Availability and acceptability of HIV counselling and testing services. A qualitative study comparing clients' experiences of accessing HIV testing at public sector primary health care facilities or non-governmental mobile services in Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Leon, Natalie; Naidoo, Pren; Jennings, Karen; Burger, Ronelle; Beyers, Nulda

2015-09-02

The South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services. This qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT). The sample consisted of 12 females and 4 males with an age range of 19-60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services. Realised access to HCT is dependent on availability and acceptability of HCT services. Those who utilised either a NGO mobile service or a public PHC facility perceived both service types as available and acceptable. Mobile NGO services provided an accessible opportunity for those who would otherwise not have tested at that time. Policy makers should consider the perceptions and experiences of those accessing HCT services when increasing access to HCT.

Manned Systems Utilization Analysis. Study 2.1: Space Servicing Pilot Program Study. [for automated payloads

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1975-01-01

Space servicing automated payloads was studied for potential cost benefits for future payload operations. Background information is provided on space servicing in general, and on a pilot flight test program in particular. An fight test is recommended to demonstrate space servicing. An overall program plan is provided which builds upon the pilot program through an interim servicing capability. A multipayload servicing concept for the time when the full capability tug becomes operational is presented. The space test program is specifically designed to provide low-cost booster vehicles and a flight test platform for several experiments on a single flight.

Evaluation of the Implementation of a New Nurse-Led Express "Test-And-Go" Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Service for Men Who Have Sex With Men at a Sexual Health Center in Melbourne, Australia.

PubMed

Chow, Eric P F; Fortune, Ria; Dobinson, Sheranne; Wakefield, Trish; Read, Tim R H; Chen, Marcus Y; Bradshaw, Catriona S; Fehler, Glenda; Fairley, Christopher K

2018-06-01

In August 2015, a nurse-led express human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing service "Test-And-Go" (TAG) for asymptomatic men who have sex with men (MSM) was implemented in a large public sexual health center in Melbourne, Australia. We aimed to compare the clients' characteristics between the TAG and routine walk-in service among asymptomatic MSM. This study was conducted at the Melbourne Sexual Health Centre, Australia, between August 5, 2015, and June 1, 2016. General estimating equation logistic regression models were constructed to examine the association between the use of TAG service and clients' demographic characteristics, sexual behaviors, and HIV/STI positivity. Clients' consultation and waiting times for both services were calculated. Of the 3520 consultations, 784 (22.3%) were TAG services and 2736 (77.7%) were routine walk-in services for asymptomatic MSM. Asymptomatic MSM were more likely to use the TAG service if they were born in Australia (adjusted odds ratio, 1.29; 95% confidence interval, 1.07-1.56), and had more than 6 male partners in the last 12 months (adjusted odds ratio, 1.13; 95% confidence interval, 1.08-1.58). Age, HIV status, condomless anal sex and HIV/STI positivity did not differ between the two services. The TAG service had a shorter median waiting time (8.4 minutes vs 52.9 minutes; p < 0.001) and consultation time (8.9 minutes vs 17.6 minutes; p < 0.001) than the routine walk-in service. Although country of birth and sexual behaviors differed between clients attending the 2 services, there were no differences in HIV and STI positivity. Importantly, the TAG service required less waiting and consultation time and hence created additional clinic capacity at the general clinic to see clients who are at higher risk.

Testing Services

NASA Technical Reports Server (NTRS)

1993-01-01

Trace Laboratories is an independent testing laboratory specializing in testing printed circuit boards, automotive products and military hardware. Technical information from NASA Tech Briefs and two subsequent JPL Technical Support packages have assisted Trace in testing surface insulation resistance on printed circuit board materials. Testing time was reduced and customer service was improved because of Jet Propulsion Laboratory technical support packages.

20 CFR 1002.236 - How is the employee's rate of pay determined when he or she returns from a period of service?

Code of Federal Regulations, 2010 CFR

2010-04-01

... missed. If the merit pay increase that the employee missed during service is based on a skills test or... reemployment position and then give him or her the skills test or examination. No fixed amount of time for... typical time necessary to prepare or study for the test, the duties and responsibilities of the...

