource use and provision of improved online facilities as necessary to improve access to clinical anatomy resources. Conclusion: Results indicate distinct trends in physiotherapists' use of clinical anatomy resources, including a desire for improved online resource access on the part of less experienced physiotherapists. The findings are relevant to hospital outpatient clinics, particularly those that employ less experienced physiotherapists. PMID:26839457

Global and Regional 3D Tomography for Improved Seismic Event Location and Uncertainty in Explosion Monitoring

NASA Astrophysics Data System (ADS)

Downey, N.; Begnaud, M. L.; Hipp, J. R.; Ballard, S.; Young, C. S.; Encarnacao, A. V.

2017-12-01

The SALSA3D global 3D velocity model of the Earth was developed to improve the accuracy and precision of seismic travel time predictions for a wide suite of regional and teleseismic phases. Recently, the global SALSA3D model was updated to include additional body wave phases including mantle phases, core phases, reflections off the core-mantle boundary and underside reflections off the surface of the Earth. We show that this update improves travel time predictions and leads directly to significant improvements in the accuracy and precision of seismic event locations as compared to locations computed using standard 1D velocity models like ak135, or 2½D models like RSTT. A key feature of our inversions is that path-specific model uncertainty of travel time predictions are calculated using the full 3D model covariance matrix computed during tomography, which results in more realistic uncertainty ellipses that directly reflect tomographic data coverage. Application of this method can also be done at a regional scale: we present a velocity model with uncertainty obtained using data obtained from the University of Utah Seismograph Stations. These results show a reduction in travel-time residuals for re-located events compared with those obtained using previously published models.

The effectiveness of external sensory cues in improving functional performance in individuals with Parkinson's disease: a systematic review with meta-analysis.

PubMed

Cassimatis, Constantine; Liu, Karen P Y; Fahey, Paul; Bissett, Michelle

2016-09-01

A systematic review with meta-analysis was performed to investigate the effect external sensory cued therapy on activities of daily living (ADL) performance that include walking and daily tasks such as dressing for individuals with Parkinson's disease (PD). A detailed computer-aided search of the literature was applied to MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE and PubMed. Studies investigating the effects of external sensory cued therapy on ADL performance for individuals with PD in all stages of disease progression were collected. Relevant articles were critically reviewed and study results were synthesized by two independent researchers. A data-analysis method was used to extract data from selected articles. A meta-analysis was carried out for all randomized-controlled trials. Six studies with 243 individuals with PD were included in this review. All six studies yielded positive findings in favour of external sensory cues. The meta-analysis showed that external sensory cued therapy improved statistically after treatment (P=0.011) and at follow-up (P<0.001) for ADL performance. The results of this review provided evidence of an improvement in ADL performance in general in individuals with PD. It is recommended that clinicians incorporate external sensory into a training programme focused on improving daily task performance.

Single-Blinded Prospective Implementation of a Preoperative Imaging Checklist for Endoscopic Sinus Surgery.

PubMed

Error, Marc; Ashby, Shaelene; Orlandi, Richard R; Alt, Jeremiah A

2018-01-01

Objective To determine if the introduction of a systematic preoperative sinus computed tomography (CT) checklist improves identification of critical anatomic variations in sinus anatomy among patients undergoing endoscopic sinus surgery. Study Design Single-blinded prospective cohort study. Setting Tertiary care hospital. Subjects and Methods Otolaryngology residents were asked to identify critical surgical sinus anatomy on preoperative CT scans before and after introduction of a systematic approach to reviewing sinus CT scans. The percentage of correctly identified structures was documented and compared with a 2-sample t test. Results A total of 57 scans were reviewed: 28 preimplementation and 29 postimplementation. Implementation of the sinus CT checklist improved identification of critical sinus anatomy from 24% to 84% correct ( P < .001). All residents, junior and senior, demonstrated significant improvement in identification of sinus anatomic variants, including those not directly included in the systematic review implemented. Conclusion The implementation of a preoperative endoscopic sinus surgery radiographic checklist improves identification of critical anatomic sinus variations in a training population.

Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review.

PubMed

Brijnath, Bianca; Protheroe, Joanne; Mahtani, Kamal Ram; Antoniades, Josefine

2016-06-20

Low levels of mental health literacy (MHL) have been identified as an important contributor to the mental health treatment gap. Interventions to improve MHL have used traditional media (eg, community talks, print media) and new platforms (eg, the Internet). Evaluations of interventions using conventional media show improvements in MHL improve community recognition of mental illness as well as knowledge, attitude, and intended behaviors toward people having mental illness. However, the potential of new media, such as the Internet, to enhance MHL has yet to be systematically evaluated. Study aims were twofold: (1) To systematically appraise the efficacy of Web-based interventions in improving MHL. (2) To establish if increases in MHL translated into improvement in individual health seeking and health outcomes as well as reductions in stigma toward people with mental illness. We conducted a systematic search and appraisal of all original research published between 2000 and 2015 that evaluated Web-based interventions to improve MHL. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to report findings. Fourteen studies were included: 10 randomized controlled trials and 4 quasi-experimental studies. Seven studies were conducted in Australia. A variety of Web-based interventions were identified ranging from linear, static websites to highly interactive interventions such as social media games. Some Web-based interventions were specifically designed for people living with mental illness whereas others were applicable to the general population. Interventions were more likely to be successful if they included "active ingredients" such as a structured program, were tailored to specific populations, delivered evidenced-based content, and promoted interactivity and experiential learning. Web-based interventions targeting MHL are more likely to be successful if they include active ingredients. Improvements in MHL see concomitant improvements in health outcomes, especially for individuals with mild to moderate depression. The most promising interventions suited to this cohort appear to be MoodGYM and BluePages, 2 interventions from Australia. However, the relationship between MHL and formal and informal help seeking is less clear; self-stigma appears to be an important mediator with results showing that despite improvements in MHL and community attitudes to mental illness, individuals with mental illness still seek help at relatively low rates. Overall, the Internet is a viable method to improve MHL. Future studies could explore how new technology interfaces (eg, mobile phones vs computers) can help improve MHL, mental health outcomes, and reduce stigma.

Entrained-flow gasification at elevated pressure: Volume 1: Final technical report, March 1, 1985-April 30,1987

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

Hedman, P.O.; Smoot, L.D.; Smith, P.J.

1987-10-15

The general purpose of this research program was to develop a basic understanding of the physical and chemical processes in entrained coal gasification and to use the results to improve and evaluate an entrained gasification computer model. The first task included the collection and analysis of in-situ gasifier data at elevated pressures with three coal types (North Dakota lignite, Wyoming subbituminous and Illinois bituminous), the design, construction, and testing of new coal/oxygen/steam injectors with a fourth coal type (Utah bituminous), the collection of supporting turbulent fluid dynamic (LDV) data from cold-flow studies, and the investigation of the feasibility of usingmore » laser-based (CARS) daignostic instruments to make measurements in coal flames. The second task included improvements to the two-dimensional gasifier submodels, tabulation and evaluation of new coal devolatilization and char oxidation data for predictions, fundamental studies of turbulent particle dispersion, the development of improved numerical methods, and validation of the comprehensive model through comparison of predictions with experimental results. The third task was to transfer technical advances to industry and to METC through technical seminars, production of a detailed data book, code placement, and publication of results. Research results for these three tasks are summarized briefly here and presented in detail in the body of the report and in supporting references. 202 refs., 73 figs., 23 tabs.« less

Prospective Study Evaluating IncobotulinumtoxinA for Cervical Dystonia or Blepharospasm: Interim Results from the First 145 Subjects with Cervical Dystonia

PubMed Central

Fernandez, Hubert H.; Pagan, Fernando; Danisi, Fabio; Greeley, David; Jankovic, Joseph; Verma, Amit; Sethi, Kapil; Pappert, Eric J.

2013-01-01

Background We report the interim results from XCiDaBLE, a large, prospective, observational “naturalistic” study evaluating Xeomin® (incobotulinumtoxinA) for Cervical Dystonia or BLEpharospasm in the United States. Methods Subjects (≥ 18 years old) with cervical dystonia (CD) are followed for two treatment cycles and monitored via Interactive Voice/Web Response. The subject's physician must have chosen to treat with incobotulinumtoxinA prior to and independent of enrollment in this study. Subject-reported scales include the Subject Global Impression-Severity and Improvement and Cervical Dystonia Impact Profile (CDIP-58), and Work Productivity and Quality of Life (QoL) are assessed by means of an employment questionnaire and work history and the SF-12v2 Health Survey (SF-12v2). Subjects are seen by the investigator for three visits, which include a baseline visit (including the first injection), a second injection visit, and a final study visit (12 weeks after the second injection). Results This ongoing study includes 145 subjects with a diagnosis of CD. The majority were female (82.3%) and white (91.0%) and had previously been treated with botulinum toxins (77.2%). There were 106 employed at the time of disease onset, but 12.6 years later only 44% were still employed at the time of enrolment into the study, and 20% were either receiving or seeking disability benefits. The mean total dose/treatment of CD was 225.2 units for the first injection. The CDIP-58 total score was significantly improved 4 weeks after the first injection compared to baseline (p≤0.0001). Most subjects noted improvement in their global impression assessment. No new or unexpected adverse events occurred. Discussion The results from these interim analyses confirm previous controlled, single-dose studies of incobotulinumtoxinA in terms of efficacy and safety. PMID:23724362

Nutrition Instruction and Lunch Surveys with Second Graders

ERIC Educational Resources Information Center

Boysen, Susan C.; Ahrens, Richard A.

1972-01-01

Report of a four-week nutrition education program conducted with two second grade classes from a school in suburban Maryland. Discusses aims, activities, and pre- and post-test results, including a parent questionnaire. Results indicated knowledge improvement, but stressed the home as the major influence over the food habits of children. (LK)

Developing and Implementing a Postsecondary Education Program for Young Adults with Intellectual and Developmental Disabilities: Processes and Procedure

ERIC Educational Resources Information Center

Francis, Grace L.; Gordon, Sarah; Kliethermes, Andrew J.; Regester, April; Baldini, Deborah; Grant, Amber

2018-01-01

Postsecondary education programs (PSEs) for young adults with intellectual and developmental disabilities in colleges and universities expand opportunities for these young adults and result in positive outcomes, including employment and improved social networks. Although participating in postsecondary education results in numerous benefits for…

Growth and characterization of tunable solid state lasers in the near infrared spectral region

NASA Technical Reports Server (NTRS)

Powell, Richard C.; Martin, Joel J.

1990-01-01

This research resulted in the publication of two major papers. The major results include the development of improved crystal growth techniques for rare earth-doped LiYF4 crystals and the determination of laser-pumped laser characteristics of Tm:Ho:Y3Al5O12 crystals.

Maintenance Procedure Display: Head Mounted Display (HMD) Evaluations

NASA Technical Reports Server (NTRS)

Whitmore, Milrian; Litaker, Harry L., Jr.; Solem, Jody A.; Holden, Kritina L.; Hoffman, Ronald R.

2007-01-01

A viewgraph presentation describing maintenance procedures for head mounted displays is shown. The topics include: 1) Study Goals; 2) Near Eye Displays (HMDs); 3) Design; 4) Phase I-Evaluation Methods; 5) Phase 1 Results; 6) Improved HMD Mounting; 7) Phase 2 -Evaluation Methods; 8) Phase 2 Preliminary Results; and 9) Next Steps.

An Improved Method for Demonstrating Visual Selection by Wild Birds.

ERIC Educational Resources Information Center

Allen, J. A.; And Others

1990-01-01

An activity simulating natural selection in which wild birds are predators, green and brown pastry "baits" are prey, and trays containing colored stones as the backgrounds is presented. Two different methods of measuring selection are used to describe the results. The materials and methods, results, and discussion are included. (KR)

Ohio's Economic Advantage. Enhancing Workforce Performance. Improving Business Results. Increasing Global Competitiveness.

ERIC Educational Resources Information Center

Ohio Board of Regents, Columbus.

This booklet contains 36 one-page "success stories" that reveal how the two-year colleges and the vocational and adult education system in Ohio are responding to business and industry needs with innovative problem solving and effective partnerships. Each profile includes a challenge, a solution, results, and comments from business…

Interventions to improve social determinants of health among elderly ethnic minority groups: a review.

PubMed

Pool, Michelle S; Agyemang, Charles O; Smalbrugge, Martin

2017-12-01

Like the European general population, ethnic minorities are aging. In this group, important social determinants of health (social participation, social isolation and loneliness) that lead to negative health outcomes frequently occur. Interventions targeting these determinants may decrease negative health outcomes. The goal of this article was to identify effective interventions that improve social participation, and minimise social isolation and loneliness in community dwelling elderly ethnic minorities. An electronic database (PubMed) was systematically searched using an extensive search strategy, for intervention studies in English, French, Dutch of German, without time limit. Additional articles were found using references. Articles were included if they studied an intervention aimed to improve social participation or minimise social isolation or loneliness and were focusing on community dwelling elderly ethnic minorities. Data regarding studies characteristics and results were extracted. Six studies (three randomized controlled trials, three non-controlled intervention studies) were included in the review. All studies were group-based interventions and had a theoretical basis. Five out of six studies showed improvement on a social participation, -isolation or loneliness outcome. Type of intervention included volunteering-, educational- and physical activities. In three studies active participation of the participant was required, these interventions were not more effective than other interventions. Some interventions improved the included social determinants of health in community dwelling elderly ethnic minorities. Investment in further development and implementation of these interventions may help to improve social determinants of health in these populations. It is necessary to evaluate these interventions in the European setting. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Promotion of a healthy work life at small enterprises in Thailand by participatory methods.

PubMed

Krungkraiwong, Sudthida; Itani, Toru; Amornratanapaichit, Ratanaporn

2006-01-01

The major problems of small enterprises include unfavourable working conditions and environment that affect safety and health of workers. The WISE (Work Improvement in Small Enterprises) methodology developed by the ILO has been widely applied to improve occupational safety and health in small enterprises in Thailand. The participatory methods building on local good practices and focusing on practicable improvements have proven effective in controlling the occupational hazards in these enterprises at their sources. As a result of applying the methods in small-scale industries, the frequency of occupational accidents was reduced and the working environment actually improved in the cases studied. The results prove that the participatory approach taken by the WISE activities is a useful and effective tool to make owner/managers and workers in small enterprises voluntarily improve their own working conditions and environment. In promoting a healthy work life at small enterprises in Thailand, it is important to further develop and spread the approach.

Pharmacological strategies to enhance adaptation in intestinal failure.

PubMed

Pape, Ulrich-Frank; Maasberg, Sebastian; Pascher, Andreas

2016-04-01

Intestinal failure because of more or less extensive resection of parts of the small and large intestine (short bowel syndrome) results from the reduction of absorptive surface of the remaining intestine and frequently results in dependence on parenteral nutrition. Parenteral nutrition, although lifesaving, is associated with short and long-term complications as well as with reduced quality of life and overall survival. Pharmacological enhancement of the physiological intestinal adaptive response by subcutaneous application of the glucagon-like peptide 2 analogue teduglutide results in an improved, hyperadaptive response. This is reflected by decreased parenteral calorie and fluid requirements, decreased parenteral nutrition infusion days per week including complete weaning off parenteral nutrition with complete oral autonomy, improved quality of life, and metabolic and nutritional stability. The advent of teduglutide as an authority-approved specific medication for intestinal failure in parenteral nutrition-dependent short bowel syndrome offers an effective and beneficial treatment for these patients. As a result, patients are more stable whether for medical or further surgical management including intestinal transplantation. Long-term efficacy and safety still have to be proven.

Tag Clouds as a Pathway to Improved Pedagogical Efficacy in Information Systems Courses: A Baseline Study Involving Web 2.0 Technologies

ERIC Educational Resources Information Center

Conn, Samuel S.; English, John; Scheffler, Fred; Hall, Simin

2011-01-01

Various Web 2.0 technologies can be used to support pedagogy. Examples include wikis, blogs, and social media including forum discussions. Online class forum discussions involving electronic text can result in robust strings of data containing meta-knowledge, inherent meaning, themes and patterns. Based on instructional design, learning outcomes…

Preservice Teachers' Conceptions about Computers: An Ongoing Search for Transformative Appropriations of Modern Technologies

ERIC Educational Resources Information Center

Katic, Elvira K.

2008-01-01

Due to the variety of text forms that are being created as a result of improving information technologies, understandings of literacy must be broadened to include a variety of meaning-making modes in order to include different social, cultural, and material contexts. The following case study examined the conceptions of technology held by two…

Synthesized airfoil data method for prediction of dynamic stall and unsteady airloads

NASA Technical Reports Server (NTRS)

Gangwani, S. T.

1983-01-01

A detailed analysis of dynamic stall experiments has led to a set of relatively compact analytical expressions, called synthesized unsteady airfoil data, which accurately describe in the time-domain the unsteady aerodynamic characteristics of stalled airfoils. An analytical research program was conducted to expand and improve this synthesized unsteady airfoil data method using additional available sets of unsteady airfoil data. The primary objectives were to reduce these data to synthesized form for use in rotor airload prediction analyses and to generalize the results. Unsteady drag data were synthesized which provided the basis for successful expansion of the formulation to include computation of the unsteady pressure drag of airfoils and rotor blades. Also, an improved prediction model for airfoil flow reattachment was incorporated in the method. Application of this improved unsteady aerodynamics model has resulted in an improved correlation between analytic predictions and measured full scale helicopter blade loads and stress data.

3D-FFT for Signature Detection in LWIR Images

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

Medvick, Patricia A.; Lind, Michael A.; Mackey, Patrick S.

Improvements in analysis detection exploitation are possible by applying whitened matched filtering within the Fourier domain to hyperspectral data cubes. We describe an implementation of a Three Dimensional Fast Fourier Transform Whitened Matched Filter (3DFFTMF) approach and, using several example sets of Long Wave Infra Red (LWIR) data cubes, compare the results with those from standard Whitened Matched Filter (WMF) techniques. Since the variability in shape of gaseous plumes precludes the use of spatial conformation in the matched filtering, the 3DFFTMF results were similar to those of two other WMF methods. Including a spatial low-pass filter within the Fourier spacemore » can improve signal to noise ratios and therefore improve detection limit by facilitating the mitigation of high frequency clutter. The improvement only occurs if the low-pass filter diameter is smaller than the plume diameter.« less

Improving Social Engagement and Initiations between Children with Autism Spectrum Disorder and Their Peers in Inclusive Settings

PubMed Central

Koegel, Lynn Kern; Vernon, Ty; Koegel, Robert L.; Koegel, Brittany L.; Paullin, Anne W.

2013-01-01

Children with Asperger’s Disorder often have difficulty with peer relationships and socialization. The current study assessed whether peer social interactions would improve in school settings if an intervention was designed that incorporated the children with Asperger’s interests. Three children who were fully-included in regular education classes but did not interact with peers prior to intervention participated in this research. Social lunch clubs, open to both the study participants and their typical peers, were implemented twice weekly during regular lunchtime periods. Results showed that all three children increased their time engaged with peers as a result of the clubs. While their initiations greatly improved over baseline levels and approximated their peers, they were often initiating below the level of most of their peers. Implications for improving peer social interactions for children with Asperger’s Disorder are discussed. PMID:25328380

Productivity improvement in engineering at Rocketdyne

NASA Technical Reports Server (NTRS)

Nordlund, R. M.; Vogt, S. T.; Woo, A. K.

1985-01-01

The Rocketdyne Division of Rockwell International has embarked on a productivity improvement program in engineering. This effort included participation in the White Collar Productivity Improvement (WCPI) project sponsored by the American Productivity Center. A number of things have been learned through this project. It seems that any productivity improvement project should be employee driven. The Rocketdyne project was essentially started as a result of a grassroots effort to remove some particular hindrances, and employee enthusiasm was a prime factor in the continuing progress of the effort. A significant result was that awareness of problems at all levels increased. Many issues surfaced in the diagnostic phase, and were then noted and discussed. This process added legitimacy to issues that had previously been merely unspoken concerns. The initial feelings of many members of the pilot group was that significant changes would occur relatively quickly. It is now recognized that this will have to be an ongoing, long-term effort.

Outcome-based and Participation-based Wellness Incentives

PubMed Central

Barleen, Nathan A.; Marzec, Mary L.; Boerger, Nicholas L.; Moloney, Daniel P.; Zimmerman, Eric M.; Dobro, Jeff

2017-01-01

Objective: This study examined whether worksite wellness program participation or achievement of health improvement targets differed according to four incentive types (participation-based, hybrid, outcome-based, and no incentive). Methods: The study included individuals who completed biometric health screenings in both 2013 and 2014 and had elevated metrics in 2013 (baseline year). Multivariate logistic regression modeling tested for differences in odds of participation and achievement of health improvement targets between incentive groups; controlling for demographics, employer characteristics, incentive amounts, and other factors. Results: No statistically significant differences between incentive groups occurred for odds of participation or achievement of health improvement target related to body mass index, blood pressure, or nonhigh-density lipoprotein cholesterol. Conclusions: Given the null findings of this study, employers cannot assume that outcome-based incentives will result in either increased program participation or greater achievement of health improvement targets than participation-based incentives. PMID:28146041

Management of local economic and ecological system of coal processing company

NASA Astrophysics Data System (ADS)

Kiseleva, T. V.; Mikhailov, V. G.; Karasev, V. A.

2016-10-01

The management issues of local ecological and economic system of coal processing company - coal processing plant - are considered in the article. The objectives of the research are the identification and the analysis of local ecological and economic system (coal processing company) performance and the proposals for improving the mechanism to support the management decision aimed at improving its environmental safety. The data on the structure of run-of-mine coal processing products are shown. The analysis of main ecological and economic indicators of coal processing enterprises, characterizing the state of its environmental safety, is done. The main result of the study is the development of proposals to improve the efficiency of local enterprise ecological and economic system management, including technical, technological and business measures. The results of the study can be recommended to industrial enterprises to improve their ecological and economic efficiency.

ïSCOPE: Safer care for older persons (in residential) environments: A study protocol

PubMed Central

2011-01-01

Background The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life. Aims Safer Care for Older Persons [in residential] Environments is a two year (2010 to 2012) proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life. Methods/design The study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility) are led by healthcare aides (non-regulated caregivers) and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking. Discussion There are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement initiatives in the long-term care sector. PMID:21745382

Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture.

PubMed

Sacks, Greg D; Shannon, Evan M; Dawes, Aaron J; Rollo, Johnathon C; Nguyen, David K; Russell, Marcia M; Ko, Clifford Y; Maggard-Gibbons, Melinda A

2015-07-01

To define the target domains of culture-improvement interventions, to assess the impact of these interventions on surgical culture and to determine whether culture improvements lead to better patient outcomes and improved healthcare efficiency. Healthcare systems are investing considerable resources in improving workplace culture. It remains unclear whether these interventions, when aimed at surgical care, are successful and whether they are associated with changes in patient outcomes. PubMed, Cochrane, Web of Science and Scopus databases were searched from January 1980 to January 2015. We included studies on interventions that aimed to improve surgical culture, defined as the interpersonal, social and organisational factors that affect the healthcare environment and patient care. The quality of studies was assessed using an adapted tool to focus the review on higher-quality studies. Due to study heterogeneity, findings were narratively reviewed. The 47 studies meeting inclusion criteria (4 randomised trials and 10 moderate-quality observational studies) reported on interventions that targeted three domains of culture: teamwork (n=28), communication (n=26) and safety climate (n=19); several targeted more than one domain. All moderate-quality studies showed improvements in at least one of these domains. Two studies also demonstrated improvements in patient outcomes, such as reduced postoperative complications and even reduced postoperative mortality (absolute risk reduction 1.7%). Two studies reported improvements in healthcare efficiency, including fewer operating room delays. These findings were supported by similar results from low-quality studies. The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including better patient outcomes and enhanced healthcare efficiency. CRD42013005987. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Surgical treatment for cervicomedullary compression among infants with achondroplasia.

PubMed

Shimony, Nir; Ben-Sira, Liat; Sivan, Yakov; Constantini, Shlomi; Roth, Jonathan

2015-05-01

Achondroplasia is the most common form of dwarfism. Respiratory failure is responsible for most deaths among these children and is often related to cervicomedullary compression (CMC). We present our experience with early cervicomedullary decompression in infants with achondroplasia. Data was retrospectively collected for infants with achondroplasia who underwent CMC decompression between 1998 and 2013. Data included presurgical and postsurgical neurological examinations, MRI scans, and sleep study results. Ten infants were included. Ages at surgery were 4 to 23 months (12.5 ± 6.88 months). All infants displayed neurological findings prior to surgery, although often subtle. All infants underwent a foramen magnum opening with a wide C1 laminectomy. Following surgery, seven patients (70 %) demonstrated improved neurological status, and one displayed neurological deterioration. Seven patients demonstrated improved sleep quality 1 year after surgery. These patients had a good or improved neurological status following surgery. Preoperative radiological findings included abnormal hyperintense T2 changes in all children (improved following surgery in six children), brainstem distortion in four children (improved in all), and diminished cerebrospinal fluid (CSF) spaces at the level of the foramen magnum in eight children (improved in seven). One child with extensive preoperative T2 changes accompanied by neurological and respiratory decline, deteriorated following surgery, and remains chronically ventilated. Infants with achondroplasia are prone to neurological and respiratory symptoms. We believe that early diagnosis and early surgery for decompression of the foramen magnum and C1 lamina can alleviate respiratory symptoms, improve neurological status, and perhaps prevent sudden infant death in this population.

Improving the quality of care for women with cardiovascular disease: report of a DCRI Think Tank, March 8 to 9, 2007.

PubMed

Berger, Jeffrey S; Bairey-Merz, C Noel; Redberg, Rita F; Douglas, Pamela S

2008-11-01

Differences in pathophysiology, diagnosis, and treatment of women with cardiovascular disease compared with men has become a major focus during the past decade. Nevertheless, little attention has focused on improving the quality of healthcare in women compared with other areas of cardiovascular medicine. To address this deficit, Duke University Medical Center convened a national Duke Clinical Research Institute (DCRI) Think Tank meeting, including basic science and clinical researchers, payers, legislators, clinical experts, government regulators, and members of the pharmaceutical and device industries. This report provides an overview of the discussions and proposed solutions. Discussion concentrated on the development of strategies to improve the quality of health care for women with heart disease. Key components to improve quality care include: (1) enhance the quantity and quality of evidence-based medicine to guide care in women through improvements in trial design, enrollment and retention of women subjects, results analysis and reporting, and better incentives to perform research in women; (2) provide incentives to develop better data in women through mandating changes in the drug and device development and approval processes; (3) incorporate specific recommendations for women into guidelines when data are sufficient; and (4) apply proven sex-based differences in risk stratification, diagnostic testing, and drug usage and dosing in clinical care. Examples of possible strategies are included. The above approach represents a necessary, but not sufficient, platform to improve the overall quality of healthcare in women with cardiovascular disease.

Implementation and Sequencing of Practice Transformation in Urban Practices with Underserved Patients.

PubMed

Quigley, Denise D; Predmore, Zachary S; Chen, Alex Y; Hays, Ron D

Patient-centered medical home (PCMH) has gained momentum as a model for primary-care health services reform. We conducted interviews at 14 primary care practices undergoing PCMH transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. We found clinics pursued a common sequence of changes in PCMH transformation: Clinics began with National Committee for Quality Assurance (NCQA) level 3 recognition, adding care coordination staff, reorganizing data flow among teams, and integrating with a centralized quality improvement and accountability infrastructure. Next, they realigned to support continuity of care. Then, clinics improved access by adding urgent care, patient portals, or extending hours. Most then improved planning and management of patient visits. Only a handful worked explicitly on improving access with same day slots, scheduling processes, and test result communication. The clinics' changes align with specific NCQA PCMH standards but also include adding physicians and services, culture changes, and improved communication with patients. NCQA PCMH level 3 recognition is only the beginning of a continuous improvement process to become patient centered. Full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy before changes to delivery of and access to care.

Vagus Nerve Stimulation in Intractable Childhood Epilepsy: a Korean Multicenter Experience

PubMed Central

You, Su Jeong; Kang, Hoon-Chul; Kim, Heung Dong; Kim, Deok-Soo; Hwang, Yong Soon; Kim, Dong Suk; Lee, Jung-Kyo; Park, Sang Keun

2007-01-01

We evaluated the long-term outcome of vagus nerve stimulation (VNS) in 28 children with refractory epilepsy. Of these 28 children, 15 (53.6%) showed a >50% reduction in seizure frequency and 9 (32.1%) had a >75% reduction. When we compared seizure reduction rates according to seizure types (generalized vs. partial) and etiologies (symptomatic vs. cryptogenic), we found no significant differences. In addition, there was no correlation between the length of the stimulation period and treatment effect. The seizure reduction rate, however, tended to be inversely related to the seizure duration before VNS implantation and age at the time of VNS therapy. VNS also improved quality of life in this group of patients, including improved memory in 9 (32.1%), improved mood in 12 (42.9%), improved behavior in 11 (39.3%), improved altertness in 12 (42.9%), improved achievement in 6 (21.4%), and improved verbal skills in 8 (28.6%). Adverse events included hoarseness in 7 patients, dyspnea at sleep in 2 patients, and wound infection in 1 patient, but all were transient and successfully managed by careful follow-up and adjustment of parameters. These results indicate that VNS is a safe and effective alternative therapy for pediatric refractory epilepsy, without significant adverse events. PMID:17596651

Swespine: the Swedish spine register : the 2012 report.

PubMed

Strömqvist, Björn; Fritzell, Peter; Hägg, Olle; Jönsson, Bo; Sandén, Bengt

2013-04-01

Swespine, the Swedish National Spine Register, has existed for 20 years and is in general use within the country since over 10 years regarding degenerative lumbar spine disorders. Today there are protocols for registering all disorders of the entire spinal column. Patient-based pre- and postoperative questionnaires, completed before surgery and at 1, 2, 5 and 10 years postoperatively. Among patient-based data are VAS pain, ODI, SF-36 and EQ-5D. Postoperatively evaluation of leg and back pain as compared to preoperatively ("global assessment"), overall satisfaction with outcome and working conditions are registered in addition to the same parameters as preoperatively evaluation. A yearly report is produced including an analytic part of a certain topic, in this issue disc prosthesis surgery. More than 75,000 surgically treated patients are registered to date with an increasing number yearly. The present report includes 7,285 patients; 1-, 2- and 5-year follow-up data of previously operated patients are also included for lumbar disorders as well as for disc prosthesis surgery. For the degenerative lumbar spine disorders (disc herniation, spinal stenosis, spondylolisthesis and DDD) significant improvements are seen in all aspects as exemplified by pronounced improvement regarding EQ-5D and ODI. Results seem to be stable over time. Spinal stenosis is the most common indication for spine surgery. Disc prosthesis surgery yields results on a par with fusion surgery in disc degenerative pain. The utility of spine surgery is well documented by the results. Results of spine surgery as documented on a national basis can be utilized for quality assurance and quality improvement as well as for research purposes, documenting changes over time and bench marking when introducing new surgical techniques. A basis for international comparisons is also laid.

Caregiver-Assisted Coping Skills Training for Lung Cancer: Results of a Randomized Clinical Trial

PubMed Central

Porter, Laura S.; Keefe, Francis J.; Garst, Jennifer; Baucom, Donald H.; McBride, Colleen; McKee, Daphne C.; Sutton, Linda; Carson, Kimberly; Knowles, Verena; Rumble, Meredith; Scipio, Cindy

2010-01-01

Context Lung cancer is one of the most common cancers in the U.S. and is associated with high levels of symptoms including pain, fatigue, shortness of breath, and psychological distress. Caregivers as well as patients are adversely affected. However, previous studies of coping skills training (CST) interventions have not been tested in patients with lung cancer nor systematically included caregivers. Objectives This study tested the efficacy of a caregiver-assisted CST protocol in a sample of patients with lung cancer. Methods Two hundred thirty-three lung cancer patients and their caregivers were randomly assigned to receive 14 telephone-based sessions of either caregiver-assisted CST or education/support involving the caregiver. Patients completed measures assessing pain, psychological distress, QOL, and self-efficacy for symptom management; caregivers completed measures assessing psychological distress, caregiver strain, and self-efficacy for helping the patient manage symptoms. Results Patients in both treatment conditions showed improvements in pain, depression, QOL, and self-efficacy and caregivers in both conditions showed improvements in anxiety and self-efficacy from baseline to four-month follow-up. Results of exploratory analyses suggested that the CST intervention was more beneficial to patients/caregivers with Stage II and III cancers, whereas the education/support intervention was more beneficial to patients/caregivers with Stage I cancer. Conclusion Taken together with the broader literature in this area, results from this study suggest that psychosocial interventions can lead to improvements in a range of outcomes for cancer patients. Suggestions for future studies include the utilization of three-group designs (e.g., comparing two active interventions to a standard-care control) and examining mechanisms of change. PMID:20832982

High-reliability gas-turbine combined-cycle development program: Phase II, Volume 3. Final report

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

Hecht, K.G.; Sanderson, R.A.; Smith, M.J.

This three-volume report presents the results of Phase II of the multiphase EPRI-sponsored High-Reliability Gas Turbine Combined-Cycle Development Program whose goal is to achieve a highly reliable gas turbine combined-cycle power plant, available by the mid-1980s, which would be an economically attractive baseload generation alternative for the electric utility industry. The Phase II program objective was to prepare the preliminary design of this power plant. The power plant was addressed in three areas: (1) the gas turbine, (2) the gas turbine ancillaries, and (3) the balance of plant including the steam turbine generator. To achieve the program goals, a gasmore » turbine was incorporated which combined proven reliability characteristics with improved performance features. This gas turbine, designated the V84.3, is the result of a cooperative effort between Kraftwerk Union AG and United Technologies Corporation. Gas turbines of similar design operating in Europe under baseload conditions have demonstrated mean time between failures in excess of 40,000. The reliability characteristics of the gas turbine ancillaries and balance-of-plant equipment were improved through system simplification and component redundancy and by selection of component with inherent high reliability. A digital control system was included with logic, communications, sensor redundancy, and manual backup. An independent condition monitoring and diagnostic system was also included. Program results provide the preliminary design of a gas turbine combined-cycle baseload power plant. This power plant has a predicted mean time between failure of nearly twice the 3000-h EPRI goal. The cost of added reliability features is offset by improved performance, which results in a comparable specific cost and an 8% lower cost of electricty compared to present market offerings.« less

High-reliability gas-turbine combined-cycle development program: Phase II. Final report

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

Hecht, K.G.; Sanderson, R.A.; Smith, M.J.

This three-volume report presents the results of Phase II of the multiphase EPRI-sponsored High-Reliability Gas Turbine Combined-Cycle Development Program whose goal is to achieve a highly reliable gas turbine combined-cycle power plant, available by the mid-1980s, which would be an economically attractive baseload generation alternative for the electric utility industry. The Phase II program objective was to prepare the preliminary design of this power plant. This volume presents information of the reliability, availability, and maintainability (RAM) analysis of a representative plant and the preliminary design of the gas turbine, the gas turbine ancillaries, and the balance of plant including themore » steam turbine generator. To achieve the program goals, a gas turbine was incorporated which combined proven reliability characteristics with improved performance features. This gas turbine, designated the V84.3, is the result of a cooperative effort between Kraftwerk Union AG and United Technologies Corporation. Gas turbines of similar design operating in Europe under baseload conditions have demonstrated mean time between failures in excess of 40,000 hours. The reliability characteristics of the gas turbine ancillaries and balance-of-plant equipment were improved through system simplification and component redundancy and by selection of component with inherent high reliability. A digital control system was included with logic, communications, sensor redundancy, and mandual backup. An independent condition monitoring and diagnostic system was also included. Program results provide the preliminary design of a gas turbine combined-cycle baseload power plant. This power plant has a predicted mean time between failure of nearly twice the 3000-hour EPRI goal. The cost of added reliability features is offset by improved performance, which results in a comparable specific cost and an 8% lower cost of electricity compared to present market offerings.« less

Implementation of basic chemistry experiment based on metacognition to increase problem-solving and build concept understanding

NASA Astrophysics Data System (ADS)

Zuhaida, A.

2018-04-01

Implementation of the experiment have the three aspects of the goal: 1) develop basic skills of experimenting; 2) develop problem-solving skills with a scientific approach; 3) improve understanding of the subject matter. On the implementation of the experiment, students have some weaknesses include: observing, identifying problems, managing information, analyzing, and evaluating. This weakness is included in the metacognition indicator.The objective of the research is to implementation of Basic Chemistry Experiment based on metacognition to increase problem-solving skills and build concept understanding for students of Science Education Department. The method of this research is a quasi- experimental method with pretest-posttest control group design. Problem-solving skills are measured through performance assessments using rubrics from problem solving reports, and results presentation. The conceptual mastery is measured through a description test. The result of the research: (1) improve the problem solving skills of the students with very high category; (2) increase the students’ concept understanding better than the conventional experiment with the result of N-gain in medium category, and (3) increase student's response positively for learning implementation. The contribution of this research is to extend the implementation of practical learning for some subjects, and to improve the students' competence in science.

Telecardiology application in jordan: its impact on diagnosis and disease management, patients' quality of life, and time- and cost-savings.

PubMed

Khader, Yousef Saleh; Jarrah, Mohamad Ismail; Al-Shudifat, Abde-Ellah M; Shdaifat, Amjad; Aljanabi, Husham; Al-Fakeh, Shadwan Ismeil; Turk, Elias Emil; Zayed, Khaled Ali; Al Quran, Hanadi A; Ellauzi, Ziad Mohd; Al Tahan, Mohammad

2014-01-01

Objectives. To assess the impact of live interactive telecardiology on diagnosis and disease management, patients' quality of life, and time- and cost-savings. Methods. All consecutive patients who attended or were referred to the teleclinics for suspected cardiac problems in two hospitals in remote areas of Jordan during the study period were included in the study. Patients were interviewed for relevant information and their quality of life was assessed during the first visit and 8 weeks after the last visit. Results. A total of 76 patients were included in this study. Final diagnosis and treatment plan were established as part of the telecardiology consultations in 71.1% and 77.3% of patients, respectively. Patients' travel was avoided for 38 (50.0%) who were managed locally. The majority of patients perceived that the visit to the telecardiology clinic results in less travel time (96.1%), less waiting time (98.1%), and lower cost (100.0%). Telecardiology consultations resulted in an improvement in the quality of life after two months of the first visit. Conclusions. Telecardiology care in remote areas of Jordan would improve the access to health care, help to reach proper diagnosis and establish the treatment plan, and improve the quality of life.

Implementation and evaluation of a community-based interprofessional learning activity.

PubMed

Luebbers, Ellen L; Dolansky, Mary A; Vehovec, Anton; Petty, Gayle

2017-01-01

Implementation of large-scale, meaningful interprofessional learning activities for pre-licensure students has significant barriers and requires novel approaches to ensure success. To accomplish this goal, faculty at Case Western Reserve University, Ohio, USA, used the Ottawa Model of Research Use (OMRU) framework to create, improve, and sustain a community-based interprofessional learning activity for large numbers of medical students (N = 177) and nursing students (N = 154). The model guided the process and included identification of context-specific barriers and facilitators, continual monitoring and improvement using data, and evaluation of student learning outcomes as well as programme outcomes. First year Case Western Reserve University medical students and undergraduate nursing students participated in team-structured prevention screening clinics in the Cleveland Metropolitan Public School District. Identification of barriers and facilitators assisted with overcoming logistic and scheduling issues, large class size, differing ages and skill levels of students and creating sustainability. Continual monitoring led to three distinct phases of improvement and resulted in the creation of an authentic team structure, role clarification, and relevance for students. Evaluation of student learning included both qualitative and quantitative methods, resulting in statistically significant findings and qualitative themes of learner outcomes. The OMRU implementation model provided a useful framework for successful implementation resulting in a sustainable interprofessional learning activity.

Telecardiology Application in Jordan: Its Impact on Diagnosis and Disease Management, Patients' Quality of Life, and Time- and Cost-Savings

PubMed Central

Khader, Yousef Saleh; Jarrah, Mohamad Ismail; Al-Shudifat, Abde-Ellah M.; Shdaifat, Amjad; Aljanabi, Husham; Al-Fakeh, Shadwan Ismeil; Turk, Elias Emil; Zayed, Khaled Ali; Al Quran, Hanadi A.; Ellauzi, Ziad Mohd; Al Tahan, Mohammad

2014-01-01

Objectives. To assess the impact of live interactive telecardiology on diagnosis and disease management, patients' quality of life, and time- and cost-savings. Methods. All consecutive patients who attended or were referred to the teleclinics for suspected cardiac problems in two hospitals in remote areas of Jordan during the study period were included in the study. Patients were interviewed for relevant information and their quality of life was assessed during the first visit and 8 weeks after the last visit. Results. A total of 76 patients were included in this study. Final diagnosis and treatment plan were established as part of the telecardiology consultations in 71.1% and 77.3% of patients, respectively. Patients' travel was avoided for 38 (50.0%) who were managed locally. The majority of patients perceived that the visit to the telecardiology clinic results in less travel time (96.1%), less waiting time (98.1%), and lower cost (100.0%). Telecardiology consultations resulted in an improvement in the quality of life after two months of the first visit. Conclusions. Telecardiology care in remote areas of Jordan would improve the access to health care, help to reach proper diagnosis and establish the treatment plan, and improve the quality of life. PMID:25400661

Refractory Pain Management in Amyloid-Associated Peripheral Neuropathy.

PubMed

Warner, Nafisseh S; Watson, James C; Bendel, Markus A; Moeschler, Susan M

2018-05-01

Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the optimal treatment approach for pain for these patients remains unclear. A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief. Scrambler therapy, a novel electrical stimulation modality, was used and was associated with substantial short-term but nonsustained benefit. Spinal cord stimulation was considered, but given his diffuse symptoms, it was deemed a less-than-optimal approach. Ultimately, an intrathecal drug delivery system was placed with infusion of hydromorphone, resulting in substantial pain reduction in all involved areas and with an improved adverse effect profile. This intervention resulted in immense improvement in the patient's quality of life, despite progression of his systemic amyloidosis. Severe pain in the setting of amyloid neuropathy is often difficult to treat. To our knowledge, this represents the first report of Scrambler therapy or an implanted intrathecal drug delivery system used for a patient with refractory amyloidosis-related neuropathic pain, resulting in substantial analgesic benefit and improved quality of life.

[Microsurgical treatment of brachial plexus injuries].

PubMed

Päzolt, H J

1986-01-01

Injuries of the brachial plexus are found to occur primarily to juvenile patients as a consequence of motorcycle accidents. While it is a severe injury, its prognosis has been substantively improved by the availability of microsurgical treatment, using long nerve transplants. Further improvement of results will be possible by early operation, a desirable objective. 44 patients with brachial palsy received treatment, including surgery in 41 cases. An account is given in this paper of intraoperative findings, surgical techniques, and results from follow-up checks. The need is underlined for long-term intensive after-care for the purpose of occupational reintegration.

Deliberately Designed Atomic-Level Silver-Containing Interface Results in Improved Rate Capability and Utilization of Silver Hollandite for Lithium-Ion Storage

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

Smith, Paul F.; Brady, Alexander B.; Lee, Seung-Yong

α-MnO 2-structured materials are generally classified as semiconductors, thus we present a strategy to increase electrochemical utilization through design of a conductive material interface. Surface treatment of silver hollandite (Ag xMn 8O 16) with Ag + (Ag 2O) provides significant benefit to the resultant electrochemistry, including a decreased charge transfer resistance, and a 2-fold increase in deliverable energy density at high rate. The improved function of this designed interface relative to conventional electrode fabrication strategies is further highlighted.

Potential biomedical applications of ion beam technology

NASA Technical Reports Server (NTRS)

Banks, B. A.; Weigand, A. J.; Babbush, C. A.; Vankampen, C. L.

1976-01-01

Electron bombardment ion thrusters used as ion sources have demonstrated a unique capability to vary the surface morphology of surgical implant materials. The microscopically rough surface texture produced by ion beam sputtering of these materials may result in improvements in the biological response and/or performance of implanted devices. Control of surface roughness may result in improved attachment of the implant to soft tissue, hard tissue, bone cement, or components deposited from blood. Potential biomedical applications of ion beam texturing discussed include: vascular prostheses, artificial heart pump diaphragms, pacemaker fixation, percutaneous connectors, orthopedic pros-thesis fixtion, and dental implants.

Potential biomedical applications of ion beam technology

NASA Technical Reports Server (NTRS)

Banks, B. A.; Weigand, A. J.; Van Kampen, C. L.; Babbush, C. A.

1976-01-01

Electron bombardment ion thrusters used as ion sources have demonstrated a unique capability to vary the surface morphology of surgical implant materials. The microscopically rough surface texture produced by ion beam sputtering of these materials may result in improvements in the biological response and/or performance of implanted devices. Control of surface roughness may result in improved attachment of the implant to soft tissue, hard tissue, bone cement, or components deposited from blood. Potential biomedical applications of ion beam texturing discussed include: vascular prostheses, artificial heart pump diaphragms, pacemaker fixation, percutaneous connectors, orthopedic prosthesis fixation, and dental implants.

Deliberately Designed Atomic-Level Silver-Containing Interface Results in Improved Rate Capability and Utilization of Silver Hollandite for Lithium-Ion Storage

DOE PAGES

Smith, Paul F.; Brady, Alexander B.; Lee, Seung-Yong; ...

2017-12-11

α-MnO 2-structured materials are generally classified as semiconductors, thus we present a strategy to increase electrochemical utilization through design of a conductive material interface. Surface treatment of silver hollandite (Ag xMn 8O 16) with Ag + (Ag 2O) provides significant benefit to the resultant electrochemistry, including a decreased charge transfer resistance, and a 2-fold increase in deliverable energy density at high rate. The improved function of this designed interface relative to conventional electrode fabrication strategies is further highlighted.

Preventing hospital-acquired venous thromboembolism: Improving patient safety with interdisciplinary teamwork, quality improvement analytics, and data transparency.

PubMed

Schleyer, Anneliese M; Robinson, Ellen; Dumitru, Roxana; Taylor, Mark; Hayes, Kimberly; Pergamit, Ronald; Beingessner, Daphne M; Zaros, Mark C; Cuschieri, Joseph

2016-12-01

Hospital-acquired venous thromboembolism (HA-VTE) is a potentially preventable cause of morbidity and mortality. Despite high rates of venous thromboembolism (VTE) prophylaxis in accordance with an institutional guideline, VTE remains the most common hospital-acquired condition in our institution. To improve the safety of all hospitalized patients, examine current VTE prevention practices, identify opportunities for improvement, and decrease rates of HA-VTE. Pre/post assessment. Urban academic tertiary referral center, level 1 trauma center, safety net hospital; all patients. We formed a multidisciplinary VTE task force to review all HA-VTE events, assess prevention practices relative to evidence-based institutional guidelines, and identify improvement opportunities. The task force developed an electronic tool to facilitate efficient VTE event review and designed decision-support and reporting tools, now integrated into the electronic health record, to bring optimal VTE prevention practices to the point of care. Performance is shared transparently across the institution. Harborview benchmarks process and outcome performance, including patient safety indicators and core measures, against hospitals nationally using Hospital Compare and Vizient data. Our program has resulted in >90% guideline-adherent VTE prevention and zero preventable HA-VTEs. Initiatives have resulted in a 15% decrease in HA-VTE and a 21% reduction in postoperative VTE. Keys to success include the multidisciplinary approach, clinical roles of task force members, senior leadership support, and use of quality improvement analytics for retrospective review, prospective reporting, and performance transparency. Ongoing task force collaboration with frontline providers is critical to sustained improvements. Journal of Hospital Medicine 2016;11:S38-S43. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

[Audit and feedback, and continuous quality improvement strategies to improve the quality of care for type 2 diabetes: a systematic review of literature].