Predictive Service Life Tests for Roofing Membranes

NASA Astrophysics Data System (ADS)

Bailey, David M.; Cash, Carl G.; Davies, Arthur G.

2002-09-01

The average service life of roofing membranes used in low-slope applications on U.S. Army buildings is estimated to be considerably shorter than the industry-presumed 20-year design life, even when installers carefully adhere to the latest guide specifications. This problem is due in large part to market-driven product development cycles, which do not include time for long-term field testing. To reduce delivery costs, contractors may provide untested, interior membranes in place of ones proven satisfactory in long-term service. Federal procurement regulations require that roofing systems and components be selected according to desired properties and generic type, not brand name. The problem is that a material certified to have satisfactory properties at installation time will not necessarily retain those properties in service. The overall objective of this research is to develop a testing program that can be executed in a matter of weeks to adequately predict a membrane's long-term performance in service. This report details accelerated aging tests of 12 popular membrane materials in the laboratory, and describes outdoor experiment stations set up for long-term exposure tests of those same membranes. The laboratory results will later be correlated with the outdoor test results to develop performance models and predictive service life tests.

Characteristics of U.S. Substance Abuse Treatment Facilities Offering HIV Services: Results From a National Survey.

PubMed

Cohn, Amy; Stanton, Cassandra; Elmasry, Hoda; Ehlke, Sarah; Niaura, Ray

2016-06-01

Substance use disorders are common among persons with HIV/AIDS. This study examined the prevalence and correlates of the provision of four HIV services in a national sample of substance abuse treatment facilities. Data were from the 2011 National Survey of Substance Abuse Treatment Services. Prevalence estimates indicated that 28% of facilities offered HIV testing, 26% early intervention, 58% HIV/AIDS education, and 8% special programs for HIV/AIDS. Facilities offering inpatient substance abuse care were more than six times as likely to offer HIV testing but not more likely to offer any other type of HIV service. Facilities offering methadone treatment were 2.5 times more likely to offer HIV services. Given the high rates of substance use among persons with HIV, the prevalence of facilities offering HIV services was low in most domains, with different barriers identified in multivariable models. Integrating comprehensive HIV prevention, testing, and support services into programs that address substance abuse is needed.

Service Life Extension of the Propulsion System of Long-Term Manned Orbital Stations

NASA Technical Reports Server (NTRS)

Kamath, Ulhas; Kuznetsov, Sergei; Spencer, Victor

2014-01-01

One of the critical non-replaceable systems of a long-term manned orbital station is the propulsion system. Since the propulsion system operates beginning with the launch of station elements into orbit, its service life determines the service life of the station overall. Weighing almost a million pounds, the International Space Station (ISS) is about four times as large as the Russian space station Mir and about five times as large as the U.S. Skylab. Constructed over a span of more than a decade with the help of over 100 space flights, elements and modules of the ISS provide more research space than any spacecraft ever built. Originally envisaged for a service life of fifteen years, this Earth orbiting laboratory has been in orbit since 1998. Some elements that have been launched later in the assembly sequence were not yet built when the first elements were placed in orbit. Hence, some of the early modules that were launched at the inception of the program were already nearing the end of their design life when the ISS was finally ready and operational. To maximize the return on global investments on ISS, it is essential for the valuable research on ISS to continue as long as the station can be sustained safely in orbit. This paper describes the work performed to extend the service life of the ISS propulsion system. A system comprises of many components with varying failure rates. Reliability of a system is the probability that it will perform its intended function under encountered operating conditions, for a specified period of time. As we are interested in finding out how reliable a system would be in the future, reliability expressed as a function of time provides valuable insight. In a hypothetical bathtub shaped failure rate curve, the failure rate, defined as the number of failures per unit time that a currently healthy component will suffer in a given future time interval, decreases during infant-mortality period, stays nearly constant during the service life and increases at the end when the design service life ends and wear-out phase begins. However, the component failure rates do not remain constant over the entire cycle life. The failure rate depends on various factors such as design complexity, current age of the component, operating conditions, severity of environmental stress factors, etc. Development, qualification and acceptance test processes provide rigorous screening of components to weed out imperfections that might otherwise cause infant mortality failures. If sufficient samples are tested to failure, the failure time versus failure quantity can be analyzed statistically to develop a failure probability distribution function (PDF), a statistical model of the probability of failure versus time. Driven by cost and schedule constraints however, spacecraft components are generally not tested in large numbers. Uncertainties in failure rate and remaining life estimates increase when fewer units are tested. To account for this, spacecraft operators prefer to limit useful operations to a period shorter than the maximum demonstrated service life of the weakest component. Running each component to its failure to determine the maximum possible service life of a system can become overly expensive and impractical. Spacecraft operators therefore, specify the required service life and an acceptable factor of safety (FOS). The designers use these requirements to limit the life test duration. Midway through the design life, when benefits justify additional investments, supplementary life test may be performed to demonstrate the capability to safely extend the service life of the system. An innovative approach is required to evaluate the entire system, without having to go through an elaborate test program of propulsion system elements. Evaluating every component through a brute force test program would be a cost prohibitive and time consuming endeavor. ISS propulsion system components were designed and built decades ago. There are no representative ground test articles for some of the components. A 'test everything' approach would require manufacturing new test articles. The paper outlines some of the techniques used for selective testing, by way of cherry picking candidate components based on failure mode effects analysis, system level impacts, hazard analysis, etc. The type of testing required for extending the service life depends on the design and criticality of the component, failure modes and failure mechanisms, life cycle margin provided by the original certification, operational and environmental stresses encountered, etc. When specific failure mechanism being considered and the underlying relationship of that mode to the stresses provided in the test can be correlated by supporting analysis, time and effort required for conducting life extension testing can be significantly reduced. Exposure to corrosive propellants over long periods of time, for instance, lead to specific failure mechanisms in several components used in the propulsion system. Using Arrhenius model, which is tied to chemically dependent failure mechanisms such as corrosion or chemical reactions, it is possible to subject carefully selected test articles to accelerated life test. Arrhenius model reflects the proportional relationship between time to failure of a component and the exponential of the inverse of absolute temperature acting on the component. The acceleration factor is used to perform tests at higher stresses that allow direct correlation between the times to failure at a high test temperature to the temperatures to be expected in actual use. As long as the temperatures are such that new failure mechanisms are not introduced, this becomes a very useful method for testing to failure a relatively small sample of items for a much shorter amount of time. In this article, based on the example of the propulsion system of the first ISS module Zarya, theoretical approaches and practical activities of extending the service life of the propulsion system are reviewed with the goal of determining the maximum duration of its safe operation.

Lifetime prediction for organic coating under alternating hydrostatic pressure by artificial neural network

PubMed Central

Tian, Wenliang; Meng, Fandi; Liu, Li; Li, Ying; Wang, Fuhui

2017-01-01

A concept for prediction of organic coatings, based on the alternating hydrostatic pressure (AHP) accelerated tests, has been presented. An AHP accelerated test with different pressure values has been employed to evaluate coating degradation. And a back-propagation artificial neural network (BP-ANN) has been established to predict the service property and the service lifetime of coatings. The pressure value (P), immersion time (t) and service property (impedance modulus |Z|) are utilized as the parameters of the network. The average accuracies of the predicted service property and immersion time by the established network are 98.6% and 84.8%, respectively. The combination of accelerated test and prediction method by BP-ANN is promising to evaluate and predict coating property used in deep sea. PMID:28094340

Implementation of a new 'community' laboratory CD4 service in a rural health district in South Africa extends laboratory services and substantially improves local reporting turnaround time.