PubMed

Vecchi, Simona; Agabiti, Nera; Mitrova, Susanna; Cacciani, Laura; Amato, Laura; Davoli, Marina; Bargagli, Anna Maria

2016-01-01

we analysed evidence on effective interventions to improve the quality of care and management in patients with diabetes type 2. This review focuses particularly on audit and feedback intervention, targeted to healthcare providers, and continuous quality improvement (CQI) involving health professionals and health care systems, respectively. we searched The Cochrane Library, PubMed, and EMBASE (search period: January 2005-December 2015) to identify systematic reviews (SR) and randomized controlled trials (RCTs) considering patients' outcomes and process measures as quality indicators in diabetes care. Selection of studies and data extraction were carried out independently by two reviewers. Methodological quality of individual studies was assessed using the checklist «Assessment of methodological quality of systematic review» (AMSTAR) and the Cochrane's tool, respectively. We produced summaries of results for each study design. the search process resulted in 810 citations. One SR and 7 RCTs that compared any intervention in which audit and feedback and CQI was a component vs. other interventions were selected. The SR found that audit and feedback activity was associated with improvements of glycaemic (mean difference: 0.26; 95%CI 0.08;0.44) and cholesterol control (mean difference: 0.03; 95%CI -0.04;0.10). CQI interventions were not associated with an improvement of quality of diabetes care. The RCTs considered in this review compared a broad range of interventions including feedback as unique activity or as part of more complex strategies. The methodological quality was generally poor in all the included trials. the available evidence suggests that audit and feedback and CQI improve quality of care in diabetic patients, although the effect is small and heterogeneous among process and outcomes indicators.

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

PubMed

Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

2014-06-01

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

Removal and Repositioning of Intracorneal Ring Segments: Improving Corneal Topography and Clinical Outcomes in Keratoconus and Ectasia.

PubMed

Chan, Kahei; Hersh, Peter S

2017-02-01

To evaluate the efficacy of removal and relocation of intracorneal ring segments for improving outcomes in treatment of keratoconus and corneal ectasia. This is a retrospective case series conducted at a cornea and refractive surgery subspecialty practice setting. Patients with previous insertion of 2 intracorneal ring segments underwent surgical removal and repositioning of segments because of unsatisfactory visual and topographic outcomes. The principal outcomes included uncorrected and corrected visual acuities, manifest refraction, topography-derived maximum keratometry (Kmax), inferior-superior topography power difference (I - S), and higher-order aberration profile derived from wavefront analysis. Three patients are presented in this case series. Uncorrected visual acuity improved in all eyes by an average of 2.75 lines. Corrected visual acuity improved in 2 eyes and remained unchanged in 1 eye. Refractive astigmatism decreased in all patients by an average of 2.50 D. Kmax decreased by an average of 1.43 D. All patients had improvement in the I - S value with a mean decrease of 5.13 D. Topography-guided repositioning and/or replacement of corneal ring segments can result in improved topographic, optical, and visual outcomes in patients in whom the initial result is suboptimal. In these cases, a single segment repositioned beneath the cone resulted in an improved outcome. Analysis of corneal topography can guide the surgeon in treatment planning and can suggest patients in whom such an effort will be rewarded with better results.

Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.

PubMed

Joseph, Jean Paul; Jerome, Gregory; Lambert, Wesler; Almazor, Patrick; Cupidon, Colette Eugene; Hirschhorn, Lisa R

2015-07-01

Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti.The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities.Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records.We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.

Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis.

PubMed

Johnson, Judith; Panagioti, Maria

2018-06-05

To assess the effectiveness of news delivery interventions to improve observer-rated skills, physician confidence, and patient-reported depression/anxiety. MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 5, 2016 (updated February 2017). Eligible studies included randomized controlled trials (RCTs), non-RCTs, and controlled before-after studies of interventions to improve the communication of bad or difficult news by physicians, medical students, and residents/interns. The EPOC risk of bias tool was used to conduct a risk of bias assessment. Main and secondary meta-analyses examined the effectiveness of the identified interventions for improving observer-rated news delivery skills and for improving physician confidence in delivering news and patient-reported depression/anxiety, respectively. Seventeen studies were included in the systematic review and meta-analysis, including 19 independent comparisons on 1,322 participants and 9 independent comparisons on 985 participants for the main and secondary (physician confidence) analyses (mean [SD] age = 35 [7] years; 46% male), respectively. Interventions were associated with large, significant improvements in observer-rated news delivery skills (19 comparisons: standardized mean difference [SMD] = 0.74, 95% CI = 0.47-1.01) and moderate, significant improvements in physician confidence (9 comparisons: SMD = 0.60, 95% CI = 0.26-0.95). One study reported intervention effects on patient-reported depression/anxiety. The risk of bias findings did not influence the significance of the results. Interventions are effective for improving news delivery and physician confidence. Further research is needed to test the impact of interventions on patient outcomes and determine optimal components and length.

Methods for using groundwater model predictions to guide hydrogeologic data collection, with application to the Death Valley regional groundwater flow system

USGS Publications Warehouse

Tiedeman, C.R.; Hill, M.C.; D'Agnese, F. A.; Faunt, C.C.

2003-01-01

Calibrated models of groundwater systems can provide substantial information for guiding data collection. This work considers using such models to guide hydrogeologic data collection for improving model predictions by identifying model parameters that are most important to the predictions. Identification of these important parameters can help guide collection of field data about parameter values and associated flow system features and can lead to improved predictions. Methods for identifying parameters important to predictions include prediction scaled sensitivities (PSS), which account for uncertainty on individual parameters as well as prediction sensitivity to parameters, and a new "value of improved information" (VOII) method presented here, which includes the effects of parameter correlation in addition to individual parameter uncertainty and prediction sensitivity. In this work, the PSS and VOII methods are demonstrated and evaluated using a model of the Death Valley regional groundwater flow system. The predictions of interest are advective transport paths originating at sites of past underground nuclear testing. Results show that for two paths evaluated the most important parameters include a subset of five or six of the 23 defined model parameters. Some of the parameters identified as most important are associated with flow system attributes that do not lie in the immediate vicinity of the paths. Results also indicate that the PSS and VOII methods can identify different important parameters. Because the methods emphasize somewhat different criteria for parameter importance, it is suggested that parameters identified by both methods be carefully considered in subsequent data collection efforts aimed at improving model predictions.

Functional Recovery in Major Depressive Disorder: Focus on Early Optimized Treatment.

PubMed

Habert, Jeffrey; Katzman, Martin A; Oluboka, Oloruntoba J; McIntyre, Roger S; McIntosh, Diane; MacQueen, Glenda M; Khullar, Atul; Milev, Roumen V; Kjernisted, Kevin D; Chokka, Pratap R; Kennedy, Sidney H

2016-09-01

This article presents the case that a more rapid, individualized approach to treating major depressive disorder (MDD) may increase the likelihood of achieving full symptomatic and functional recovery for individual patients and that studies show it is possible to make earlier decisions about appropriateness of treatment in order to rapidly optimize that treatment. A PubMed search was conducted using terms including major depressive disorder, early improvement, predictor, duration of untreated illness, and function. English-language articles published before September 2015 were included. Additional studies were found within identified research articles and reviews. Thirty antidepressant studies reporting predictor criteria and outcome measures are included in this review. Studies were reviewed to extract definitions of predictors, outcome measures, and results of the predictor analysis. Results were summarized separately for studies reporting effects of early improvement, baseline characteristics, and duration of untreated depression. Shorter duration of the current depressive episode and duration of untreated depression are associated with better symptomatic and functional outcomes in MDD. Early improvement of depressive symptoms predicts positive symptomatic outcomes (response and remission), and early functional improvement predicts an increased likelihood of functional remission. The approach to treatment of depression that exhibits the greatest potential for achieving full symptomatic and functional recovery is early optimized treatment: early diagnosis followed by rapid individualized treatment. Monitoring symptoms and function early in treatment is crucial to ensuring that patients do not remain on ineffective or poorly tolerated treatment, which may delay recovery and heighten the risk of residual functional deficits. © Copyright 2016 Physicians Postgraduate Press, Inc.

Wrinkling and collapse of mesh reinforced membrane inflated beam under bending

NASA Astrophysics Data System (ADS)

Tao, Qiang; Wang, Changguo; Xue, Zhiming; Xie, Zhimin; Tan, Huifeng

2016-11-01

A novel concept of mesh reinforced membrane (MRM) is proposed in this paper. The tensile collapse mechanism of MRM is elucidated based on three obvious deformed stages. An improved Shell-Membrane model is used to predict the wrinkling and collapse of MRM inflated beam which is verified by a non-contact experiment based on the digital image correlation technique. Further the wrinkling details including the wrinkling evolution, pattern, shape, stress distribution are simulated to evaluate the functions of MRM for loading-carrying capacity of inflated beam. Pressure resistant performance of inflated beam was studied at last. The results revealed that MRM shows a great improvement on the collapse moment of inflated beam. MRM contributes to restrain wrinkling evolution by changing the transfer path of loadings which results from dispersing stress distribution and changing wrinkling pattern. The results show good references to the wrinkling control and the improvement of load-carrying capacity of inflated beam.

B-meson decay constants from improved lattice nonrelativistic QCD with physical u, d, s, and c quarks.

PubMed

Dowdall, R J; Davies, C T H; Horgan, R R; Monahan, C J; Shigemitsu, J

2013-05-31

We present the first lattice QCD calculation of the decay constants f(B) and f(B(s)) with physical light quark masses. We use configurations generated by the MILC Collaboration including the effect of u, d, s, and c highly improved staggered quarks in the sea at three lattice spacings and with three u/d quark mass values going down to the physical value. We use improved nonrelativistic QCD (NRQCD) for the valence b quarks. Our results are f(B)=0.186(4) GeV, f(B(s))=0.224(4) GeV, f(B(s))/f(B)=1.205(7), and M(B(s))-M(B)=85(2) MeV, superseding earlier results with NRQCD b quarks. We discuss the implications of our results for the standard model rates for B((s))→μ(+)μ(-) and B→τν.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004-2012.

PubMed

Hamel, Donald J; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T; Okonkwo, Prosper; Kanki, Phyllis J

From 2004-2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President's Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

Does cognition improve following LVAD implantation?

PubMed

Pavol, Marykay A; Willey, Joshua Z; Wei, Ying; Yuzefpolskaya, Melana; Marshall, Randolph S; Marascalco, Philip J; Harwood, Jason; Lazar, Ronald M

2018-05-23

Studies of cognition after LVAD surgery have produced mixed results. To explore whether cognition would improve, decline, or remain stable after LVAD surgery, we examined cognition before and 1- and 3-months after LVAD surgery. Patients with post-surgical stroke were excluded. 28 subjects (mean age = 54.31 ± 12 years) comprised an observational case series from the DuraHeart LVAS device® trial. Cognitive testing was performed at baseline, 1-month, and 3-month post-surgery, and included tests of attention, memory, language, visualmotor speed (TMT) and visualconstruction. No difference in cognition was found between baseline and 1-month exams (means z score improvement = 0.06, p = 0.43) but cognition improved significantly between baseline and 3-month exams (mean z score improvement = 0.34, p < 0.00001). Examination of individual test scores found, after correction for multiple comparisons, only the TMT variable was significantly different at the 3-month exam. We found significantly improved cognition 3 months after LVAD surgery in a subset of patients without post-surgical stroke. The reasons for the lack of cognitive improvement at the 1-month post-surgical assessment may include ongoing medical and physiological disruptions in the immediate post-operative period. Further research into the sources of delayed improvement is warranted. Cognitive assessments performed immediately after surgery should be interpreted with caution because the results may not reflect longer term cognitive outcomes. LVAD patients may require additional support to successfully manage their health in the weeks immediately following surgery but assistance needs may decrease over time.

Improvement of the orbit of the Spektr-R spacecraft in the RadioAstron mission and required conditions for improvement using a Kalman filter

NASA Astrophysics Data System (ADS)

Zhamkov, A. S.; Zharov, V. E.

2017-05-01

This paper is concerned with improvement of the state vector of the Spektr-R spacecraft of the RadioAstron mission. The state vector includes three coordinates of the position of the spacecraft and three components of its velocity in the Geocentric Celestial Reference System. Improvement of the orbit of the spacecraft is understood as improvement of the state vector. The results are compared with the original orbits determined at the Keldysh Institute of Applied Mathematics (IAM). The paper considers both using the Kalman filter based on a single set of radio-range and Doppler data from ground-based stations and the analysis of conditions that will lead to improvement of the orbit. It has been shown that using three ground-based stations that perform simultaneous measurements the problem is solved completely, even when a poor initial approximation is used. Based on the results, a list of requirements is obtained that will provide more accurate information on the orbit of the Spektr-R spacecraft.

Management of vocal fold scar with autologous fat implantation: perceptual results.

PubMed

Neuenschwander, M C; Sataloff, R T; Abaza, M M; Hawkshaw, M J; Reiter, D; Spiegel, J R

2001-06-01

Vocal fold scar disrupts the mucosal wave and interferes with glottic closure. Treatment involves a multidisciplinary approach that includes voice therapy, medical management, and sometimes surgery. We reviewed the records of the first eight patients who underwent autologous fat implantation for vocal fold scar. Information on the etiology of scar, physical findings, and prior interventions were collected. Videotapes of videostroboscopic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS)] were randomized and analyzed independently by four blinded observers. Etiology of scar included mass excision (7), vocal fold stripping (3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures performed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (2). Strobovideolaryngoscopy: Statistically significant improvement was found in glottic closure, mucosal wave, and stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significant improvement was found in all five parameters, including overall Grade, Roughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an important adjunctive procedure in the management of vocal fold scar, and a useful addition to the armamentarium of the experienced phonomicrosurgeon.

What Is Nursing Home Quality and How Is It Measured?

PubMed Central

Castle, Nicholas G.; Ferguson, Jamie C.

2010-01-01

Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. Results: Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review. Implications: We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed. PMID:20631035

Effects of pilates on patients with chronic non-specific low back pain: a systematic review

PubMed Central

Lin, Hui-Ting; Hung, Wei-Ching; Hung, Jia-Ling; Wu, Pei-Shan; Liaw, Li-Jin; Chang, Jia-Hao

2016-01-01

[Purpose] To evaluate the effects of Pilates on patients with chronic low back pain through a systematic review of high-quality articles on randomized controlled trials. [Subjects and Methods] Keywords and synonyms for “Pilates” and “Chronic low back pain” were used in database searches. The databases included PubMed, Physiotherapy Evidence Database (PEDro), Medline, and the Cochrane Library. Articles involving randomized controlled trials with higher than 5 points on the PEDro scale were reviewed for suitability and inclusion. The methodological quality of the included randomized controlled trials was evaluated using the PEDro scale. Relevant information was extracted by 3 reviewers. [Results] Eight randomized controlled trial articles were included. Patients with chronic low back pain showed statistically significant improvement in pain relief and functional ability compared to patients who only performed usual or routine health care. However, other forms of exercise were similar to Pilates in the improvement of pain relief and functional capacity. [Conclusion] In patients with chronic low back pain, Pilates showed significant improvement in pain relief and functional enhancement. Other exercises showed effects similar to those of Pilates, if waist or torso movement was included and the exercises were performed for 20 cumulative hours. PMID:27821970

Use of improved materials systems in marine piling : final report.

DOT National Transportation Integrated Search

1982-12-01

This report contains the results of a study to evaluate the feasibility of manufacturing precast, prestressed marine pile from polymer concrete, polymer impregnated concrete, internally sealed concrete and latex modified concrete. Included in the rep...

Evaluation of concrete pavement patching techniques.

DOT National Transportation Integrated Search

1989-01-01

This final report presents the results of a study undertaken to improve in concrete pavement patching techniques. Activities included an evaluation of the suitability of the impact hammer and maturity calculations for determining when a patch is read...

PESTICIDE SCREENING RESULTS FROM EIGHT DAYCARE CENTERS

EPA Science Inventory

To improve assessments of children's exposures to pesticides in support of the Food Quality Protection Act, priority research and data needs include: pesticide use patterns, pesticide residue distributions, and dermal exposure assessment approaches. To address these gaps, the ...

Kubo–Greenwood approach to conductivity in dense plasmas with average atom models

DOE PAGES

Starrett, C. E.

2016-04-13

In this study, a new formulation of the Kubo–Greenwood conductivity for average atom models is given. The new formulation improves upon previous treatments by explicitly including the ionic-structure factor. Calculations based on this new expression lead to much improved agreement with ab initio results for DC conductivity of warm dense hydrogen and beryllium, and for thermal conductivity of hydrogen. We also give and test a slightly modified Ziman–Evans formula for the resistivity that includes a non-free electron density of states, thus removing an ambiguity in the original Ziman–Evans formula. Again, results based on this expression are in good agreement withmore » ab initio simulations for warm dense beryllium and hydrogen. However, for both these expressions, calculations of the electrical conductivity of warm dense aluminum lead to poor agreement at low temperatures compared to ab initio simulations.« less

TOPICAL REVIEW: Human soft tissue analysis using x-ray or gamma-ray techniques

NASA Astrophysics Data System (ADS)

Theodorakou, C.; Farquharson, M. J.

2008-06-01

This topical review is intended to describe the x-ray techniques used for human soft tissue analysis. X-ray techniques have been applied to human soft tissue characterization and interesting results have been presented over the last few decades. The motivation behind such studies is to provide improved patient outcome by using the data obtained to better understand a disease process and improve diagnosis. An overview of theoretical background as well as a complete set of references is presented. For each study, a brief summary of the methodology and results is given. The x-ray techniques include x-ray diffraction, x-ray fluorescence, Compton scattering, Compton to coherent scattering ratio and attenuation measurements. The soft tissues that have been classified using x-rays or gamma rays include brain, breast, colon, fat, kidney, liver, lung, muscle, prostate, skin, thyroid and uterus.

Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes

PubMed Central

Hendriksen, Ingrid J.M.; Snoijer, Mirjam; de Kok, Brenda P.H.; van Vilsteren, Jeroen; Hofstetter, Hedwig

2016-01-01

Objective: Evaluation of the effectiveness of a workplace health promotion program on employees’ vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors’ role on these outcomes. Methods: The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used. Results: Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence. Conclusions: Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes. PMID:27136605

Simulation Comparison of Wake Mitigation Control Strategies for a Two-Turbine Case

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

Fleming, Paul; Gebraad, Pieter M. O.; Lee, Sang

2015-12-01

Wind turbines arranged in a wind plant impact each other through their wakes. Wind plant control is an active research field that attempts to improve wind plant performance by coordinating control of individual turbines to take into account these turbine–wake interactions. High-fidelity simulations of a two-turbine fully waked scenario are used to investigate several wake mitigation strategies, in this paper, including modification of yaw and tilt angles of an upstream turbine to induce wake skew, as well as repositioning of the downstream turbine. The simulation results are compared through change relative to a baseline operation in terms of overall powermore » capture and loading on the upstream and downstream turbine. Results demonstrated improved power production for all methods. Moreover, analysis of control options, including individual pitch control, shows potential to minimize the increase of, or even reduce, turbine loads.« less

Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review.

PubMed

Schenker, Yael; Fernandez, Alicia; Sudore, Rebecca; Schillinger, Dean

2011-01-01

Patient understanding in clinical informed consent is often poor. Little is known about the effectiveness of interventions to improve comprehension or the extent to which such interventions address different elements of understanding in informed consent. . To systematically review communication interventions to improve patient comprehension in informed consent for medical and surgical procedures. Data Sources. A systematic literature search of English-language articles in MEDLINE (1949-2008) and EMBASE (1974-2008) was performed. In addition, a published bibliography of empirical research on informed consent and the reference lists of all eligible studies were reviewed. Study Selection. Randomized controlled trials and controlled trials with nonrandom allocation were included if they compared comprehension in informed consent for a medical or surgical procedure. Only studies that used a quantitative, objective measure of understanding were included. All studies addressed informed consent for a needed or recommended procedure in actual patients. Data Extraction. Reviewers independently extracted data using a standardized form. All results were compared, and disagreements were resolved by consensus. Data Synthesis. Forty-four studies were eligible. Intervention categories included written information, audiovisual/multimedia, extended discussions, and test/feedback techniques. The majority of studies assessed patient understanding of procedural risks; other elements included benefits, alternatives, and general knowledge about the procedure. Only 6 of 44 studies assessed all 4 elements of understanding. Interventions were generally effective in improving patient comprehension, especially regarding risks and general knowledge. Limitations. Many studies failed to include adequate description of the study population, and outcome measures varied widely. . A wide range of communication interventions improve comprehension in clinical informed consent. Decisions to enhance informed consent should consider the importance of different elements of understanding, beyond procedural risks, as well as feasibility and acceptability of the intervention to clinicians and patients. Conceptual clarity regarding the key elements of informed consent knowledge will help to focus improvements and standardize evaluations.

Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: A Systematic Review

PubMed Central

Schenker, Yael; Fernandez, Alicia; Sudore, Rebecca; Schillinger, Dean

2017-01-01

Background Patient understanding in clinical informed consent is often poor. Little is known about the effectiveness of interventions to improve comprehension or the extent to which such interventions address different elements of understanding in informed consent. Purpose To systematically review communication interventions to improve patient comprehension in informed consent for medical and surgical procedures. Data Sources A systematic literature search of English-language articles in MEDLINE (1949–2008) and EMBASE (1974–2008) was performed. In addition, a published bibliography of empirical research on informed consent and the reference lists of all eligible studies were reviewed. Study Selection Randomized controlled trials and controlled trials with non-random allocation were included if they compared comprehension in informed consent for a medical or surgical procedure. Only studies that used a quantitative, objective measure of understanding were included. All studies addressed informed consent for a needed or recommended procedure in actual patients. Data Extraction Reviewers independently extracted data using a standardized form. All results were compared, and disagreements were resolved by consensus. Data Synthesis Forty-four studies were eligible. Intervention categories included written information, audiovisual/multimedia, extended discussions, and test/feedback techniques. The majority of studies assessed patient understanding of procedural risks; other elements included benefits, alternatives, and general knowledge about the procedure. Only 6 of 44 studies assessed all 4 elements of understanding. Interventions were generally effective in improving patient comprehension, especially regarding risks and general knowledge. Limitations Many studies failed to include adequate description of the study population, and outcome measures varied widely. Conclusions A wide range of communication interventions improve comprehension in clinical informed consent. Decisions to enhance informed consent should consider the importance of different elements of understanding, beyond procedural risks, as well as feasibility and acceptability of the intervention to clinicians and patients. Conceptual clarity regarding the key elements of informed consent knowledge will help to focus improvements and standardize evaluations. PMID:20357225

A quality improvement programme to increase compliance with an anti-infective prescribing policy

PubMed Central

Thakkar, Kandarp; Gilchrist, Mark; Dickinson, Edward; Benn, Jonathan; Franklin, Bryony Dean; Jacklin, Ann; Adeniran, Shola; Ali, Alisha; Brannigan, Eimear; Bamford, Kathy; Lam-Chong, Kelly; Dickinson, Edward; Gilchrist, Mark; Jacklin, Ann; Lawson, Wendy; Mehta, Roopal; Newsholme, William; Rana, Ambreen; Reynolds, Sarah; Sanderson, Frances; Wei Tan, Xin; Thakkar, Kandarp; Bracey, Gemma

2011-01-01

Objectives The UK Department of Health has made recommendations on safe and appropriate prescribing of anti-infectives. In response, we reviewed our anti-infective policies to ensure they were in line with best practice. As a result, a new adult anti-infective policy was launched. To help facilitate its implementation, a quality improvement programme was established, with the aim of achieving >90% compliance with the new policy. Methods Patients under the care of the medical admissions teams who had been prescribed one or more systemic anti-infectives between January and November 2008 were included in the study. Study pharmacists collected data daily on all patients, including the anti-infective(s) prescribed and indication(s) documented on either the patient's drug prescription chart or health records. A definition of compliance was developed, which required documented indication(s) and associated anti-infectives to match the anti-infective policy. A baseline compliance level was established; we then implemented a series of interventions using the plan-do-study-act (‘PDSA’) approach to monitor and improve compliance. Three overlapping intervention phases were retrospectively identified: raising awareness; education; and weekly feedback of results in the form of run charts distributed to medical teams. Results Over the 11 month study period, compliance with the policy increased from 30% to 71%. Since 2008, we have seen the average compliance increase year-on-year to over 90% in 2010 using a sustainable once weekly data collection model. Conclusions This study shows that it is possible to use quality improvement methodology to support antimicrobial stewardship within existing resources and suggests that an improvement in policy compliance can be both achieved and sustained. PMID:21642650

Global clinical response in Cushing’s syndrome patients treated with mifepristone

PubMed Central

Katznelson, Laurence; Loriaux, D Lynn; Feldman, David; Braunstein, Glenn D; Schteingart, David E; Gross, Coleman

2014-01-01

Objective Mifepristone, a glucocorticoid receptor antagonist, improves clinical status in patients with Cushing’s syndrome (CS). We examined the pattern, reliability and correlates of global clinical response (GCR) assessments during a 6-month clinical trial of mifepristone in CS. Design Post hoc analysis of secondary end-point data from a 24-week multicentre, open-label trial of mifepristone (300–1200mg daily) in CS. Intraclass correlation coefficient (ICC) was used to examine rater concordance, and drivers of clinical improvement were determined by multivariate regression analysis. Patients Forty-six adult patients with refractory CS along with diabetes mellitus type 2 or impaired glucose tolerance, and/or a diagnosis of hypertension. Measurements Global clinical assessment made by three independent reviewers using a three-point ordinal scale (+1 = improvement; 0=no change; −1=worsening) based on eight broad clinical categories including glucose control, lipids, blood pressure, body composition, clinical appearance, strength, psychiatric/cognitive symptoms and quality of life at Weeks 6, 10, 16, and 24. Results Positive GCR increased progressively over time with 88% of patients having improved at Week 24 (P<0·001). The full concordance among reviewers occurred in 76·6% of evaluations resulting in an ICC of 0·652 (P<0·001). Changes in body weight (P<0·0001), diastolic blood pressure (P<0·0001), two-hour postoral glucose challenge glucose concentration (P = 0·0003), and Cushingoid appearance (P=0·022) were strong correlates of GCR. Conclusions Mifepristone treatment for CS results in progressive clinical improvement. Overall agreement among clinical reviewers was substantial and determinants of positive GCR included change in weight, blood pressure, glucose levels and appearance. PMID:24102404

Building a Protocol Expressway: The Case of Mayo Clinic Cancer Center

PubMed Central

McJoynt, Terre A.; Hirzallah, Muhanad A.; Satele, Daniel V.; Pitzen, Jason H.; Alberts, Steven R.; Rajkumar, S. Vincent

2009-01-01

Purpose Inconsistencies and errors resulting from nonstandard processes, together with redundancies, rework, and excess workload, lead to extended time frames for clinical trial protocol development. This results in dissatisfaction among sponsors, investigators, and staff and restricts the availability of novel treatment options for patients. Methods A team of experts from Mayo Clinic formed, including Protocol Development Unit staff and management from the three Mayo Clinic campuses (Florida, Minnesota, and Arizona), a systems and procedures analyst, a quality office analyst, and two physician members to address the identified deficiencies. The current-state process was intensively reviewed, and improvement steps were taken to accelerate the development and approval of cancer-related clinical trials. The primary goal was to decrease the time from receipt of a new protocol through submission to an approving authority, such as the National Cancer Institute or institutional review board. Results Using the Define, Measure, Analyze, Improve, Control (DMAIC) framework infused with Lean waste-reduction methodologies, areas were identified for improvement, including enhancing first-time quality and processing new studies on a first-in/first-out basis. The project was successful in improving the mean turnaround time for internally authored protocols (P < .001) from 25.00 weeks (n = 41; range, 3.43 to 94.14 weeks) to 10.15 weeks (n = 14; range, 4.00 to 22.14 weeks). The mean turnaround time for externally authored protocols was improved (P < .001) from 20.61 weeks (n = 85; range, 3.29 to 108.57 weeks) to 7.79 weeks (n = 50; range, 2.00 to 20.86 weeks). Conclusion DMAIC framework combined with Lean methodologies is an effective tool to structure the definition, planning, analysis, and implementation of significant process changes. PMID:19564529

Higher-order time integration of Coulomb collisions in a plasma using Langevin equations

DOE PAGES

Dimits, A. M.; Cohen, B. I.; Caflisch, R. E.; ...

2013-02-08

The extension of Langevin-equation Monte-Carlo algorithms for Coulomb collisions from the conventional Euler-Maruyama time integration to the next higher order of accuracy, the Milstein scheme, has been developed, implemented, and tested. This extension proceeds via a formulation of the angular scattering directly as stochastic differential equations in the two fixed-frame spherical-coordinate velocity variables. Results from the numerical implementation show the expected improvement [O(Δt) vs. O(Δt 1/2)] in the strong convergence rate both for the speed |v| and angular components of the scattering. An important result is that this improved convergence is achieved for the angular component of the scattering ifmore » and only if the “area-integral” terms in the Milstein scheme are included. The resulting Milstein scheme is of value as a step towards algorithms with both improved accuracy and efficiency. These include both algorithms with improved convergence in the averages (weak convergence) and multi-time-level schemes. The latter have been shown to give a greatly reduced cost for a given overall error level when compared with conventional Monte-Carlo schemes, and their performance is improved considerably when the Milstein algorithm is used for the underlying time advance versus the Euler-Maruyama algorithm. A new method for sampling the area integrals is given which is a simplification of an earlier direct method and which retains high accuracy. Lastly, this method, while being useful in its own right because of its relative simplicity, is also expected to considerably reduce the computational requirements for the direct conditional sampling of the area integrals that is needed for adaptive strong integration.« less

Perceptual learning improves contrast sensitivity, visual acuity, and foveal crowding in amblyopia.

PubMed

Barollo, Michele; Contemori, Giulio; Battaglini, Luca; Pavan, Andrea; Casco, Clara

2017-01-01

Amblyopic observers present abnormal spatial interactions between a low-contrast sinusoidal target and high-contrast collinear flankers. It has been demonstrated that perceptual learning (PL) can modulate these low-level lateral interactions, resulting in improved visual acuity and contrast sensitivity. We measured the extent and duration of generalization effects to various spatial tasks (i.e., visual acuity, Vernier acuity, and foveal crowding) through PL on the target's contrast detection. Amblyopic observers were trained on a contrast-detection task for a central target (i.e., a Gabor patch) flanked above and below by two high-contrast Gabor patches. The pre- and post-learning tasks included lateral interactions at different target-to-flankers separations (i.e., 2, 3, 4, 8λ) and included a range of spatial frequencies and stimulus durations as well as visual acuity, Vernier acuity, contrast-sensitivity function, and foveal crowding. The results showed that perceptual training reduced the target's contrast-detection thresholds more for the longest target-to-flanker separation (i.e., 8λ). We also found generalization of PL to different stimuli and tasks: contrast sensitivity for both trained and untrained spatial frequencies, visual acuity for Sloan letters, and foveal crowding, and partially for Vernier acuity. Follow-ups after 5-7 months showed not only complete maintenance of PL effects on visual acuity and contrast sensitivity function but also further improvement in these tasks. These results suggest that PL improves facilitatory lateral interactions in amblyopic observers, which usually extend over larger separations than in typical foveal vision. The improvement in these basic visual spatial operations leads to a more efficient capability of performing spatial tasks involving high levels of visual processing, possibly due to the refinement of bottom-up and top-down networks of visual areas.

Exemplar pediatric collaborative improvement networks: achieving results.

PubMed

Billett, Amy L; Colletti, Richard B; Mandel, Keith E; Miller, Marlene; Muething, Stephen E; Sharek, Paul J; Lannon, Carole M

2013-06-01

A number of pediatric collaborative improvement networks have demonstrated improved care and outcomes for children. Regionally, Cincinnati Children's Hospital Medical Center Physician Hospital Organization has sustained key asthma processes, substantially increased the percentage of their asthma population receiving "perfect care," and implemented an innovative pay-for-performance program with a large commercial payor based on asthma performance measures. The California Perinatal Quality Care Collaborative uses its outcomes database to improve care for infants in California NICUs. It has achieved reductions in central line-associated blood stream infections (CLABSI), increased breast-milk feeding rates at hospital discharge, and is now working to improve delivery room management. Solutions for Patient Safety (SPS) has achieved significant improvements in adverse drug events and surgical site infections across all 8 Ohio children's hospitals, with 7700 fewer children harmed and >$11.8 million in avoided costs. SPS is now expanding nationally, aiming to eliminate all events of serious harm at children's hospitals. National collaborative networks include ImproveCareNow, which aims to improve care and outcomes for children with inflammatory bowel disease. Reliable adherence to Model Care Guidelines has produced improved remission rates without using new medications and a significant increase in the proportion of Crohn disease patients not taking prednisone. Data-driven collaboratives of the Children's Hospital Association Quality Transformation Network initially focused on CLABSI in PICUs. By September 2011, they had prevented an estimated 2964 CLABSI, saving 355 lives and $103,722,423. Subsequent improvement efforts include CLABSI reductions in additional settings and populations.

Temporal and spatial binning of TCSPC data to improve signal-to-noise ratio and imaging speed

NASA Astrophysics Data System (ADS)

Walsh, Alex J.; Beier, Hope T.

2016-03-01

Time-correlated single photon counting (TCSPC) is the most robust method for fluorescence lifetime imaging using laser scanning microscopes. However, TCSPC is inherently slow making it ineffective to capture rapid events due to the single photon product per laser pulse causing extensive acquisition time limitations and the requirement of low fluorescence emission efficiency to avoid bias of measurement towards short lifetimes. Furthermore, thousands of photons per pixel are required for traditional instrument response deconvolution and fluorescence lifetime exponential decay estimation. Instrument response deconvolution and fluorescence exponential decay estimation can be performed in several ways including iterative least squares minimization and Laguerre deconvolution. This paper compares the limitations and accuracy of these fluorescence decay analysis techniques to accurately estimate double exponential decays across many data characteristics including various lifetime values, lifetime component weights, signal-to-noise ratios, and number of photons detected. Furthermore, techniques to improve data fitting, including binning data temporally and spatially, are evaluated as methods to improve decay fits and reduce image acquisition time. Simulation results demonstrate that binning temporally to 36 or 42 time bins, improves accuracy of fits for low photon count data. Such a technique reduces the required number of photons for accurate component estimation if lifetime values are known, such as for commercial fluorescent dyes and FRET experiments, and improve imaging speed 10-fold.

Control of manganese dioxide particles resulting from in situ chemical oxidation using permanganate.

PubMed

Crimi, Michelle; Ko, Saebom

2009-02-01

In situ chemical oxidation using permanganate is an approach to organic contaminant site remediation. Manganese dioxide particles are products of permanganate reactions. These particles have the potential to deposit in the subsurface and impact the flow-regime in/around permanganate injection, including the well screen, filter pack, and the surrounding subsurface formation. Control of these particles can allow for improved oxidant injection and transport and contact between the oxidant and contaminants of concern. The goals of this research were to determine if MnO(2) can be stabilized/controlled in an aqueous phase, and to determine the dependence of particle stabilization on groundwater characteristics. Bench-scale experiments were conducted to study the ability of four stabilization aids (sodium hexametaphosphate (HMP), Dowfax 8390, xanthan gum, and gum arabic) in maintaining particles suspended in solution under varied reaction conditions and time. Variations included particle and stabilization aid concentrations, ionic content, and pH. HMP demonstrated the most promising results, as compared to xanthan gum, gum arabic, and Dowfax 8390 based on results of spectrophotometric studies of particle behavior, particle filtration, and optical measurements of particle size and zeta potential. HMP inhibited particle settling, provided for greater particle stability, and resulted in particles of a smaller average size over the range of experimental conditions evaluated compared to results for systems that did not include HMP. Additionally, HMP did not react unfavorably with permanganate. These results indicate that the inclusion of HMP in a permanganate oxidation system improves conditions that may facilitate particle transport.

Integrated reservoir characterization for unconventional reservoirs using seismic, microseismic and well log data

NASA Astrophysics Data System (ADS)

Maity, Debotyam

This study is aimed at an improved understanding of unconventional reservoirs which include tight reservoirs (such as shale oil and gas plays), geothermal developments, etc. We provide a framework for improved fracture zone identification and mapping of the subsurface for a geothermal system by integrating data from different sources. The proposed ideas and methods were tested primarily on data obtained from North Brawley geothermal field and the Geysers geothermal field apart from synthetic datasets which were used to test new algorithms before actual application on the real datasets. The study has resulted in novel or improved algorithms for use at specific stages of data acquisition and analysis including improved phase detection technique for passive seismic (and teleseismic) data as well as optimization of passive seismic surveys for best possible processing results. The proposed workflow makes use of novel integration methods as a means of making best use of the available geophysical data for fracture characterization. The methodology incorporates soft computing tools such as hybrid neural networks (neuro-evolutionary algorithms) as well as geostatistical simulation techniques to improve the property estimates as well as overall characterization efficacy. The basic elements of the proposed characterization workflow involves using seismic and microseismic data to characterize structural and geomechanical features within the subsurface. We use passive seismic data to model geomechanical properties which are combined with other properties evaluated from seismic and well logs to derive both qualitative and quantitative fracture zone identifiers. The study has resulted in a broad framework highlighting a new technique for utilizing geophysical data (seismic and microseismic) for unconventional reservoir characterization. It provides an opportunity to optimally develop the resources in question by incorporating data from different sources and using their temporal and spatial variability as a means to better understand the reservoir behavior. As part of this study, we have developed the following elements which are discussed in the subsequent chapters: 1. An integrated characterization framework for unconventional settings with adaptable workflows for all stages of data processing, interpretation and analysis. 2. A novel autopicking workflow for noisy passive seismic data used for improved accuracy in event picking as well as for improved velocity model building. 3. Improved passive seismic survey design optimization framework for better data collection and improved property estimation. 4. Extensive post-stack seismic attribute studies incorporating robust schemes applicable in complex reservoir settings. 5. Uncertainty quantification and analysis to better quantify property estimates over and above the qualitative interpretations made and to validate observations independently with quantified uncertainties to prevent erroneous interpretations. 6. Property mapping from microseismic data including stress and anisotropic weakness estimates for integrated reservoir characterization and analysis. 7. Integration of results (seismic, microseismic and well logs) from analysis of individual data sets for integrated interpretation using predefined integration framework and soft computing tools.

The effectiveness of virtual reality interventions in improving balance in adults with impaired balance compared to standard or no treatment: A systematic review.

PubMed

Booth, Vicky; Masud, Tahir; Bath-Hextall, Fiona

Balance impairment can result in falls and reduced activities of daily living and function. Virtual reality and interactive gaming systems provide a novel and potentially environmentally flexible treatment option to improve postural stability and reduce falls in balance impaired populations. There are no existing systematic reviews in this topic area. To search, critically appraise and synthesise the best available evidence on whether virtual reality interventions, including interactive gaming systems, are effective at improving balance in adults with impaired balance. Adults with impaired, altered or reduced balance identified either through reduced balance outcome measure score or increased risk or incidence of falls.Types of interventions:Any virtual reality or interactive gaming systems used within a rehabilitative setting.The primary outcome was an objective measure of balance (i.e. balance outcome measure such as Berg Balance Score) or number and/or incidence of falls. Secondary outcome measures of interest included any adverse effects experienced, an outcome measure indicating functional balance (i.e. walking speed), quality of life (through use of an objective measure i.e. EuroQOL), and number of days in hospital due to falls.Types of studies:Randomised controlled trials (RCT). A three-stage strategy searched the following electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PsycBITE, OTseeker, Ei Compendex, Inspec, Current Controlled Trials, and the National Institute of Health Clinical Trials Database. The methodological quality of each included study was independently assessed using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) to systematically comment on influence of bias. Data was individually extracted from the included studies using the standardised JBI data extraction tool from JBI-MAStARI. Data was analysed using Review Manager 5 software. Results were expressed as mean difference (MD) with 95% confidence intervals for continuous outcomes. Meta-analysis was not possible due to the variation of the interventions given and small number of included trials; hence, a description of the results was given. Four studies were included in the systematic review. All the included studies used different types of virtual reality or interactive gaming interventions. Two of the included studies used the same balance outcome measure. There was a notable inconsistency of balance outcome measurement between all the included studies. No data was given regarding falls in any of the studies. A secondary outcome, the 10m walk test, was recorded in two of the studies. The four included studies had small sample sizes and poor methodological quality. Despite the presentation of statistically significant results, the clinical significance is questionable. The review can not recommend the inclusion of virtual reality or interactive gaming systems into the rehabilitation of balance impairment based on the results of the four included studies. Further investigation in this topic area is required.

A multifaceted approach to education, observation, and feedback in a successful hand hygiene campaign.

PubMed

Doron, Shira I; Kifuji, Kayoko; Hynes, Brooke Tyson; Dunlop, Dan; Lemon, Tricia; Hansjosten, Karen; Cheung, Teresa; Curley, Barbara; Snydman, David R; Fairchild, David G

2011-01-01

Prevention of health care-associated infections starts with scrupulous hand hygiene (HH). Improving HH compliance is a major target for the World Health Organization Patient Safety Challenge and is one of The Joint Commission's National Patient Safety Goals. Yet, adherence to HH protocols is generally poor for health care professionals, despite interventions designed to improve compliance. At Tufts Medical Center (Boston), HH compliance rates were consistently low despite the presence of a traditional HH campaign that used communication and education. A comprehensive program incorporated strong commitment by hospital leadership-who were actively involved in responsibilities previously only performed by infection preventionists and quality and patient safety staff-dedication of financial resources, including securing a grant; collaborating with a private advertising firm in a marketing campaign; and employing a multifaceted approach to education, observation, and feedback. This campaign resulted in a rapid and sustained improvement in HH compliance: Compared with the mean HH compliance rate for the six months before the campaign (72%), postcampaign HH compliance (mean = 94%) was significantly greater (p < .0001). Factors contributing to the success of the campaign included the development of the marketing campaign to fit this academic medical center's particular culture, strong support from the medical center leadership, a multifaceted educational approach, and monthly feedback on HH compliance. A comprehensive campaign resulted in rapid and sustained improvement in HH compliance at an academic medical center after traditional communication and education strategies failed to improve HH performance.

Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise

PubMed Central

Noble, Simon; Pease, Nikki; Sui, Jessica; Davies, James; Lewis, Sarah; Malik, Usman; Alikhan, Raza; Prout, Hayley; Nelson, Annmarie

2016-01-01

Objectives Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. Setting Specialist cancer centre, district general hospital and primary care. Participants Patients with CAT and their referring clinicians. Intervention A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. Primary and secondary outcome measures The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. Results Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. Conclusions A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. PMID:27895068

Aerobic Exercise Improves Mood, Cognition, and Language Function in Parkinson's Disease: Results of a Controlled Study.

PubMed

Altmann, Lori J P; Stegemöller, Elizabeth; Hazamy, Audrey A; Wilson, Jonathan P; Bowers, Dawn; Okun, Michael S; Hass, Chris J

2016-10-01

Parkinson's disease (PD) results in a range of non-motor deficits that can affect mood, cognition, and language, and many of these issues are unresponsive to pharmacological intervention. Aerobic exercise can improve mood and cognition in healthy older adults, although only a few studies have examined exercise effects on these domains in PD. The current study assesses the effects of aerobic exercise on aspects of cognition, mood, and language production in people with PD. This study compares the effects of aerobic exercise to stretch-balance training and a no-contact control group in participants with idiopathic PD. The aerobic and stretch-balance groups trained three times a week for 16 weeks, while controls continued normal activities. Outcome measures included disease severity, mood, cognition (speed of processing, memory, and executive function), and language production (picture descriptions). Cognition and language were assessed in single and dual task conditions. Depressive symptoms increased only in the control group (p<.02). Executive function improved in the aerobic exercise group only in the single task (p=.007) and declined in controls in the dual task. Completeness of picture descriptions improved significantly more in the aerobic group than in the stretch-balance group (p<.02). Aerobic exercise is a viable intervention for PD that can be protective against increased depressive symptoms, and can improve several non-motor domains, including executive dysfunction and related aspects of language production. (JINS, 2016, 22, 878-889).

Impetus of composite mechanics on test methods for fiber composites

NASA Technical Reports Server (NTRS)

Chamis, C. C.

1978-01-01

The impetus of composite mechanics on composite test methods and/or on interpreting test results is described by using examples from composite micromechanics, composite macromechanics and laminate theory. The specific examples included contributions such as criteria for selecting resin matrices for improved composite strength, the 10 deg off-axis tensile test, criteria for configuring hybrids and superhybrids for improved impact resistance and the reduced bending rigidities concept for buckling and vibration analyses.

Improved Main Shaft Seal Life in Gas Turbines Using Laser Surface Texturing

NASA Astrophysics Data System (ADS)

McNickle, Alan D.; Etsion, Izhak

2002-10-01

This paper presents a general overview of the improved main shaft seal life in gas turbines using laser surface texturing (LST). The contents include: 1) Laser Surface Texturing System; 2) Seal Schematic with LST applied; 3) Dynamic Rig Tests; 4) Surface Finish Definitions; 5) Wear Test Rig; 6) Dynamic Test Rig; 7) Seal Cross Section-Rig Test; and 8) Typical Test Results. This paper is in viewgraph form.

American Recovery and Reinvestment Act - Improper Planning of the Administrative Buildings Project at Camp Lejeune, Norlh Carolina

DTIC Science & Technology

2011-09-30

the project was for “routine maintenance and repair and improvements to non-historic buildings and structures in the Camp Lejeune Complex...and cost overruns; and (5) program goals are achieved, including specific program outcomes and improved results on broader economic indicators. 1...Department of the Navy received approximately $1.2 billion in Recovery Act funds for Operations and Maintenance ; Military Construction; and Research

Using Field and Satellite Measurements to Improve Snow and Riming Processes in Cloud Resolving Models

NASA Technical Reports Server (NTRS)

Colle, Brian A.; Molthan, Andrew L.

2013-01-01

The representation of clouds in climate and weather models is a driver in forecast uncertainty. Cloud microphysics parameterizations are challenged by having to represent a diverse range of ice species. Key characteristics of predicted ice species include habit and fall speed, and complex interactions that result from mixed-phased processes like riming. Our proposed activity leverages Global Precipitation Measurement (GPM) Mission ground validation studies to improve parameterizations

Data Processing and Text Mining Technologies on Electronic Medical Records: A Review

PubMed Central

Sun, Wencheng; Li, Yangyang; Liu, Fang; Fang, Shengqun; Wang, Guoyan

2018-01-01

Currently, medical institutes generally use EMR to record patient's condition, including diagnostic information, procedures performed, and treatment results. EMR has been recognized as a valuable resource for large-scale analysis. However, EMR has the characteristics of diversity, incompleteness, redundancy, and privacy, which make it difficult to carry out data mining and analysis directly. Therefore, it is necessary to preprocess the source data in order to improve data quality and improve the data mining results. Different types of data require different processing technologies. Most structured data commonly needs classic preprocessing technologies, including data cleansing, data integration, data transformation, and data reduction. For semistructured or unstructured data, such as medical text, containing more health information, it requires more complex and challenging processing methods. The task of information extraction for medical texts mainly includes NER (named-entity recognition) and RE (relation extraction). This paper focuses on the process of EMR processing and emphatically analyzes the key techniques. In addition, we make an in-depth study on the applications developed based on text mining together with the open challenges and research issues for future work. PMID:29849998

Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

PubMed

Schiff, Gordon D; Reyes Nieva, Harry; Griswold, Paula; Leydon, Nicholas; Ling, Judy; Federico, Frank; Keohane, Carol; Ellis, Bonnie R; Foskett, Cathy; Orav, E John; Yoon, Catherine; Goldmann, Don; Weissman, Joel S; Bates, David W; Biondolillo, Madeleine; Singer, Sara J

2017-08-01

Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P<0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P<0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES. A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.

Auditory Outcomes with Hearing Rehabilitation in Children with Unilateral Hearing Loss: A Systematic Review.

PubMed

Appachi, Swathi; Specht, Jessica L; Raol, Nikhila; Lieu, Judith E C; Cohen, Michael S; Dedhia, Kavita; Anne, Samantha

2017-10-01

Objective Options for management of unilateral hearing loss (UHL) in children include conventional hearing aids, bone-conduction hearing devices, contralateral routing of signal (CROS) aids, and frequency-modulating (FM) systems. The objective of this study was to systematically review the current literature to characterize auditory outcomes of hearing rehabilitation options in UHL. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to January 2016. Manual searches of bibliographies were also performed. Review Methods Studies analyzing auditory outcomes of hearing amplification in children with UHL were included. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Results Of the 249 articles identified, 12 met inclusion criteria. Seven articles solely focused on outcomes with bone-conduction hearing devices. Outcomes favored improved pure-tone averages, speech recognition thresholds, and sound localization in implanted patients. Five studies focused on FM systems, conventional hearing aids, or CROS hearing aids. Limited data are available but suggest a trend toward improvement in speech perception with hearing aids. FM systems were shown to have the most benefit for speech recognition in noise. Studies evaluating CROS hearing aids demonstrated variable outcomes. Conclusions Data evaluating functional and objective auditory measures following hearing amplification in children with UHL are limited. Most studies do suggest improvement in speech perception, speech recognition in noise, and sound localization with a hearing rehabilitation device.

Improvements to the ICRH antenna time-domain 3D plasma simulation model

NASA Astrophysics Data System (ADS)

Smithe, David N.; Jenkins, Thomas G.; King, J. R.

2015-12-01

We present a summary of ongoing improvements to the 3D time-domain plasma modeling software that has been used to look at ICRH antennas on Alcator C-Mod, NSTX, and ITER [1]. Our past investigations have shown that in low density cases where the slow wave is propagating, strong amplitude lower hybrid resonant fields can occur. Such a scenario could result in significant parasitic power loss in the SOL. The primary resonance broadening in this case is likely collisions with neutral gas, and thus we are upgrading the model to include realistic neutral gas in the SOL, in order to provide a better understanding of energy balance in these situations. Related to this, we are adding a temporal variation capability to the local plasma density in front of the antenna in order to investigate whether the near fields of the antenna could modify the local density sufficiently to initiate a low density situation. We will start with a simple scalar ponderomotive potential density expulsion model [2] for the density evolution, but are also looking to eventually couple to a more complex fluid treatment that would include tensor pressures and convective physics and sources of neutrals and ionization. We also review continued benchmarking efforts, and ongoing and planned improvements to the computational algorithms, resulting from experience gained during our recent supercomputing runs on the Titan supercomputer, including GPU operations.

The effects of workstation changes and behavioral interventions on safe typing postures in an office.

PubMed

Gravina, Nicole; Lindstrom-Hazel, Debra; Austin, John

2007-01-01

The purpose of the present study was to determine the effectiveness of an ergonomic and behavioral safety intervention for improving participants' safe typing postures in a library office setting. A single-subject multiple baseline design across five participants was employed to evaluate the effects of the four independent variables (workstation adjustment, equipment trial (rollermouse mouse alternative), peer observations, and graphic feedback). Six participant postures were observed repeatedly while participants worked at their workstations throughout the study. Each of the interventions resulted in improvements in safety for more than one posture compared to the previous phase. Results of the study indicate that a comprehensive ergonomic program that includes a workstation adjustment and a behavioral safety approach may be helpful to produce maximum improvements in employees' safe ergonomic postures.

Combining Distance and Face-To Teaching and Learning in Spatial Computations

NASA Astrophysics Data System (ADS)

Gulland, E.-K.; Schut, A. G. T.; Veenendaal, B.

2011-09-01

Retention and passing rates as well as student engagement in computer programming and problem solving units are a major concern in tertiary spatial science courses. A number of initiatives were implemented to improve this. A pilot study reviews the changes made to the teaching and learning environment, including the addition of new resources and modifications to assessments, and investigates their effectiveness. In particular, the study focuses on the differences between students studying in traditional, oncampus mode and distance, e-learning mode. Student results and retention rates from 2009-2011, data from in-lecture clicker response units and two anonymous surveys collected in 2011 were analysed. Early results indicate that grades improved for engaged students but pass rates or grades of the struggling cohort of students did not improve significantly.

Benefits of an improved wheat crop information system

NASA Technical Reports Server (NTRS)

Kinne, I. L.

1976-01-01

The ECON work and the results of the independent reviews are summarized. Attempts are made to put this information into layman's terms and to present the benefits that can realistically be expected from a LANDSAT-type remote sensing system. Further the mechanisms by which these benefits can be expected to accrue are presented. The benefits are given including the nature of expected information improvements, how and why they can lead to benefits to society, and the estimated magnitude of the expected benefits. A brief description is presented of the ECON models, how they work, their results, and a summary of the pertinent aspects of each review. The ECON analyses show that substantial benefits will accrue from implementation of an improved wheat crop information system based on remote sensing.

Comparison of Different Attitude Correction Models for ZY-3 Satellite Imagery

NASA Astrophysics Data System (ADS)

Song, Wenping; Liu, Shijie; Tong, Xiaohua; Niu, Changling; Ye, Zhen; Zhang, Han; Jin, Yanmin

2018-04-01

ZY-3 satellite, launched in 2012, is the first civilian high resolution stereo mapping satellite of China. This paper analyzed the positioning errors of ZY-3 satellite imagery and conducted compensation for geo-position accuracy improvement using different correction models, including attitude quaternion correction, attitude angle offset correction, and attitude angle linear correction. The experimental results revealed that there exist systematic errors with ZY-3 attitude observations and the positioning accuracy can be improved after attitude correction with aid of ground controls. There is no significant difference between the results of attitude quaternion correction method and the attitude angle correction method. However, the attitude angle offset correction model produced steady improvement than the linear correction model when limited ground control points are available for single scene.

A rapid assessment and response approach to review and enhance Advocacy, Communication and Social Mobilisation for Tuberculosis control in Odisha state, India

PubMed Central

2011-01-01

Background Tuberculosis remains a major public health problem in India with the country accounting for 1 in 5 of all TB cases reported globally. An advocacy, communication and social mobilisation project for Tuberculosis control was implemented and evaluated in Odisha state of India. The purpose of the study was to identify the impact of project interventions including the use of 'Interface NGOs' and involvement of community groups such as women's self-help groups, local government bodies, village health sanitation committees, and general health staff in promoting TB control efforts. Methods The study utilized a rapid assessment and response (RAR) methodology. The approach combined both qualitative field work approaches, including semi-structured interviews and focus group discussions with empirical data collection and desk research. Results Results revealed that a combination of factors including the involvement of Interface NGOs, coupled with increased training and engagement of front line health workers and community groups, and dissemination of community based resources, contributed to improved awareness and knowledge about TB in the targeted districts. Project activities also contributed towards improving health worker and community effectiveness to raise the TB agenda, and improved TB literacy and treatment adherence. Engagement of successfully treated patients also assisted in reducing community stigma and discrimination. Conclusion The expanded use of advocacy, communication and social mobilisation activities in TB control has resulted in a number of benefits. These include bridging pre-existing gaps between the health system and the community through support and coordination of general health services stakeholders, NGOs and the community. The strategic use of 'tailored messages' to address specific TB problems in low performing areas also led to more positive behavioural outcomes and improved efficiencies in service delivery. Implications for future studies are that a comprehensive and well planned range of ACSM activities can enhance TB knowledge, attitudes and behaviours while also mobilising specific community groups to build community efficacy to combat TB. The use of rapid assessments combined with other complementary evaluation approaches can be effective when reviewing the impact of TB advocacy, communication and social mobilisation activities. PMID:21663623

The future of nearshore processes research

USGS Publications Warehouse

Elko, Nicole A.; Feddersen, Falk; Foster, Diane; Hapke, Cheryl J.; McNinch, Jesse E.; Mulligan, Ryan P.; Tuba Ӧzkan-Haller, H.; Plant, Nathaniel G.; Raubenheimer, Britt

2014-01-01

The nearshore is the transition region between land and the continental shelf including (from onshore to offshore) coastal plains, wetlands, estuaries, coastal cliffs, dunes, beaches, surf zones (regions of wave breaking), and the inner shelf (Figure ES-1). Nearshore regions are vital to the national economy, security, commerce, and recreation. The nearshore is dynamically evolving, is often densely populated, and is under increasing threat from sea level rise, long-term erosion, extreme storms, and anthropogenic influences. Worldwide, almost one billion people live at elevations within 10 m of present sea level. Long-term erosion threatens communities, infrastructure, ecosystems, and habitat. Extreme storms can cause billions of dollars of damage. Degraded water quality impacts ecosystem and human health. Nearshore processes, the complex interactions between water, sediment, biota, and humans, must be understood and predicted to manage this often highly developed yet vulnerable nearshore environment. Over the past three decades, the understanding of nearshore processes has improved. However, societal needs are growing with increased coastal urbanization and threats of future climate change, and significant scientific challenges remain. To address these challenges, members of academia, industry, and federal agencies (USGS, USACE, NPS, NOAA, FEMA, ONR) met at the “The Past and Future of Nearshore Processes Research: Reflections on the Sallenger Years and a New Vision for the Future” workshop to develop a nearshore processes research vision where societal needs and science challenges intersect. The resulting vision is comprised of three broad research themes: Long-term coastal evolution due to natural and anthropogenic processes: As global climate change alters the rates of sea level rise and potentially storm patterns and coastal urbanization increases over the coming decades, an understanding of coastal evolution is critical. Improved knowledge of long-term morphological, ecological, and societal processes and their interactions will result in an improved ability to simulate coastal change. This will enable proactive solutions for resilient coasts and better guidance for reducing coastal vulnerability.Extreme Events: Flooding, erosion, and the subsequent recovery: Hurricane Sandy caused flooding and erosion along hundreds of miles of shoreline, flooded New York City, and impacted communities and infrastructure. Overall U.S. coastal extreme event related economic losses have increased substantially. Furthermore, climate change may cause an increase in coastal extreme events and rising sea levels could increase the occurrence of extreme events. Addressing this research theme will result in an improved understanding of the physical processes during extreme events, leading to improved models of flooding, erosion, and recovery. The resulting societal benefit will be more resilient coastal communities.The physical, biological and chemical processes impacting human and ecosystem health: Nearshore regions are used for recreation, tourism, and human habitation, and provide habitat and valuable ecosystem services. These areas must be sustained for future generations, however overall coastal water quality is declining due to microbial pathogens, fertilizers, pesticides, and heavy metal contamination, threatening ecosystem and human health. To ensure sustainable nearshore regions, predictive real-time water- and sediment-based based pollutant modeling capabilities must be developed, which requires expanding our knowledge of the physics, chemistry, and biology of the nearshore. The resulting societal benefits will include better beach safety, healthier ecosystems, and improved mitigation and regulatory policies.The scientists and engineers of the U.S. nearshore community are poised to make significant progress on these research themes, which have significant societal impact. The U.S. nearshore community, including academic, government, and industry colleagues, recommends multi-agency investment into a coordinated development of observational and modeling research infrastructure to address these themes, as discussed in the whitepaper. The observational infrastructure should include development of new sensors and methods, focused observational programs, and expanded nearshore observing systems. The modeling infrastructure should include improved process representation, better model coupling, incorporation of data assimilation techniques, and testing of real-time models. The observations will provide test beds to compare and improve models.

Frequency-Domain Identification Of Aeroelastic Modes

NASA Technical Reports Server (NTRS)

Acree, C. W., Jr.; Tischler, Mark B.

1991-01-01

Report describes flight measurements and frequency-domain analyses of aeroelastic vibrational modes of wings of XV-15 tilt-rotor aircraft. Begins with description of flight-test methods. Followed by brief discussion of methods of analysis, which include Fourier-transform computations using chirp z transformers, use of coherence and other spectral functions, and methods and computer programs to obtain frequencies and damping coefficients from measurements. Includes brief description of results of flight tests and comparisions among various experimental and theoretical results. Ends with section on conclusions and recommended improvements in techniques.

Early Results from NICER Observations of Accreting Neutron Stars

NASA Astrophysics Data System (ADS)

Chakrabarty, Deepto; Ozel, Feryal; Arzoumanian, Zaven; Gendreau, Keith C.; Bult, Peter; Cackett, Ed; Chenevez, Jerome; Fabian, Andy; Guillot, Sebastien; Guver, Tolga; Homan, Jeroen; Keek, Laurens; Lamb, Frederick; Ludlam, Renee; Mahmoodifar, Simin; Markwardt, Craig B.; Miller, Jon M.; Psaltis, Dimitrios; Strohmayer, Tod E.; Wilson-Hodge, Colleen A.; Wolff, Michael T.

2018-01-01

The Neutron Star Interior Composition Explorer (NICER) offers significant new capabilities for the study of accreting neuton stars relative to previous X-ray missions including large effective area, low background, and greatly improved low-energy response. The NICER Burst and Accretion Working Group has designed a 2 Ms observation program to study a number of phenomena in accreting neutron stars including type-I X-ray bursts, superbursts, accretion-powered pulsations, quasi-periodic oscillations, and accretion disk reflection spectra. We present some early results from the first six months of the NICER mission.

Recent Goddard Space Flight Center (GSFC) experience with on-orbit calibration of attitude sensors

NASA Technical Reports Server (NTRS)

Davis, W.; Hashmall, J.; Harman, R.

1992-01-01

The results of on-orbit calibration for several satellites by the flight Dynamics Facility (FDF) at GSFC are reviewed. The examples discussed include attitude calibrations for sensors, including fixed-head star trackers, fine sun sensors, three-axis magnetometers, and inertial reference units taken from recent experience with the Compton Gamma Ray observatory, the Upper Atmosphere Research Satellite, and the Extreme Ultraviolet Explorer calibration. The methods used and the results of calibration are discussed, as are the improvements attained from in-flight calibration.

Laser therapy for the treatment of arthritic knees: a clinical study

NASA Astrophysics Data System (ADS)

Kahn, F.; Liboro, R.; Saraga, F.

2010-02-01

In a follow-up clinical study to our previously published 2006 SPIE conference proceeding, we analyzed a cross-section of patients treated for a variety of knee problems that present at our Meditech Laser Rehabilitation Clinics on a daily basis. Of the 98 patients with knee pathologies included in this study, 63% presented with degenerative osteoarthritis. On average 11 treatments, each 30-45 minutes in duration, were administered for the individual patient resulting in a significant improvement rate in excess of 92%. Laser Therapy is active at both the cellular and systemic levels activating a variety of mechanisms including cartilage regeneration, DNA synthesis, improved microcirculation and an analgesic and anti-inflammatory effect.

Medical equipment libraries: implementation, experience and user satisfaction.

PubMed

Keay, S; McCarthy, J P; Carey-Smith, B E

2015-01-01

The hospital-wide pooling and sharing of certain types of medical equipment can lead to both significant improvements in patient safety and financial advantages when compared with a department or ward-level equipment ownership system. In September 2003, a Medical Equipment Loan Service (MELS) was established, focusing initially on infusion pumps. The aims and expected benefits included; improving availability of equipment for both patients and clinical users, managing and reducing clinical risk, reducing equipment diversity, improving equipment management and reducing the overall cost of equipment provision. A user survey was carried out in 2005 and repeated in 2011. The results showed wide and continued satisfaction with the service. The process and difficulties of establishing the service and its development to include additional types of equipment are described. The benefits of managing medical equipment which is in widespread general use, through a MELS as part of a Clinical Engineering Department, are presented.

Improving Patients Experience in Peadiatric Emergency Waiting Room.

PubMed

Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

2016-01-01

When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

Improving the dependability of research in personality and social psychology: recommendations for research and educational practice.

PubMed

Funder, David C; Levine, John M; Mackie, Diane M; Morf, Carolyn C; Sansone, Carol; Vazire, Simine; West, Stephen G

2014-02-01

In this article, the Society for Personality and Social Psychology (SPSP) Task Force on Publication and Research Practices offers a brief statistical primer and recommendations for improving the dependability of research. Recommendations for research practice include (a) describing and addressing the choice of N (sample size) and consequent issues of statistical power, (b) reporting effect sizes and 95% confidence intervals (CIs), (c) avoiding "questionable research practices" that can inflate the probability of Type I error, (d) making available research materials necessary to replicate reported results, (e) adhering to SPSP's data sharing policy, (f) encouraging publication of high-quality replication studies, and (g) maintaining flexibility and openness to alternative standards and methods. Recommendations for educational practice include (a) encouraging a culture of "getting it right," (b) teaching and encouraging transparency of data reporting, (c) improving methodological instruction, and (d) modeling sound science and supporting junior researchers who seek to "get it right."

Recent Advances in Synthesis and Characterization of SWCNTs Produced by Laser Oven Process

NASA Technical Reports Server (NTRS)

Aepalli, Sivaram

2004-01-01

Results from the parametric study of the two-laser oven process indicated possible improvements with flow conditions and laser characteristics. Higher flow rates, lower operating pressures coupled with changes in flow tube material are found to improve the nanotube yields. The collected nanotube material is analyzed using a combination of characterization techniques including SEM, TEM, TGA, Raman and UV-VIS-NIR to estimate the purity of the samples. In-situ diagnostics of the laser oven process is now extended to include the surface temperature of the target material. Spectral emission from the target surface is compared with black body type emission to estimate the temperature. The surface temperature seemed to correlate well with the ablation rate as well as the quality of the SWCNTs. Recent changes in improving the production rate by rastering the target and using cw laser will be presented.

Recent Advances in Synthesis and Characterization of SWCNTs produced by laser oven process

NASA Technical Reports Server (NTRS)

Arepalli, Sivaram

2004-01-01

Results from the parametric study of the two-laser oven process indicated possible improvements with flow conditions and laser characteristics (ref. 1). Higher flow rates, lower operating pressures coupled with changes in flow tube material are found to improve the nanotube yields. The collected nanotube material is analyzed using a combination of characterization techniques including SEM, TEM, TGA, Raman and UV-VIS-NIR to estimate the purity of the samples. Insitu diagnostics of the laser oven process is now extended to include the surface temperature of the target material. Spectral emission from the target surface is compared with black body type emission to estimate the temperature. The surface temperature seemed to correlate well with the ablation rate as well as the quality of the SWCNTs. Recent changes in improving the production rate by rastering the target and using cw laser will be presented.

Improved operating scenarios of the DIII-D tokamak as a result of the addition of UNIX computer systems

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

Henline, P.A.

1995-12-31

The increased use of UNIX based computer systems for machine control, data handling and analysis has greatly enhanced the operating scenarios and operating efficiency of the DIII-D tokamak. This paper will describe some of these UNIX systems and their specific uses. These include the plasma control system, the electron cyclotron heating control system, the analysis of electron temperature and density measurements and the general data acquisition system (which is collecting over 130 Mbytes of data). The speed and total capability of these systems has dramatically affected the ability to operate DIII-D. The improved operating scenarios include better plasma shape controlmore » due to the more thorough MHD calculations done between shots and the new ability to see the time dependence of profile data as it relates across different spatial locations in the tokamak. Other analysis which engenders improved operating abilities will be described.« less

Improved operating scenarios of the DIII-D tokamak as a result of the addition of UNIX computer systems

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

Henline, P.A.

1995-10-01

The increased use of UNIX based computer systems for machine control, data handling and analysis has greatly enhanced the operating scenarios and operating efficiency of the DRI-D tokamak. This paper will describe some of these UNIX systems and their specific uses. These include the plasma control system, the electron cyclotron heating control system, the analysis of electron temperature and density measurements and the general data acquisition system (which is collecting over 130 Mbytes of data). The speed and total capability of these systems has dramatically affected the ability to operate DIII-D. The improved operating scenarios include better plasma shape controlmore » due to the more thorough MHD calculations done between shots and the new ability to see the time dependence of profile data as it relates across different spatial locations in the tokamak. Other analysis which engenders improved operating abilities will be described.« less

Bs and Ds decay constants in three-flavor lattice QCD.

PubMed

Wingate, Matthew; Davies, Christine T H; Gray, Alan; Lepage, G Peter; Shigemitsu, Junko

2004-04-23

Capitalizing on recent advances in lattice QCD, we present a calculation of the leptonic decay constants f(B(s)) and f(D(s)) that includes effects of one strange sea quark and two light sea quarks via an improved staggered action. By shedding the quenched approximation and the associated lattice scale uncertainty, lattice QCD greatly increases its predictive power. Nonrelativistic QCD is used to simulate heavy quarks with masses between 1.5m(c) and m(b). We arrive at the following results: f(B(s))=260+/-7+/-26+/-8+/-5 and f(D(s))=290+/-20+/-29+/-29+/-6 MeV. The first quoted error is the statistical uncertainty, and the rest estimate the sizes of higher order terms neglected in this calculation. All of these uncertainties are systematically improvable by including another order in the weak coupling expansion, the nonrelativistic expansion, or the Symanzik improvement program.

Research Activities for the DORIS Contribution to the Next International Terrestrial Reference Frame

NASA Technical Reports Server (NTRS)

Soudarin, L.; Moreaux, G.; Lemoine, F.; Willis, P.; Stepanek, P.; Otten, M.; Govind, R.; Kuzin, S.; Ferrage, P.

2012-01-01

For the preparation of ITRF2008, the IDS processed data from 1993 to 2008, including data from TOPEX/Poseidon, the SPOT satellites and Envisat in the weekly solutions. Since the development of ITRF2008, the IDS has been engaged in a number of efforts to try and improve the reference frame solutions. These efforts include (i) assessing the contribution of the new DORIS satellites, Jason-2 and Cryosat2 (2008-2011), (ii) individually analyzing the DORIS satellite contributions to geocenter and scale, and (iii) improving orbit dynamics (atmospheric loading effects, satellite surface force modeling. . . ). We report on the preliminary results from these research activities, review the status of the IDS combination which is now routinely generated from the contributions of the IDS analysis centers, and discuss the prospects for continued improvement in the DORIS contribution to the next international reference frame.

The Measurable Benefits of a Workplace Wellness Program in Canada: Results After One Year.

PubMed

Lowensteyn, Ilka; Berberian, Violette; Belisle, Patrick; DaCosta, Deborah; Joseph, Lawrence; Grover, Steven A

2018-03-01

The aim of this study was to evaluate the impact of an employee wellness program in Canada. A comprehensive program including web-based lifestyle challenges was evaluated with annual health screenings. Among 730 eligible employees, 688 (94%) registered for the program, 571 (78%) completed a health screening at baseline, and 314 (43%) at 1 year. Most (66%) employees tracked their activity for more than 6 weeks. At 1-year follow-up, there were significant clinical improvements in systolic blood pressure -3.4 mm Hg, and reductions in poor sleep quality (33% to 28%), high emotional stress (21% to 15%), and fatigue (11% to 6%). A positive dose-response was noted where the greatest improvements were observed among those who participated the most. The program had high employee engagement. After 1 year, the benefits included clinically important improvements in physical and mental health.