PubMed

Coetzee, L M; Cassim, N; Glencross, D K

2015-12-16

The CD4 integrated service delivery model (ITSDM) provides for reasonable access to pathology services across South Africa (SA) by offering three new service tiers that extend services into remote, under-serviced areas. ITSDM identified Pixley ka Seme as such an under-serviced district. To address the poor service delivery in this area, a new ITSDM community (tier 3) laboratory was established in De Aar, SA. Laboratory performance and turnaround time (TAT) were monitored post implementation to assess the impact on local service delivery. Using the National Health Laboratory Service Corporate Data Warehouse, CD4 data were extracted for the period April 2012-July 2013 (n=11,964). Total mean TAT (in hours) was calculated and pre-analytical and analytical components assessed. Ongoing testing volumes, as well as external quality assessment performance across ten trials, were used to indicate post-implementation success. Data were analysed using Stata 12. Prior to the implementation of CD4 testing at De Aar, the total mean TAT was 20.5 hours. This fell to 8.2 hours post implementation, predominantly as a result of a lower pre-analytical mean TAT reducing from a mean of 18.9 to 1.8 hours. The analytical testing TAT remained unchanged after implementation and monthly test volumes increased by up to 20%. External quality assessment indicated adequate performance. Although subjective, questionnaires sent to facilities reported improved service delivery. Establishing CD4 testing in a remote community laboratory substantially reduces overall TAT. Additional community CD4 laboratories should be established in under-serviced areas, especially where laboratory infrastructure is already in place.

47 CFR 87.45 - Time in which station is placed in operation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SPECIAL RADIO SERVICES AVIATION SERVICES Applications and Licenses § 87.45 Time in which station is placed..., excluding radionavigation land test stations. When a new license has been issued or additional operating...

Time devoted to pre- and post-HIV test counselling in different health services according to participants of a rapid testing program in Madrid, Spain.

PubMed

Hoyos Miller, Juan; Fernández-Balbuena, Sonia; Belza Egozcue, María José; García de Olalla, Patricia; Pulido Manzanero, Jose; Molist Señe, Gemma; de la Fuente de Hoz, Luis

2014-02-01

The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test. We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008. The majority (71%) were men (48% had had sex with other men), 51% were <30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported <10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings. Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement. Copyright © 2012 Elsevier España, S.L. All rights reserved.

21 CFR 864.7875 - Thrombin time test.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Thrombin time test. 864.7875 Section 864.7875 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7875 Thrombin time test. (a...

21 CFR 864.7875 - Thrombin time test.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Thrombin time test. 864.7875 Section 864.7875 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7875 Thrombin time test. (a...

21 CFR 864.7875 - Thrombin time test.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Thrombin time test. 864.7875 Section 864.7875 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7875 Thrombin time test. (a...

21 CFR 864.7875 - Thrombin time test.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Thrombin time test. 864.7875 Section 864.7875 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7875 Thrombin time test. (a...

21 CFR 864.7875 - Thrombin time test.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Thrombin time test. 864.7875 Section 864.7875 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7875 Thrombin time test. (a...

49 CFR 236.378 - Time locking.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Time locking. 236.378 Section 236.378 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... and Tests § 236.378 Time locking. Time locking shall be tested when placed in service and thereafter...

49 CFR 236.378 - Time locking.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Time locking. 236.378 Section 236.378 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... and Tests § 236.378 Time locking. Time locking shall be tested when placed in service and thereafter...

An Estimation Method of Waiting Time for Health Service at Hospital by Using a Portable RFID and Robust Estimation

NASA Astrophysics Data System (ADS)

Ishigaki, Tsukasa; Yamamoto, Yoshinobu; Nakamura, Yoshiyuki; Akamatsu, Motoyuki

Patients that have an health service by doctor have to wait long time at many hospitals. The long waiting time is the worst factor of patient's dissatisfaction for hospital service according to questionnaire for patients. The present paper describes an estimation method of the waiting time for each patient without an electronic medical chart system. The method applies a portable RFID system to data acquisition and robust estimation of probability distribution of the health service and test time by doctor for high-accurate waiting time estimation. We carried out an health service of data acquisition at a real hospital and verified the efficiency of the proposed method. The proposed system widely can be used as data acquisition system in various fields such as marketing service, entertainment or human behavior measurement.