Ice2sea - the future glacial contribution to sea-level rise

NASA Astrophysics Data System (ADS)

Vaughan, D. G.; Ice2sea Consortium

2009-04-01

The melting of continental ice (glaciers, ice caps and ice sheets) is a substantial source of current sea-level rise, and one that is accelerating more rapidly than was predicted even a few years ago. Indeed, the most recent report from Intergovernmental Panel on Climate Change highlighted that the uncertainty in projections of future sea-level rise is dominated by uncertainty concerning continental ice, and that understanding of the key processes that will lead to loss of continental ice must be improved before reliable projections of sea-level rise can be produced. Such projections are urgently required for effective sea-defence management and coastal adaptation planning. Ice2sea is a consortium of European institutes and international partners seeking European funding to support an integrated scientific programme to improve understanding concerning the future glacial contribution to sea-level rise. This includes improving understanding of the processes that control, past, current and future sea-level rise, and generation of improved estimates of the contribution of glacial components to sea-level rise over the next 200 years. The programme will include targeted studies of key processes in mountain glacier systems and ice caps (e.g. Svalbard), and in ice sheets in both polar regions (Greenland and Antarctica) to improve understanding of how these systems will respond to future climate change. It will include fieldwork and remote sensing studies, and develop a suite of new, cross-validated glacier and ice-sheet model. Ice2sea will deliver these results in forms accessible to scientists, policy-makers and the general public, which will include clear presentations of the sources of uncertainty. Our aim is both, to provide improved projections of the glacial contribution to sea-level rise, and to leave a legacy of improved tools and techniques that will form the basis of ongoing refinements in sea-level projection. Ice2sea will provide exciting opportunities for many early-career glaciologists and ice-modellers in a variety of host institutes.

Do Health Care Delivery System Reforms Improve Value? The Jury Is Still Out.

PubMed

Korenstein, Deborah; Duan, Kevin; Diaz, Manuel J; Ahn, Rosa; Keyhani, Salomeh

2016-01-01

Widespread restructuring of health delivery systems is underway in the United States to reduce costs and improve the quality of health care. To describe studies evaluating the impact of system-level interventions (incentives and delivery structures) on the value of US health care, defined as the balance between quality and cost. We identified articles in PubMed (2003 to July 2014) using keywords identified through an iterative process, with reference and author tracking. We searched tables of contents of relevant journals from August 2014 through 11 August 2015 to update our sample. We included prospective or retrospective studies of system-level changes, with a control, reporting both quality and either cost or utilization of resources. Data about study design, study quality, and outcomes was extracted by one reviewer and checked by a second. Thirty reports of 28 interventions were included. Interventions included patient-centered medical home implementations (n=12), pay-for-performance programs (n=10), and mixed interventions (n=6); no other intervention types were identified. Most reports (n=19) described both cost and utilization outcomes. Quality, cost, and utilization outcomes varied widely; many improvements were small and process outcomes predominated. Improved value (improved quality with stable or lower cost/utilization or stable quality with lower cost/utilization) was seen in 23 reports; 1 showed decreased value, and 6 showed unchanged, unclear, or mixed results.Study limitations included variability among specific endpoints reported, inconsistent methodologies, and lack of full adjustment in some observational trials. Lack of standardized MeSH terms was also a challenge in the search. On balance, the literature suggests that health system reforms can improve value. However, this finding is tempered by the varying outcomes evaluated across studies with little documented improvement in outcome quality measures. Standardized measures of value would facilitate assessment of the impact of interventions across studies and better estimates of the broad impact of system change.

Use of improved structural materials systems in marine piling : interim report.

DOT National Transportation Integrated Search

1982-09-01

This report contains the results of a study to evaluate the feasibility of manufacturing precast, prestressed marine pile from polymer concrete, polymer impregnated concrete, internally sealed concrete and latex modified concrete. Included in the rep...

Utility investigation best practices and effects on TxDOT highway improvement projects.

DOT National Transportation Integrated Search

2013-04-01

The lack of adequate information about the location and characteristics of utility facilities can result in a number of problems, including damages to utilities, disruptions to utility services and traffic, lost utility facilities as constructi...

Power Search.

ERIC Educational Resources Information Center

Haskin, David

1997-01-01

Compares six leading Web search engines (AltaVista, Excite, HotBot, Infoseek, Lycos, and Northern Light), looking at the breadth of their coverage, accuracy, and ease of use, and finds a clear favorite of the six. Includes tips that can improve search results. (AEF)

Airborne measurements of CO2 column concentrations made with a pulsed IPDA lidar using a multiple-wavelength-locked laser and HgCdTe APD detector

NASA Astrophysics Data System (ADS)

Abshire, James B.; Ramanathan, Anand K.; Riris, Haris; Allan, Graham R.; Sun, Xiaoli; Hasselbrack, William E.; Mao, Jianping; Wu, Stewart; Chen, Jeffrey; Numata, Kenji; Kawa, Stephan R.; Yang, Mei Ying Melissa; DiGangi, Joshua

2018-04-01

Here we report on measurements made with an improved CO2 Sounder lidar during the ASCENDS 2014 and 2016 airborne campaigns. The changes made to the 2011 version of the lidar included incorporating a rapidly wavelength-tunable, step-locked seed laser in the transmitter, using a much more sensitive HgCdTe APD detector and using an analog digitizer with faster readout time in the receiver. We also improved the lidar's calibration approach and the XCO2 retrieval algorithm. The 2014 and 2016 flights were made over several types of topographic surfaces from 3 to 12 km aircraft altitudes in the continental US. The results are compared to the XCO2 values computed from an airborne in situ sensor during spiral-down maneuvers. The 2014 results show significantly better performance and include measurement of horizontal gradients in XCO2 made over the Midwestern US that agree with chemistry transport models. The results from the 2016 airborne lidar retrievals show precisions of ˜ 0.7 parts per million (ppm) with 1 s averaging over desert surfaces, which is an improvement of about 8 times compared to similar measurements made in 2011. Measurements in 2016 were also made over fresh snow surfaces that have lower surface reflectance at the laser wavelengths. The results from both campaigns showed that the mean values of XCO2 retrieved from the lidar consistently agreed with those based on the in situ sensor to within 1 ppm. The improved precision and accuracy demonstrated in the 2014 and 2016 flights should benefit future airborne science campaigns and advance the technique's readiness for a space-based instrument.

Current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination: an expert Delphi survey among dental hygienists

PubMed Central

2017-01-01

Purpose This study aimed to investigate current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination (KDHNLE) through an expert Delphi survey. Methods A Delphi survey was conducted from May through August 2016 in Korea. This Delphi survey included 20 persons representing the field of dental hygiene (7 groups from various dental hygiene-related organizations). The Delphi survey was administered through e-mail as 3 rounds of questionnaire surveys regarding the issues facing the KDHNLE and potential solutions to those challenges. The primary Delphi survey was an open questionnaire. In each round, subjects’ responses were categorized according to the detailed themes of their responses. The minimum value of the content validity ratio of the survey results was determined by the number of panels participating in the Delphi survey. Results Issues facing the KDHNLE were identified from the results of the Delphi survey. The following 4 items had an average importance score of 4.0 or higher and were considered as important by over 85% of the panels: the failure of the practical test to reflect actual clinical settings, the focus of the practical test on dental scaling, the gap between the items evaluated on the national examination and actual practical work, and insufficiency in strengthening the expertise of licensed dental hygienists. The following items were suggested for improvement: more rigorous rater training, adjustment of the difficulty of the licensing examination, the introduction of a specialized dental hygienist system, and more rigorous refresher training for licensed dental hygienists. Conclusion Based on the above results, the KDHNLE should be improved according to the core competencies of dental hygienists, including on-site clinical practice experience. PMID:28900069

The Body Project 4 All: A pilot randomized controlled trial of a mixed-gender dissonance-based body image program

PubMed Central

Kilpela, Lisa Smith; Blomquist, Kerstin; Verzijl, Christina; Wilfred, Salomé; Beyl, Robbie; Becker, Carolyn Black

2017-01-01

Objective The Body Project is a cognitive dissonance-based body image improvement program with ample research support among female samples. More recently, researchers have highlighted the extent of male body dissatisfaction and disordered eating behaviors; however, boys/men have not been included in the majority of body image improvement programs. This study aims to explore the efficacy of a mixed-gender Body Project compared to the historically female-only body image intervention program. Method Participants included male and female college students (N=185) across two sites. We randomly assigned women to a mixed-gender modification of the two-session, peer-led Body Project (MG), the two-session, peer-led, female-only (FO) Body Project, or a waitlist control (WL), and men to either MG or WL. Participants completed self-report measures assessing negative affect, appearance-ideal internalization, body satisfaction, and eating disorder pathology at baseline, post-test, and at two- and six-month follow-up. Results We used linear mixed effects modeling to estimate the change from baseline over time for each dependent variable across conditions. For women, results were mixed regarding post-intervention improvement compared to WL, and were largely non-significant compared to WL at 6-month follow-up. Alternatively, results indicated that men in MG consistently improved compared to WL through 6-month follow-up on all measures except negative affect and appearance-ideal internalization. Discussion Results differed markedly between female and male samples, and were more promising for men than for women. Various explanations are provided, and further research is warranted prior to drawing firm conclusions regarding mixed-gender programming of the Body Project. PMID:27188688

Decreasing troponin turnaround time in the emergency department using the central laboratory: A process improvement study.

PubMed

Boelstler, Arlene M; Rowland, Ralph; Theoret, Jennifer; Takla, Robert B; Szpunar, Susan; Patel, Shraddha P; Lowry, Andrew M; Pena, Margarita E

2015-03-01

To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

PBL on Line: A Proposal for the Organization, Part-Time Monitoring and Assessment of PBL Group Activities

ERIC Educational Resources Information Center

Marti, Enric; Gil, Debora; Gurguí, Antoni; Hernández-Sabaté, Aura; Rocarías, Jaume; Poveda, Ferran

2015-01-01

This report presents the organisation of PBL (Project Based Learning) for a subject included in the IT engineering degree course. It is the result of 10 years of experience of the implantation and continuous improvement of the PBL class structure. The latest innovations include the experience of part-time monitoring with PBL groups using the Open…

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres.

PubMed

van Lent, Wineke A M; de Beer, Relinde D; van Harten, Wim H

2010-08-31

Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations.Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals.

Does Pedometer Goal Setting Improve Physical Activity among Native Elders? Results from a Randomized Pilot Study

ERIC Educational Resources Information Center

Sawchuk, Craig N.; Russo, Joan E.; Charles, Steve; Goldberg, Jack; Forquera, Ralph; Roy-Byrne, Peter; Buchwald, Dedra

2011-01-01

We examined if step-count goal setting resulted in increases in physical activity and walking compared to only monitoring step counts with pedometers among American Indian/Alaska Native elders. Outcomes included step counts, self-reported physical activity and well-being, and performance on the 6-minute walk test. Although no significant…

Automatic Content Analysis; Part I of Scientific Report No. ISR-18, Information Storage and Retrieval...

ERIC Educational Resources Information Center

Cornell Univ., Ithaca, NY. Dept. of Computer Science.

Four papers are included in Part One of the eighteenth report on Salton's Magical Automatic Retriever of Texts (SMART) project. The first paper: "Content Analysis in Information Retrieval" by S. F. Weiss presents the results of experiments aimed at determining the conditions under which content analysis improves retrieval results as well…

The Successful Mobilization of a Campus Community for Student Retention. Report of the University Retention Steering Committee.

ERIC Educational Resources Information Center

Eastern Michigan Univ., Ypsilanti.

Components of a student retention program at Eastern Michigan University are examined; for each effort to improve retention, project objectives and design, results, and recommendations are presented. Retention initiatives, decided upon as a result of a campus-wide mobilization of effort, include: a student-focused orientation system, a fast track…

The Impact of OECD-PISA Results on Japanese Educational Policy

ERIC Educational Resources Information Center

Tasaki, Noritomo

2017-01-01

The author describes the results of PISA, including those of 2015 and Japan's reaction, as well as their impact. Highly-ranked in PISA, Japan has always tried to improve its education system. The promotion of reading comprehension remains an important issue and low interest and motivation to learn subjects are crucial problems. The author…

Operational Group Sandy technical progress report

USGS Publications Warehouse

,

2013-01-01

This report documents results from the March 2013 deployment of the OGS. It includes background information on Hurricane Sandy and the federal response; the OGS methodology; scenarios for Hurricane Sandy’s impact on coastal communities and urban ecosystems; potential interventions to improve regional resilience to future major storms; a discussion of scenario results; and lessons learned about the OGS process.

Stability and square integrability of derivatives of solutions of nonlinear fourth order differential equations with delay.

PubMed

Korkmaz, Erdal

2017-01-01

In this paper, we give sufficient conditions for the boundedness, uniform asymptotic stability and square integrability of the solutions to a certain fourth order non-autonomous differential equations with delay by using Lyapunov's second method. The results obtained essentially improve, include and complement the results in the literature.

[The efficacy of health improvement measures for sickly children in a children's health promotion facility].

PubMed

Khan, M A; Kuiantseva, L V; Rassulova, M A; Bykova, H I

2011-01-01

The results of the present study confirm the efficacy of combined health improvement measures applied in the children's health promotion facility for the treatment of frequently ill children. These measures included climatic therapy, rational day regimen, full-rate balanced diet, therapeutic physical exercises, and aromatherapy with the use of natural essential oils, e.g. clary sage oil. Children presenting with the symptoms of an acute respiratory infection were additionally treated with polarized light having the anti-inflammatory, immunocorrective, and antioxidative properties and thereby improved adaptive capacity of the organism.

New Developments in Robotics and Single-site Gynecologic Surgery.

PubMed

Matthews, Catherine A

2017-06-01

Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.

Demonstration of the Health Literacy Universal Precautions Toolkit

PubMed Central

Mabachi, Natabhona M.; Cifuentes, Maribel; Barnard, Juliana; Brega, Angela G.; Albright, Karen; Weiss, Barry D.; Brach, Cindy; West, David

2016-01-01

The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements. PMID:27232681

Cavitation-resistant inducer

DOEpatents

Dunn, C.; Subbaraman, M.R.

1989-06-13

An improvement in an inducer for a pump is disclosed wherein the inducer includes a hub, a plurality of radially extending substantially helical blades and a wall member extending about and encompassing an outer periphery of the blades. The improvement comprises forming adjacent pairs of blades and the hub to provide a substantially rectangular cross-sectional flow area which cross-sectional flow area decreases from the inlet end of the inducer to a discharge end of the inducer, resulting in increased inducer efficiency improved suction performance, reduced susceptibility to cavitation, reduced susceptibility to hub separation and reduced fabrication costs. 11 figs.

Annual report to the Chairman and Ranking Minority Members, House and Senate Committees on Appropriations. Status of open recommendations: Improving operations of federal departments and agencies

NASA Technical Reports Server (NTRS)

1995-01-01

Each year, GAO's work contributes to many legislative and executive branch actions that result in significant financial savings and other improvements in government operations. Some, but not all, are identified through GAO's system for periodically following up to determine the status of actions taken on the recommendations made in its audit and evaluation reports. In fiscal year 1994, GAO made 1,450 recommendations, but, more importantly, about 4,400 GAO recommendations made over the past 5 years have been implemented. This report includes summary information on the status of all GAO recommendations that have not been fully implemented and highlights some of the key ones. This information should help congressional and agency leaders prepare for upcoming appropriations and oversight activities and stimulate further actions to achieve the desired improvements in government operations. In addition to including printed issue area summaries highlighting the ipact of GAO's work and the key open recommendations, this volume includes a set of computer diskettes with details on all open recommendations.

The uses of cognitive training technologies in the treatment of autism spectrum disorders.

PubMed

Wass, Sam V; Porayska-Pomsta, Kaska

2014-11-01

In this review, we focus on research that has used technology to provide cognitive training - i.e. to improve performance on some measurable aspect of behaviour - in individuals with autism spectrum disorders. We review technology-enhanced interventions that target three different cognitive domains: (a) emotion and face recognition, (b) language and literacy, and (c) social skills. The interventions reviewed allow for interaction through different modes, including point-and-click and eye-gaze contingent software, and are delivered through diverse implementations, including virtual reality and robotics. In each case, we examine the evidence of the degree of post-training improvement observed following the intervention, including evidence of transfer to altered behaviour in ecologically valid contexts. We conclude that a number of technological interventions have found that observed improvements within the computerised training paradigm fail to generalise to altered behaviour in more naturalistic settings, which may result from problems that people with autism spectrum disorders experience in generalising and extrapolating knowledge. However, we also point to several promising findings in this area. We discuss possible directions for future work. © The Author(s) 2013.

Crossing the Barriers: An Analysis of Land Access Barriers to Geothermal Development and Potential Improvement Scenarios

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

Levine, Aaron L; Young, Katherine R

Developers have identified many non-technical barriers to geothermal power development, including access to land. Activities required for accessing land, such as environmental review and private and public leasing can take a considerable amount of time and can delay or prevent project development. This paper discusses the impacts to available geothermal resources and deployment caused by land access challenges, including tribal and cultural resources, environmentally sensitive areas, biological resources, land ownership, federal and state lease queues, and proximity to military installations. In this analysis, we identified challenges that have the potential to prevent development of identified and undiscovered hydrothermal geothermal resources.more » We found that an estimated 400 MW of identified geothermal resource potential and 4,000 MW of undiscovered geothermal resource potential were either unallowed for development or contained one or more significant barriers that could prevent development at the site. Potential improvement scenarios that could be employed to overcome these barriers include (1) providing continuous funding to the U.S. Forest Service (USFS) for processing geothermal leases and permit applications and (2) the creation of advanced environmental mitigation measures. The model results forecast that continuous funding to the USFS could result in deployment of an additional 80 MW of geothermal capacity by 2030 and 124 MW of geothermal capacity by 2050 when compared to the business-as-usual scenario. The creation of advanced environmental mitigation measures coupled with continuous funding to the USFS could result in deployment of an additional 97 MW of geothermal capacity by 2030 and 152 MW of geothermal capacity by 2050 when compared to the business-as-usual scenario. The small impact on potential deployment in these improvement scenarios suggests that these 4,400 MW have other barriers to development in addition to land access. In other words, simply making more resources available for development does not increase deployment; however, impacts to deployment could increase when coupled with other improvements (e.g., permitting, market and/or technology improvements).« less

Advances in Ice Penetrating Radar

NASA Astrophysics Data System (ADS)

Paden, J. D.

2016-12-01

Radars have been employed for ice remote sensing since the mid-twentieth century. The original application in radioglaciology was to obtain ice thickness: an essential parameter in ice flux calculations and boundary condition in ice flow models. Later, radars were used to estimate basal conditions and track laterally persistent features in the ice. The Center for Remote Sensing of Ice Sheet's recent hardware advances include multichannel systems and radar suites covering the usable frequency spectrum. These advances coupled with increased interest in the polar regions result in a concomitant exponential growth in data. We focus on a few results that have come from these changes. Multichannel radar systems improved clutter rejection and enabled 3D imaging. Using computer vision algorithms, we have automated the process of extracting the ice bottom surface in 3D imagery for complex topographies including narrow glacier channels where the ice surface and ice bottom merge together within the 3D images. We present results of wide swath imaging which have enabled narrow, 2-3 km wide, glacier channels to be fully imaged in a single pass. When radar data are available across the frequency spectrum, we have the ability to enhance target detection and measure frequency dependent properties. For example, we can couple HF sounder measurements in warmer ice where scattering attenuates and hides the signal of interest with VHF sounder measurements in cooler ice which have much improved resolution from a single flight line. We present examples of improved bed detection with coupled HF and VHF imagery in a temperate to cold ice transition that show the strong frequency dependence of englacial scattering. To handle the increased data rate, we developed a standard processing chain and data product for CReSIS radar systems, including legacy systems. Application specific GIS tools are an essential part and enable us to merge other data products during data analysis. By using imagery, gravity, mass conservation, etc., we improve the accuracy of ice bottom tracking. We present examples of the integration of these information sources to produce improved ice thickness estimates and show examples of data products which span more than two decades.

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

PubMed Central

Jennings, Mary Carol; Pradhan, Subarna; Schleiff, Meike; Sacks, Emma; Freeman, Paul A; Gupta, Sundeep; Rassekh, Bahie M; Perry, Henry B

2017-01-01

Background We summarize the findings of assessments of projects, programs, and research studies (collectively referred to as projects) included in a larger review of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH). Findings on neonatal and child health are reported elsewhere in this series. Methods We searched PUBMED and other databases through December 2015, and included assessments that underwent data extraction. Data were analyzed to identify themes in interventions implemented, health outcomes, and strategies used in implementation. Results 152 assessments met inclusion criteria. The majority of assessments were set in rural communities. 72% of assessments included 1–10 specific interventions aimed at improving maternal health. A total of 1298 discrete interventions were assessed. Outcome measures were grouped into five main categories: maternal mortality (19% of assessments); maternal morbidity (21%); antenatal care attendance (50%); attended delivery (66%) and facility delivery (69%), with many assessments reporting results on multiple indicators. 15 assessments reported maternal mortality as a primary outcome, and of the seven that performed statistical testing, six reported significant decreases. Seven assessments measured changes in maternal morbidity: postpartum hemorrhage, malaria or eclampsia. Of those, six reported significant decreases and one did not find a significant effect. Assessments of community–based interventions on antenatal care attendance, attended delivery and facility–based deliveries all showed a positive impact. The community–based strategies used to achieve these results often involved community collaboration, home visits, formation of participatory women’s groups, and provision of services by outreach teams from peripheral health facilities. Conclusions This comprehensive and systematic review provides evidence of the effectiveness of CBPHC in improving key indicators of maternal morbidity and mortality. Most projects combined community– and facility–based approaches, emphasizing potential added benefits from such holistic approaches. Community–based interventions will be an important component of a comprehensive approach to accelerate improvements in maternal health and to end preventable maternal deaths by 2030. PMID:28685040

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014

PubMed Central

Bleich, Sara N.; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce

2015-01-01

Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients. PMID:26564013

Interventions to improve immigrant health. A scoping review

PubMed Central

Ortiz-Barreda, Gaby; Ben-Shlomo, Yoav; Holdsworth, Michelle; Salami, Bukola; Rammohan, Anu; Chung, Roger Yat-Nork; Padmadas, Sabu S.; Krafft, Thomas

2017-01-01

Abstract Background: Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. Aims: To conduct a systematic search of the literature evaluating health interventions for immigrants; to map the characteristics of identified studies including range of interventions, immigrant populations and their host countries, clinical areas targeted and reported evaluations, challenges and limitations of the interventions identified. Following the results, to develop recommendations for research in the field. Methods: A scoping review approach was chosen to provide an overview of the type, extent and quantity of research available. Studies were included if they empirically evaluated health interventions targeting immigrants and/or their descendants, included a control group, and were published in English (PubMed and Embase from 1990 to 2015). Results: Most of the 83 studies included were conducted in the USA, encompassed few immigrant groups and used a randomized controlled trial (RCT) or cluster RCT design. Most interventions addressed chronic and non-communicable diseases and attendance at cancer screening services, used individual targeted approaches, targeted adult women and recruited participants from health centres. Outcome measures were often subjective, with the exception of interventions for cardiovascular risk and diabetes. Generally, authors claimed that interventions were beneficial, despite a number of reported limitations. Conclusions: Recommendations for enhancing interventions to improve immigrant health are provided to help researchers, funders and health care commissioners when deciding upon the scope, nature and design of future research in this area. PMID:28339883

The impact of medication on health-related quality of life in patients with generalized anxiety disorder.

PubMed

Wilson, Hilary; Mannix, Sally; Oko-osi, Hafiz; Revicki, Dennis A

2015-01-01

Generalized anxiety disorder (GAD) is a psychiatric disorder characterized by excess worry and anxiety. GAD impacts overall health-related quality of life (HRQL), level of functioning, and disability. This literature review was conducted to understand the impact of pharmacological treatments on HRQL and functional outcomes. A literature review was conducted to identify randomized controlled trials (RCTs) comparing GAD pharmacological treatments with one or more patient-reported outcome (PRO) measure assessing HRQL, disability, functioning, or work productivity. Four databases were searched (PubMed, EMBASE, Cochrane Reviews, PsycInfo). Limits included English-language publications from 2004-2014. Abstracts and articles were reviewed to select articles reporting results of RCTs of pharmacological treatments for GAD that included one or more PRO measure. Article abstraction and summarization focused on key elements of the study design and PRO results. One hundred sixty-three abstracts were reviewed; 44 articles were requested; 12 articles, representing 19 studies, were deemed relevant. The Sheehan Disability Scale (SDS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were the most frequently utilized PRO measures. In clinical trials with significant anxiety symptom reductions, the SDS and Q-LES-Q also improved with treatment and differentiated from placebo. Two trials included a measure of work productivity; both demonstrated significant improvements with short-term treatment. Treatments that reduce anxiety symptoms are also associated with improvements in patient-reported HRQL, function, and disability. In addition to evaluation of treatment impacts on anxiety symptoms, clinical trials should include PRO measures of HRQL, disability, and functioning.

Treatment of generalized anxiety disorder: comparison of a new beta-blocking drug (CGP 361 A), low-dose neuroleptic (flupenthixol), and placebo.

PubMed

Bjerrum, H; Allerup, P; Thunedborg, K; Jakobsen, K; Bech, P

1992-09-01

In an attempt to evaluate an alternative drug treatment to benzodiazepines in generalized anxiety disorders, a placebo controlled trial was carried out with a new beta-adrenergic blocker (CPG 361 A). A low-dosage neuroleptic (flupenthixol) was included as a reference drug. Depending on the clinical assessment scales the placebo treatment resulted in moderate to excellent improvement in 36% to 56% of the patients after four weeks of treatment. The active drugs generally had a higher improvement range (from 31% to 80%). The global improvement scale was found to be better than the other scales in discriminating between placebo (50% improvement) and the active drugs (CGP 361 A brought about 78% improvement and flupenthixol brought about 80% improvement). However, only for flupenthixol was the difference of statistical significance.

An Improved Elastic and Nonelastic Neutron Transport Algorithm for Space Radiation

NASA Technical Reports Server (NTRS)

Clowdsley, Martha S.; Wilson, John W.; Heinbockel, John H.; Tripathi, R. K.; Singleterry, Robert C., Jr.; Shinn, Judy L.

2000-01-01

A neutron transport algorithm including both elastic and nonelastic particle interaction processes for use in space radiation protection for arbitrary shield material is developed. The algorithm is based upon a multiple energy grouping and analysis of the straight-ahead Boltzmann equation by using a mean value theorem for integrals. The algorithm is then coupled to the Langley HZETRN code through a bidirectional neutron evaporation source term. Evaluation of the neutron fluence generated by the solar particle event of February 23, 1956, for an aluminum water shield-target configuration is then compared with MCNPX and LAHET Monte Carlo calculations for the same shield-target configuration. With the Monte Carlo calculation as a benchmark, the algorithm developed in this paper showed a great improvement in results over the unmodified HZETRN solution. In addition, a high-energy bidirectional neutron source based on a formula by Ranft showed even further improvement of the fluence results over previous results near the front of the water target where diffusion out the front surface is important. Effects of improved interaction cross sections are modest compared with the addition of the high-energy bidirectional source terms.

Evaluating laboratory key performance using quality indicators in Alexandria University Hospital Clinical Chemistry Laboratories.

PubMed

Rizk, Mostafa M; Zaki, Adel; Hossam, Nermine; Aboul-Ela, Yasmin

2014-12-01

The performance of clinical laboratories plays a fundamental role in the quality and effectiveness of healthcare. To evaluate the laboratory performance in Alexandria University Hospital Clinical Laboratories using key quality indicators and to compare the performance before and after an improvement plan based on ISO 15189 standards. The study was carried out on inpatient samples for a period of 7 months that was divided into three phases: phase I included data collection for evaluation of the existing process before improvement (March-May 2012); an intermediate phase, which included corrective, preventive action, quality initiative and steps for improvement (June 2012); and phase II, which included data collection for evaluation of the process after improvement (July 2012-September 2012). In terms of the preanalytical indicators, incomplete request forms in phase I showed that the total number of received requests were 31 944, with a percentage of defected request of 33.66%; whereas in phase II, there was a significant reduction in all defected request items (P<0.001) with a percentage of defected requests of 9.64%. As for the analytical indicators, the proficiency testing accuracy score in phase I showed poor performance of 10 analytes in which total error (TE) exceeded total error allowable (TEa), with a corresponding sigma value of less than 3, which indicates test problems and an unreliable method. The remaining analytes showed an acceptable performance in which TE did not exceed the TEa, with a sigma value of more than 6. Following an intervention of 3 months, the performance showed marked improvement. Error tracking in phase I showed a TE of (5.11%), whereas in phase II it was reduced to 2.48% (P<0.001).For the postanalytical indicators, our results in phase I showed that the percentage of nonreported critical results was 26.07%. In phase II, there was a significant improvement (P<0.001). The percentage of nonreported results was 11.37%, the reasons were either inability to contact the authorized doctor (8.24%), wrong patient identification (1.0%), lack of reporting by lab doctor (1.11%), and finally, lack of reporting by the lab technician (1.03%). Standardization and monitoring of each step in the total testing process is very important and is associated with the most efficient and well-organized laboratories.

Integrating Point-of-Care Testing into a Community Emergency Department: A Mixed-Methods Evaluation.

PubMed

Pines, Jesse M; Zocchi, Mark S; Carter, Caitlin; Marriott, Charles Z; Bernard, Matthew; Warner, Leah H

2018-05-13

Point-of-care testing (POCT) is a commonly used technology that hastens the time to laboratory results in emergency departments (ED). We evaluated an ED-based POCT program on ED length of stay and time to care, coupled with qualitative interviews of local ED stakeholders. We conducted a mixed-methods study (2012-16) to examine the impact of point-of-care testing in a single, community ED. The quantiative analysis involved an observational before-after study comparing time to laboratory test result (POC troponin or POC chemistry) and ED length of stay after implementation of POCT, using a propensity-weighted interrupted time series analysis (ITSA). A complementary qualitative analysis involved five semi-structured interviews with staff using grounded theory on the benefits and challenges to ED POCT. A total of 47,399 ED visits were included in the study (24,705 in pre-intervention period and 22,694 in post-intervention). After POCT implementation, overall laboratory testing increased marginally from 61 to 62%. Central laboratory troponin and chemistry declined by >50% and was replaced by POCT. Prior to POCT implementation, time to troponin and chemistry had declined steadily due to other improvements in laboratory efficiency. After POCT implementation, there was an immediate 20 minute further decline (p<0.001) in both time to troponin and time to chemistry results using the propensity-weighted comparisons. However, the declining trend observed prior to POCT implementation did not continue at the same rate post implementation. Similarly, prior to POCT implementation, ED length of stay (LOS) declined due to other quality improvements. After POCT implementation, LOS continued declined at a similar rate. Because of this prior trend, the ITSA did not show a significant decline in LOS attributable to POCT. Common benefits of POCT perceived by staff in qualitative interviews included improved quality of care (64%), and reductions in time to test results (44%). Common challenges included concerns over POCT accuracy (32%), and technical barriers (29%). In the study ED, implementation of POCT was associated with a reduction in time to test result for both troponin and chemistry. Local staff felt that faster time to test result improved quality of care; however, concerns were raised with POCT accuracy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

GAMERA - The New Magnetospheric Code

NASA Astrophysics Data System (ADS)

Lyon, J.; Sorathia, K.; Zhang, B.; Merkin, V. G.; Wiltberger, M. J.; Daldorff, L. K. S.

2017-12-01

The Lyon-Fedder-Mobarry (LFM) code has been a main-line magnetospheric simulation code for 30 years. The code base, designed in the age of memory to memory vector ma- chines,is still in wide use for science production but needs upgrading to ensure the long term sustainability. In this presentation, we will discuss our recent efforts to update and improve that code base and also highlight some recent results. The new project GAM- ERA, Grid Agnostic MHD for Extended Research Applications, has kept the original design characteristics of the LFM and made significant improvements. The original de- sign included high order numerical differencing with very aggressive limiting, the ability to use arbitrary, but logically rectangular, grids, and maintenance of div B = 0 through the use of the Yee grid. Significant improvements include high-order upwinding and a non-clipping limiter. One other improvement with wider applicability is an im- proved averaging technique for the singularities in polar and spherical grids. The new code adopts a hybrid structure - multi-threaded OpenMP with an overarching MPI layer for large scale and coupled applications. The MPI layer uses a combination of standard MPI and the Global Array Toolkit from PNL to provide a lightweight mechanism for coupling codes together concurrently. The single processor code is highly efficient and can run magnetospheric simulations at the default CCMC resolution faster than real time on a MacBook pro. We have run the new code through the Athena suite of tests, and the results compare favorably with the codes available to the astrophysics community. LFM/GAMERA has been applied to many different situations ranging from the inner and outer heliosphere and magnetospheres of Venus, the Earth, Jupiter and Saturn. We present example results the Earth's magnetosphere including a coupled ring current (RCM), the magnetospheres of Jupiter and Saturn, and the inner heliosphere.

Interventions to Improve Suboptimal Prescribing in Nursing Homes: A Narrative Review

PubMed Central

Marcum, Zachary A.; Handler, Steven M.; Wright, Rollin; Hanlon, Joseph T.

2010-01-01

Background Appropriate medication prescribing for nursing home residents remains a challenge. Objective The purpose of this study was to conduct a narrative review of the published literature describing randomized controlled trials that used interventions to improve suboptimal prescribing in nursing homes. Methods The PubMed, International Pharmaceutical Abstracts, and EMBASE databases were searched for articles published in the English language between January 1975 and December 2009, using the terms drug utilization, pharmaceutical services, aged, long-term care, nursing homes, prescribing, geriatrics, and randomized controlled trial. A manual search of the reference lists of identified articles and the authors’ files, book chapters, and recent review articles was also conducted. Abstracts and posters from meetings were not included in the search. Studies were included if they: (1) had a randomized controlled design; (2) had a process measure outcome for quality of prescribing or a distal outcome measure for medication-related adverse patient events; and (3) involved nursing home residents. Results Eighteen studies met the inclusion criteria for this review. Seven of those studies described educational approaches using various interventions (eg, outreach visits) and measured suboptimal prescribing in different manners (eg, adherence to guidelines). Two studies described computerized decision-support systems to measure the intervention’s impact on adverse drug events (ADEs) and appropriate drug orders. Five studies described clinical pharmacist activities, most commonly involving a medication review, and used various measures of suboptimal prescribing, including a measure of medication appropriateness and the total number of medications prescribed. Two studies each described multidisciplinary and multifaceted approaches that included heterogeneous interventions and measures of prescribing. Most (15/18; 83.3%) of these studies reported statistically significant improvements in ≥1 aspect of suboptimal prescribing. Only 3 of the studies reported significant improvements in distal health outcomes, and only 3 measured ADEs or adverse drug reactions. Conclusions Mixed results were reported for a variety of approaches used to improve suboptimal prescribing. However, the heterogeneity of the study interventions and the various measures of suboptimal prescribing used in these studies does not allow for an authoritative conclusion based on the currently available literature. PMID:20624609

Economic evaluation of distribution system smart grid investments

DOE PAGES

Onen, Ahmet; Cheng, Danling; Broadwater, Robert P.; ...

2014-12-31

This paper investigates economic benefits of smart grid automation investments. A system consisting of 7 substations and 14 feeders is used in the evaluation. Here benefits that can be quantified in terms of dollar savings are considered, termed “hard dollar” benefits. Smart Grid investment evaluations to be considered include investments in improved efficiency, more cost effective use of existing system capacity with automated switches, and coordinated control of capacitor banks and voltage regulators. These Smart Grid evaluations are sequentially ordered, resulting in a series of incremental hard dollar benefits. Hard dollar benefits come from improved efficiency, delaying large capital equipmentmore » investments, shortened storm restoration times, and reduced customer energy use. Analyses used in the evaluation involve hourly power flow analysis over multiple years and Monte Carlo simulations of switching operations during storms using a reconfiguration for restoration algorithm. The economic analysis uses the time varying value of the Locational Marginal Price. Algorithms used include reconfiguration for restoration involving either manual or automated switches and coordinated control involving two modes of control. Field validations of phase balancing and capacitor design results are presented. The evaluation shows that investments in automation can improve performance while at the same time lowering costs.« less

Newborn screening: an appeal for improved parent education.

PubMed

Tluczek, Audrey; Orland, Kate Murphy; Nick, Sara Wolfgram; Brown, Roger L

2009-01-01

The purpose of this study, which was part of a larger investigation of newborn screening (NBS) for cystic fibrosis (CF), was to learn how parents were informed about NBS and obtain their suggestions for improving the process of educating parents about NBS. Qualitative study using directed and summative content analyses was conducted on 100 interviews with 193 parents of 100 newborns recruited from 4 clinical populations including parents of infants with (1) a CF diagnosis, (2) one CF mutation and therefore CF carriers, (3) congenital hypothyroidism, and (4) normal screening results. Parents described much inconsistency in the timing of and methods used to inform them about NBS. Mothers with higher income were 3.69 times more likely to receive information before their infants' births than mothers with lower income. Parents recommended improving verbal and written communication with parents about NBS at multiple junctures from preconception to the infant's first few days of life. Parents suggested that providers take time to explain the purpose and importance of NBS, which diseases are included in testing, and when parents can expect results. These findings suggest a need to establish evidence-based guidelines for informing parents about NBS.

Staff perception of interprofessional working relationships after a work redesign intervention in a Danish orthopaedic hand unit outpatient clinic.

PubMed

de Beijer, Anke Elisabeth; Hansen, Torben Bæk; Stilling, Maiken; Jakobsen, Flemming

2016-01-01

There is evidence that clinical pathways improve quality of care; however, knowledge is limited concerning the influence on and the benefits experienced by the interprofessional teams working with these pathways. Our working methods in a hand unit in an orthopaedic outpatient clinic in Denmark were redesigned to include, among other changes, the introduction of clinical pathways. Changes included standardising treatment and communication methods, delegating tasks from medical specialists to nurses, and providing nurses with their own consultation room. Using focus group interviews before and after the implementation of the new working methods, we investigated staff-perceived experiences of the effects on working relationships and the utilisation of professional skills and attitudes, resulting from the mentioned change in working methods. The results were changes in daily communication methods among healthcare staff and improvements in the actual communication and collaborative problem solving skills concerning standard patients with simple hand pathology; however, there are still challenges for patients with more complex hand pathology. Though this new interprofessional arrangement improves the use of nurse and medical specialist professional competencies, it also requires a high degree of trust among the team members.

Persistent Lung Disease in Adults with NKX2.1 Mutation and Familial Neuroendocrine Cell Hyperplasia of Infancy

PubMed Central

Nevel, Rebekah J.; Garnett, Errine T.; Worrell, John A.; Morton, Ronald L.; Nogee, Lawrence M.; Blackwell, Timothy S.

2016-01-01

Rationale: Neuroendocrine cell hyperplasia of infancy (NEHI) is a diffuse lung disease that presents in infancy and improves during childhood. Long-term outcomes have not previously been described. In one familial cohort, we have reported that NEHI is associated with a heterozygous variant of NKX2.1/TTF1. Objectives: Our objective was to determine whether pulmonary abnormalities persist in adults with NEHI, to aid in elucidating the natural history of this disease. Methods: Four adult relatives with heterozygous NKX2.1 mutation and with clinical histories compatible with NEHI enrolled in a prospective study that included questionnaires, pulmonary function tests, and chest computed tomography scans. Measurements and Main Results: Mild radiologic abnormalities including mosaicism were seen in all four cases. Three individuals had obstruction on pulmonary function tests, two had marked air trapping, and three had symptomatic impairments with exercise intolerance. Conclusions: Although clinical improvement occurs over time, NEHI may result in lifelong pulmonary abnormalities in some cases. Further studies are required to better describe the natural history of this disease and would be facilitated by additional delineation of genetic mechanisms to enable improved case identification. PMID:27187870

Follow-Up Study of Complicated Grief among Parents Eighteen Months after a Child's Death in the Pediatric Intensive Care Unit

PubMed Central

Shear, Katherine; Newth, Christopher J.L.; Harrison, Rick; Berger, John; Zimmerman, Jerry; Anand, K.J.S.; Carcillo, Joseph; Donaldson, Amy E.; Dean, J. Michael; Willson, Douglas F.; Nicholson, Carol

2011-01-01

Abstract Objective We previously demonstrated that parents whose children die in a pediatric intensive care unit (PICU) have a high level of complicated grief symptoms 6 months after the death. In this study, we investigate the change in the extent of complicated grief symptoms among these parents between 6 and 18 months postdeath and identify factors predicting improvement. Methods One hundred thirty-eight parents of 106 children completed surveys at 6 and 18 months. Surveys included the Inventory of Complicated Grief (ICG), measures of grief avoidance, attachment, caregiving and social support, and demographics. Multivariable analysis was performed using generalized estimating equations to identify characteristics independently associated with improvement in ICG score. Results ICG scores were 33.4 ± 13.6 at 6 months and 28.0 ± 13.5 at 18 months, representing an improvement in ICG score of 5.4 + 8.0 (95% confidence interval [CI] 4.1–6.8, p < 0.001). Variables independently associated with greater improvement in ICG score included traumatic death and greater grief avoidance. Variables independently associated with less improvement included being the biological parent and having more responsive caregiving. Parents with one or two surviving children had more improvement in ICG score than those with no surviving children whereas parents with three or more surviving children had less improvement. Conclusion Complicated grief symptoms decrease among parents between 6 and 18 months after their child's death in the PICU; however, high symptom levels persists for some. Better understanding of the trajectory of complicated grief will allow parents at risk for persistent distress to receive professional support. PMID:21281122

Role of WhatsApp-based discussions in improving residents' knowledge of post-operative pain management: a pilot study.

PubMed

Bakshi, Sumitra G; Bhawalkar, Pranay

2017-10-01

To provide a platform for the dissemination of basic knowledge of pain management, a WhatsApp group was created by residents and consultants. Common clinical scenarios, resident queries, and important instructions to be followed by residents with respect to running the Acute Pain Service were discussed in the group. This study evaluates the benefits of this interaction. This study was approved by the hospital ethics board and was registered with the Clinical Trial Registry of India. Second- and third-year anesthesia residents were included in a WhatsApp group, along with consultants (board certified anesthesiologists with a special interest in pain). Pain knowledge assessment was performed pre- and post-discussion using a standard 22-point questionnaire. A feedback form, which included self-rated confidence scores (1-10, 10-most confident) and opinions about the 3-month WhatsApp discussion, was collected. Improvements in the documentation in clinical sheets post-discussion were also analyzed. A total of 38 residents were included in the WhatsApp group. An improvement in the percentage of correct answers from 69.1% (pre-discussion) to 73.6% (post-discussion) was observed (P = 0.031). Improvements in the self-rated residents' confidence levels were also noted (P < 0.05). A total of 37 residents felt that the WhatsApp-based discussion was useful. Documentation of the details of epidural blockade in clinical sheets improved from 30% to 100%. The WhatsApp discussion improved residents' knowledge and confidence levels, and also resulted in improved documentation of essential details in the clinical notes. This form of education is promising and should be explored in future studies.

Case history: improved maxillary growth and development following digit sucking elimination and orofacial myofunctional therapy.

PubMed

Green, Shari

2013-11-01

Orofacial myologists are frequently called upon to address retained oral habit concerns. During this process, current I.A.O.M. recommended treatment includes addressing tongue, lip, and jaw rest posture concerns. Following digit sucking remediation, we may also be called upon to address these rest posture issues, and tongue thrust more aggressively together. In this process, facial growth and development and jaw structure may coincidentally improve as a result of 'nature taking its course' by addressing both swallow AND rest posture. In a select subset of clients, dramatic improvements may occur if the timing is right. This article discusses one such case that appears to have yielded a significant improvement in oral postures influencing improved facial and oral growth and development.

Equivalent plate modeling for conceptual design of aircraft wing structures

NASA Technical Reports Server (NTRS)

Giles, Gary L.

1995-01-01

This paper describes an analysis method that generates conceptual-level design data for aircraft wing structures. A key requirement is that this data must be produced in a timely manner so that is can be used effectively by multidisciplinary synthesis codes for performing systems studies. Such a capability is being developed by enhancing an equivalent plate structural analysis computer code to provide a more comprehensive, robust and user-friendly analysis tool. The paper focuses on recent enhancements to the Equivalent Laminated Plate Solution (ELAPS) analysis code that significantly expands the modeling capability and improves the accuracy of results. Modeling additions include use of out-of-plane plate segments for representing winglets and advanced wing concepts such as C-wings along with a new capability for modeling the internal rib and spar structure. The accuracy of calculated results is improved by including transverse shear effects in the formulation and by using multiple sets of assumed displacement functions in the analysis. Typical results are presented to demonstrate these new features. Example configurations include a C-wing transport aircraft, a representative fighter wing and a blended-wing-body transport. These applications are intended to demonstrate and quantify the benefits of using equivalent plate modeling of wing structures during conceptual design.

Oral Huangqi Formulae for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

PubMed Central

Wu, Lei; Chen, Yuanbin; Xu, Yinji; Guo, Xinfeng; Li, Xiaoyan; Zhang, Anthony Lin; May, Brian H.; Xue, Charlie Changli; Wen, Zehuai; Lin, Lin

2013-01-01

Objective. To evaluate the efficacy and safety of oral Huangqi formulae for the treatment of stable COPD. Methods. The major databases were searched until September 2010 and supplemented with a manual search. Randomized controlled trials (RCTs) of oral Huangqi formulae that reported on lung function, St. George's Respiratory Questionnaire, symptom improvement and/or frequency of exacerbations were extracted by two reviewers. The Cochrane tool was used for the assessment of risk of bias in the included trials. Data were analyzed with RevMan 5.1.2 software. Results. 25 RCTs (1,661 participants) were included. Compared with conventional therapy (CT) alone, oral Huangqi formulae plus CT increased FEV1, and a similar result was found comparing Huangqi formulae with no treatment. Improvements in SGRQ total score, COPD-related symptoms and reduction of frequency of exacerbations were found in patients receiving Huangqi formulae plus CT compared to those receiving CT alone or CT plus placebo. No serious adverse events were reported. However, there were some methodological inadequacies in the included studies. Conclusions. The benefits of Huangqi formulae for stable COPD were promising, but its efficacy and safety have not been established due to methodological weakness and possible bias in the reported results. Further rigorously designed studies are warranted. PMID:23606889

[The effectiveness of the improvement of health in the schoolchildren staying in a country summer camp].

PubMed

Lir, D N; Perevalov, A Ya

Organization of recreational activities in the children's camps is inseparable from the assessment of their effectiveness. The objective of the present study was to estimate the influence of the pastime of the children in a summer camp under the habitual climatic conditions and the resulting improvement of their health status including the body component composition and the functional state of the organism. The study included 44 schoolchildren at the age from 9 to12 years. The analysis of the effectiveness of recreational activities was carried out with the use of the method for the assessment of health improvement based at the children`s summer camps. Alterations in the component composition of the body were evaluated from the results of bioimpedansometry. The physical development of the majority of the schoolchildren involved in the study both in the beginning and the end of the camp period was fairly well balanced. During the period of resting in the camp (14 days), changes in the body weight were largely attributable to the alteration in the lean body mass whereas the fat component remained rather stable. The cardio-respiratory system did not show any unambiguous signs of positive dynamics. The physical conditions of the children estimated based on the hand dynamometry index showed a negative change. The comprehensive assessment of the degree of health improvement with the use of a scoring system made it possible to demonstrated that half of the schoolchildren spending time in the summer camp under the moderate climate conditions markedly improved their somatic health, functional and physical state whereas the remaining half enjoyed only a slight improvement. We suppose that the main causes preventing manifestations of the maximal positive effect of the pastime in the summer camp on the health status of the children included the short period of stay in the camp and the irrational use of the available complex of recreational activities, such as the sound nutrition regimen, adequate physical loading including locomotor activity, and psychological comfort). Bioimpedansometry which objectively reflects any changes in the body component composition is recommended for the application as one of the additional instruments for the objective analysis of the changes in the body component composition of the children and of the effects exerted by the recreational activities in the summer camp on their health status.

Clinician Descriptions of Communication Strategies to Improve Treatment Engagement by Racial/Ethnic Minorities in Mental Health Services: A Systematic Review

PubMed Central

Aggarwal, Neil Krishan; Pieh, Matthew C.; Dixon, Lisa; Guarnaccia, Peter; Alegría, Margarita; Lewis-Fernández, Roberto

2015-01-01

Objective To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment. Methods Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services. Results Twenty-three studies met inclusion criteria. Low treatment initiation and high treatment discontinuation were related to patient views that the mental health system did not address their understandings of illness, care or stigma. Treatment participation was based more on clinician language use, communication style, and discussions of patient-clinician differences. Conclusion Clinicians may improve treatment initiation and continuation by incorporating patient views of illness into treatment and targeting stigma. Clinicians may improve treatment participation by using simple language, tailoring communication to patient preferences, discussing differences, and demonstrating positive affect. Practice implications Lack of knowledge about the mental health system and somatic symptoms may delay treatment initiation. Discussions of clinician backgrounds, power, and communication style may improve treatment participation. Treatment continuation may improve if clinicians tailor communication and treatment plans congruent with patient expectations. PMID:26365436

Screening of transporters to improve xylodextrin utilization in the yeast Saccharomyces cerevisiae.

PubMed

Zhang, Chenlu; Acosta-Sampson, Ligia; Yu, Vivian Yaci; Cate, Jamie H D

2017-01-01

The economic production of cellulosic biofuel requires efficient and full utilization of all abundant carbohydrates naturally released from plant biomass by enzyme cocktails. Recently, we reconstituted the Neurospora crassa xylodextrin transport and consumption system in Saccharomyces cerevisiae, enabling growth of yeast on xylodextrins aerobically. However, the consumption rate of xylodextrin requires improvement for industrial applications, including consumption in anaerobic conditions. As a first step in this improvement, we report analysis of orthologues of the N. crassa transporters CDT-1 and CDT-2. Transporter ST16 from Trichoderma virens enables faster aerobic growth of S. cerevisiae on xylodextrins compared to CDT-2. ST16 is a xylodextrin-specific transporter, and the xylobiose transport activity of ST16 is not inhibited by cellobiose. Other transporters identified in the screen also enable growth on xylodextrins including xylotriose. Taken together, these results indicate that multiple transporters might prove useful to improve xylodextrin utilization in S. cerevisiae. Efforts to use directed evolution to improve ST16 from a chromosomally-integrated copy were not successful, due to background growth of yeast on other carbon sources present in the selection medium. Future experiments will require increasing the baseline growth rate of the yeast population on xylodextrins, to ensure that the selective pressure exerted on xylodextrin transport can lead to isolation of improved xylodextrin transporters.

Joy, Exercise, Enjoyment, Getting out: A Qualitative Study of Older People's Experience of Cycling in Sydney, Australia

PubMed Central

Passmore, Erin; Mason, Chloe; Rissel, Chris

2013-01-01

Introduction. Cycling can be an enjoyable way to meet physical activity recommendations and is suitable for older people; however cycling participation by older Australians is low. This qualitative study explored motivators, enablers, and barriers to cycling among older people through an age-targeted cycling promotion program. Methods. Seventeen adults who aged 50–75 years participated in a 12-week cycling promotion program which included a cycling skills course, mentor, and resource pack. Semistructured interviews at the beginning and end of the program explored motivators, enablers, and barriers to cycling. Results. Fitness and recreation were the primary motivators for cycling. The biggest barrier was fear of cars and traffic, and the cycling skills course was the most important enabler for improving participants' confidence. Reported outcomes from cycling included improved quality of life (better mental health, social benefit, and empowerment) and improved physical health. Conclusions. A simple cycling program increased cycling participation among older people. This work confirms the importance of improving confidence in this age group through a skills course, mentors, and maps and highlights additional strategies for promoting cycling, such as ongoing improvement to infrastructure and advertising. PMID:23864869

Introducing an accountability framework for polio eradication in Ethiopia: results from the first year of implementation 2014-2015

PubMed Central

Kassahun, Aron; Braka, Fiona; Gallagher, Kathleen; Gebriel, Aregai Wolde; Nsubuga, Peter; M’pele-Kilebou, Pierre

2017-01-01

Introduction the World Health Organization (WHO), Ethiopia country office, introduced an accountability framework into its Polio Eradication Program in 2014 with the aim of improving the program's performance. Our study aims to evaluate staff performance and key program indicators following the introduction of the accountability framework. Methods the impact of the WHO accountability framework was reviewed after its first year of implementation from June 2014 to June 2015. We analyzed selected program and staff performance indicators associated with acute flaccid paralysis (AFP) surveillance from a database available at WHO. Data on managerial actions taken were also reviewed. Performance of a total of 38 staff was evaluated during our review. Results our review of results for the first four quarters of implementation of the polio eradication accountability framework showed improvement both at the program and individual level when compared with the previous year. Managerial actions taken during the study period based on the results from the monitoring tool included eleven written acknowledgments, six discussions regarding performance improvement, six rotations of staff, four written first-warning letters and nine non-renewal of contracts. Conclusion the introduction of the accountability framework resulted in improvement in staff performance and overall program indicators for AFP surveillance. PMID:28890753

Clinical pathology of llamas and alpacas.

PubMed

Tornquist, Susan J

2009-07-01

Clinical laboratory data including hematology, hemostasis, biochemical, and cytologic findings contribute to diagnosis and monitoring of numerous conditions in camelids. Establishment of reference intervals and descriptions of normal components of fluids in these species have improved our ability to interpret test results.

Multihole Arc-Welding Orifice

NASA Technical Reports Server (NTRS)

Swaim, Benji D.

1989-01-01

Modified orifice for variable-polarity plasma-arc welding directs welding plume so it creates clean, even welds on both Inconel(R) and aluminum alloys. Includes eight holes to relieve back pressure in plasma. Quality of welds on ferrous and nonferrous alloys improved as result.

34 CFR 300.600 - State monitoring and enforcement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environment. (2) State exercise of general supervision, including child find, effective monitoring, the use of... CHILDREN WITH DISABILITIES Monitoring, Enforcement, Confidentiality, and Program Information Monitoring...) The primary focus of the State's monitoring activities must be on— (1) Improving educational results...

Microbial control of the gypsy moth in recently infested states: experiences and expectations

Treesearch

Timothy C. Tigner

1985-01-01

Experiences and expectations concerning microbial control of the gypsy moth in recently infested states are summarized. Initial experience included mixed results, but expectations remain optimistic. Public sentiment assures continued pressure for improvement in microbial control technology.

A Tale of Two Technologies.

ERIC Educational Resources Information Center

Tosti, Donald T.; Jackson, Stephanie F.

2001-01-01

Discusses information technology and human performance technology (HPT) and considers the potential of performance technology to improve business results. Topics include the strategic value of HPT in organizational governance, developing leadership capability, team building, fostering collaboration, and corporate culture change; and the need to…

The TRIDEC Virtual Tsunami Atlas - customized value-added simulation data products for Tsunami Early Warning generated on compute clusters

NASA Astrophysics Data System (ADS)

Löwe, P.; Hammitzsch, M.; Babeyko, A.; Wächter, J.

2012-04-01

The development of new Tsunami Early Warning Systems (TEWS) requires the modelling of spatio-temporal spreading of tsunami waves both recorded from past events and hypothetical future cases. The model results are maintained in digital repositories for use in TEWS command and control units for situation assessment once a real tsunami occurs. Thus the simulation results must be absolutely trustworthy, in a sense that the quality of these datasets is assured. This is a prerequisite as solid decision making during a crisis event and the dissemination of dependable warning messages to communities under risk will be based on them. This requires data format validity, but even more the integrity and information value of the content, being a derived value-added product derived from raw tsunami model output. Quality checking of simulation result products can be done in multiple ways, yet the visual verification of both temporal and spatial spreading characteristics for each simulation remains important. The eye of the human observer still remains an unmatched tool for the detection of irregularities. This requires the availability of convenient, human-accessible mappings of each simulation. The improvement of tsunami models necessitates the changes in many variables, including simulation end-parameters. Whenever new improved iterations of the general models or underlying spatial data are evaluated, hundreds to thousands of tsunami model results must be generated for each model iteration, each one having distinct initial parameter settings. The use of a Compute Cluster Environment (CCE) of sufficient size allows the automated generation of all tsunami-results within model iterations in little time. This is a significant improvement to linear processing on dedicated desktop machines or servers. This allows for accelerated/improved visual quality checking iterations, which in turn can provide a positive feedback into the overall model improvement iteratively. An approach to set-up and utilize the CCE has been implemented by the project Collaborative, Complex, and Critical Decision Processes in Evolving Crises (TRIDEC) funded under the European Union's FP7. TRIDEC focuses on real-time intelligent information management in Earth management. The addressed challenges include the design and implementation of a robust and scalable service infrastructure supporting the integration and utilisation of existing resources with accelerated generation of large volumes of data. These include sensor systems, geo-information repositories, simulations and data fusion tools. Additionally, TRIDEC adopts enhancements of Service Oriented Architecture (SOA) principles in terms of Event Driven Architecture (EDA) design. As a next step the implemented CCE's services to generate derived and customized simulation products are foreseen to be provided via an EDA service for on-demand processing for specific threat-parameters and to accommodate for model improvements.

Homeland Security Research Improves the Nation's Ability to ...

EPA Pesticide Factsheets

Technical Brief Homeland Security (HS) Research develops data, tools, and technologies to minimize the impact of accidents, natural disasters, terrorist attacks, and other incidents that can result in toxic chemical, biological or radiological (CBR) contamination. HS Research develops ways to detect contamination, sampling strategies, sampling and analytical methods, cleanup methods, waste management approaches, exposure assessment methods, and decision support tools (including water system models). These contributions improve EPA’s response to a broad range of environmental disasters.

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

NASA Technical Reports Server (NTRS)

Fasching, W. A.

1979-01-01

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

Improving patient safety: patient-focused, high-reliability team training.

PubMed

McKeon, Leslie M; Cunningham, Patricia D; Oswaks, Jill S Detty

2009-01-01

Healthcare systems are recognizing "human factor" flaws that result in adverse outcomes. Nurses work around system failures, although increasing healthcare complexity makes this harder to do without risk of error. Aviation and military organizations achieve ultrasafe outcomes through high-reliability practice. We describe how reliability principles were used to teach nurses to improve patient safety at the front line of care. Outcomes include safety-oriented, teamwork communication competency; reflections on safety culture and clinical leadership are discussed.

WRF Improves Downscaled Precipitation During El Niño Events over Complex Terrain in Northern South America: Implications for Deforestation Studies

NASA Astrophysics Data System (ADS)

Rendón, A.; Posada, J. A.; Salazar, J. F.; Mejia, J.; Villegas, J.

2016-12-01

Precipitation in the complex terrain of the tropical Andes of South America can be strongly reduced during El Niño events, with impacts on numerous societally-relevant services, including hydropower generation, the main electricity source in Colombia. Simulating rainfall patterns and behavior in such areas of complex terrain has remained a challenge for regional climate models. Current data products such as ERA-Interim and other reanalysis and modelling products generally fail to correctly represent processes at scales that are relevant for these processes. Here we assess the added value to ERA-Interim by dynamical downscaling using the WRF regional climate model, including a comparison of different cumulus parameterization schemes. We found that WRF improves the representation of precipitation during the dry season of El Niño (DJF) events using a 1996-2014 observation period. Further, we use these improved capability to simulate an extreme deforestation scenario under El Niño conditions for an area in the central Andes of Colombia, where a big proportion of the country's hydropower is generated. Our results suggest that forests dampen the effects of El Niño on precipitation. In synthesis, our results illustrate the utility of regional modelling to improve data sources, as well as their potential for predicting the local-to-regional effects of global-change-type processes in regions with limited data availability.

Hatha Yoga Practice Improves Attention and Processing Speed in Older Adults: Results from an 8-Week Randomized Control Trial.

PubMed

Gothe, Neha P; Kramer, Arthur F; McAuley, Edward

2017-01-01

Age-related cognitive decline is well documented across various aspects of cognitive function, including attention and processing speed, and lifestyle behaviors such as physical activity play an important role in preventing cognitive decline and maintaining or even improving cognitive function. The purpose of this study was to evaluate the effects of an 8-week Hatha yoga intervention on attention and processing speed among older adults. Participants (n = 118; mean age, 62 ± 5.59) were randomly assigned to an 8-week Hatha yoga group or a stretching control group and completed cognitive assessments-Attention Network Task, Trail Making Test parts A and B, and Pattern Comparison Test-at baseline and after the 8-week intervention. Analyses of covariance revealed significantly faster reaction times for the yoga group on the Attention Network Task's neutral, congruent, and incongruent conditions (p ≤ 0.04). The yoga intervention also improved participants' visuospatial and perceptual processing on the Trail Making Test part B (p = 0.002) and pattern comparison (p < 0.001) tests. These results suggest that yoga practice that includes postures, breathing, and meditative exercises lead to improved attentional and information processing abilities. Although the underlying mechanisms remain largely speculative, more systematic trials are needed to explore the extent of cognitive benefits and their neurobiological mechanisms.

Short note: the experimental geopotential model XGM2016

NASA Astrophysics Data System (ADS)

Pail, R.; Fecher, T.; Barnes, D.; Factor, J. F.; Holmes, S. A.; Gruber, T.; Zingerle, P.

2018-04-01

As a precursor study for the upcoming combined Earth Gravitational Model 2020 (EGM2020), the Experimental Gravity Field Model XGM2016, parameterized as a spherical harmonic series up to degree and order 719, is computed. XGM2016 shares the same combination methodology as its predecessor model GOCO05c (Fecher et al. in Surv Geophys 38(3): 571-590, 2017. doi: 10.1007/s10712-016-9406-y). The main difference between these models is that XGM2016 is supported by an improved terrestrial data set of 15^' × 15^' gravity anomaly area-means provided by the United States National Geospatial-Intelligence Agency (NGA), resulting in significant upgrades compared to existing combined gravity field models, especially in continental areas such as South America, Africa, parts of Asia, and Antarctica. A combination strategy of relative regional weighting provides for improved performance in near-coastal ocean regions, including regions where the altimetric data are mostly unchanged from previous models. Comparing cumulative height anomalies, from both EGM2008 and XGM2016 at degree/order 719, yields differences of 26 cm in Africa and 40 cm in South America. These differences result from including additional information of satellite data, as well as from the improved ground data in these regions. XGM2016 also yields a smoother Mean Dynamic Topography with significantly reduced artifacts, which indicates an improved modeling of the ocean areas.

Simulation-Based Cryosurgery Training: Variable Insertion-Depth Planning in Prostate Cryosurgery

PubMed Central

Sehrawat, Anjali; Keelan, Robert; Shimada, Kenji; Wilfong, Dona M.; McCormick, James T.; Rabin, Yoed

2015-01-01

A proof-of-concept for an advanced-level computerized training tool for cryosurgery is demonstrated, based on three-dimensional cryosurgery simulations and a variable insertion-depth strategy for cryoprobes. The objective for system development is twofold: to identify a cryoprobe layout in order to best-match a planning isotherm with the target region shape, and to verify that cryoprobe placement does not violate accepted geometric constraints. System validation has been performed by collecting training data from 17 surgical residents, having no prior experience or advanced knowledge of cryosurgery. This advanced-level study includes an improved training-session design, in order to enhance knowledge dissemination and elevate participant motivation to excel. In terms of match between a planning isotherm and the target region shape, results of this demonstrate trainee performance improvement from 4.4% in a pretest to 44.4% in a posttest over a course of 50 minutes of training. In terms of combined performance, including the above geometrical match and constraints on cryoprobe placement, this study demonstrates trainee performance improvement from 2.2% in the pretest to 31.1% in the posttest. Given the relatively short training session and the lack of prior knowledge, these improvements are significant and encouraging. These results are of particular significance, as they have been obtained from a surgical resident population, which are exposed to the typical stress and constraints in advanced surgical education. PMID:26546576

Family satisfaction with critical care: measurements and messages.

PubMed

Rothen, Hans U; Stricker, Kay H; Heyland, Daren K

2010-12-01

Family satisfaction in the ICU reflects the extent to which perceived needs and expectations of family members of critically ill patients are met by healthcare professionals. Here, we present recently developed tools to assess family satisfaction, with a special focus on their psychometric properties. Assessing family satisfaction, however, is not of much use if it is not followed by interpretation of the results and, if needed, consecutive measures to improve care of the patients and their families, or improvement in communication and decision-making. Accordingly, this review will outline recent findings in this field. Finally, possible areas of future research are addressed. To assess family satisfaction in the ICU, several domains deserve attention. They include, among others, care of the patient, counseling and emotional support of family members, information and decision-making. Overall, communication between physicians or nurses and members of the family remains a key topic, and there are many opportunities to improve. They include not only communication style, timing and appropriate wording but also, for example, assessments to see if information was adequately received and also understood. Whether unfulfilled needs of individual members of the family or of the family as a social system result in negative long-term sequels remains an open question. Assessing and analyzing family satisfaction in the ICU ultimately will support healthcare professionals in their continuing effort to improve care of critically ill patients and their families.

Initial Development of a Spatially Separated Speech-in-Noise and Localization Training Program

PubMed Central

Tyler, Richard S.; Witt, Shelley A.; Dunn, Camille C.; Wang, Wenjun

2010-01-01

Objective This article describes the initial development of a novel approach for training hearing-impaired listeners to improve their ability to understand speech in the presence of background noise and to also improve their ability to localize sounds. Design Most people with hearing loss, even those well fit with hearing devices, still experience significant problems understanding speech in noise. Prior research suggests that at least some subjects can experience improved speech understanding with training. However, all training systems that we are aware of have one basic, critical limitation. They do not provide spatial separation of the speech and noise, therefore ignoring the potential benefits of training binaural hearing. In this paper we describe our initial experience with a home-based training system that includes spatially separated speech-in-noise and localization training. Results Throughout the development of this system patient input, training and preliminary pilot data from individuals with bilateral cochlear implants were utilized. Positive feedback from subjective reports indicated that some individuals were engaged in the treatment, and formal testing showed benefit. Feedback and practical issues resulted from the reduction of an eight-loudspeaker to a two-loudspeaker system. Conclusions These preliminary findings suggest we have successfully developed a viable spatial hearing training system that can improve binaural hearing in noise and localization. Applications include, but are not limited to, hearing with hearing aids and cochlear implants. PMID:20701836

Neuropsychological and quality of life assessment in patients with Parkinson's disease submitted to bilateral deep brain stimulation in the subthalamic nucleus

PubMed Central

Heluani, Alessandra Shenandoa; Porto, Fábio Henrique de Gobbi; Listik, Sergio; de Campos, Alexandre Walter; Machado, Alexandre Aluizio Costa; Cukiert, Arthur; de Oliveira Jr, José Oswaldo

2012-01-01

Deep brain stimulation (DBS) has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD). Recently, DBS in the subthalamic nucleus (STN) has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms. Objective To evaluate the influence of DBS in the STN on cognition, mood and quality of life. Methods We studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); and the Hospital Anxiety and Depression Scale (HAD), were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test. Results A total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively). No significant difference was found on the cognitive battery or mood scale. Conclusion DBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood. PMID:29213806

Know your audience: analysis of chief complaints at clinica esperanza, a student-run free clinic in memphis, tennessee.

PubMed

Cesari, Whitney A; Vaikunth, Sumeet S; Lewis, Jim B; Panda, Mukta

2012-10-01

To identify the chief complaints and demographics at Clinica Esperanza, a student-run free clinic for an underserved Hispanic population. A retrospective chart review of patient files from 2005 through 2010 was undertaken, as approved by the University of Tennessee Health Science Center's Institutional Review Board. From 2005 through 2010, Clinica Esperanza fielded 2551 patient visits, consisting of 951 unique patients, 609 females and 342 males. Mean age was 34 years, and 60% of patients presented once, while 13% followed up for 1 year, 9% for 2 years, 6% for 3, 6% for 4, and 4% for 5. "Pap smear," "abdominal pain," and "follow-up lab results" ranked, in order, as the 3 top chief complaints. Resulting data have led to several improvements. The clinic has remained open weekly to improve patient continuity. With the top 10 chief complaints identified, they are better addressed. More funding is allocated for speculums and proper training of Pap smear technique. Systematic reporting of lab results is being implemented. Physical therapists and pharmacists now participate to address musculoskeletal and medication-based needs, respectively. A volunteer gastroenterologist has been recruited to provide specialized care for abdominal pain. An electrocardiogram machine is now used to evaluate chest pain. To improve student-patient communication, online language learning modules have been created. Based on these data, improvements in health care services have been made, including better continuity, emphasis on top chief complaints, and provider education in medical Spanish. Future plans include on-site pharmacy, smoother referrals, and similar clinics on the University of Tennessee Health Science Center's other campuses.

Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review

PubMed Central

Rushforth, Bruno; McCrorie, Carolyn; Glidewell, Liz; Midgley, Eleanor; Foy, Robbie

2016-01-01

Background Despite the availability of evidence-based guidance, many patients with type 2 diabetes do not achieve treatment goals. Aim To guide quality improvement strategies for type 2 diabetes by synthesising qualitative evidence on primary care physicians’ and nurses’ perceived influences on care. Design and setting Systematic review of qualitative studies with findings organised using the Theoretical Domains Framework. Method Databases searched were MEDLINE, Embase, CINAHL, PsycInfo, and ASSIA from 1980 until March 2014. Studies included were English-language qualitative studies in primary care of physicians’ or nurses’ perceived influences on treatment goals for type 2 diabetes. Results A total of 32 studies were included: 17 address general diabetes care, 11 glycaemic control, three blood pressure, and one cholesterol control. Clinicians struggle to meet evolving treatment targets within limited time and resources, and are frustrated with resulting compromises. They lack confidence in knowledge of guidelines and skills, notably initiating insulin and facilitating patient behaviour change. Changing professional boundaries have resulted in uncertainty about where clinical responsibility resides. Accounts are often couched in emotional terms, especially frustrations over patient compliance and anxieties about treatment intensification. Conclusion Although resources are important, many barriers to improving care are amenable to behaviour change strategies. Improvement strategies need to account for differences between clinical targets and consider tailored rather than ‘one size fits all’ approaches. Training targeting knowledge is necessary but insufficient to bring about major change; approaches to improve diabetes care need to delineate roles and responsibilities, and address clinicians’ skills and emotions around treatment intensification and facilitation of patient behaviour change. PMID:26823263