Qualitative Assessment of the Integration of HIV Services With Infant Routine Immunization Visits in Tanzania

PubMed Central

Wallace, Aaron; Kimambo, Sajida; Dafrossa, Lyimo; Rusibamayila, Neema; Rwebembera, Anath; Songoro, Juma; Arthur, Gilly; Luman, Elizabeth; Finkbeiner, Thomas; Goodson, James L.

2015-01-01

Background In 2009, a project was implemented in 8 primary health clinics throughout Tanzania to explore the feasibility of integrating pediatric HIV prevention services with routine infant immunization visits. Methods We conducted interviews with 64 conveniently sampled mothers of infants who had received integrated HIV and immunization services and 16 providers who delivered the integrated services to qualitatively identify benefits and challenges of the intervention midway through project implementation. Findings Mothers’ perceived benefits of the integrated services included time savings, opportunity to learn their child's HIV status and receive HIV treatment, if necessary. Providers’ perceived benefits included reaching mothers who usually would not come for only HIV testing. Mothers and providers reported similar challenges, including mothers’ fear of HIV testing, poor spousal support, perceived mandatory HIV testing, poor patient flow affecting confidentiality of service delivery, heavier provider workloads, and community stigma against HIV-infected persons; the latter a more frequent theme in rural compared with urban locations. Interpretation Future scale-up should ensure privacy of these integrated services received at clinics and community outreach to address stigma and perceived mandatory testing. Increasing human resources for health to address higher workloads and longer waiting times for proper patient flow is necessary in the long term. PMID:24326602

Ubiquitous health monitoring and real-time cardiac arrhythmias detection: a case study.

PubMed

Li, Jian; Zhou, Haiying; Zuo, Decheng; Hou, Kun-Mean; De Vaulx, Christophe

2014-01-01

As the symptoms and signs of heart diseases that cause sudden cardiac death, cardiac arrhythmia has attracted great attention. Due to limitations in time and space, traditional approaches to cardiac arrhythmias detection fail to provide a real-time continuous monitoring and testing service applicable in different environmental conditions. Integrated with the latest technologies in ECG (electrocardiograph) analysis and medical care, the pervasive computing technology makes possible the ubiquitous cardiac care services, and thus brings about new technical challenges, especially in the formation of cardiac care architecture and realization of the real-time automatic ECG detection algorithm dedicated to care devices. In this paper, a ubiquitous cardiac care prototype system is presented with its architecture framework well elaborated. This prototype system has been tested and evaluated in all the clinical-/home-/outdoor-care modes with a satisfactory performance in providing real-time continuous cardiac arrhythmias monitoring service unlimitedly adaptable in time and space.

Emergency medical services and congestion : urban sprawl and pre-hospital emergency care time.

DOT National Transportation Integrated Search

2009-01-01

This research measured the association between urban sprawl and emergency medical service (EMS) response time. The purpose was to test the hypothesis that features of the built environment increase the probability of delayed ambulance arrival. Using ...

Oral Language Proficiency Testing at the Foreign Service Institute. An Update--1983.

ERIC Educational Resources Information Center

Crawford, Gary D.; And Others

The Foreign Service Institute (FSI) has been engaged in oral language proficiency testing theory and practice for more than 20 years. The FSI test has been consistent during this time in format, evaluation criteria, performance standards, and level definitions. Current concerns about the degree of standardization of the format and the strength of…

Bayes Analysis and Reliability Implications of Stress-Rupture Testing a Kevlar/Epoxy COPV using Temperature and Pressure Acceleration

NASA Technical Reports Server (NTRS)

Phoenix, S. Leigh; Kezirian, Michael T.; Murthy, Pappu L. N.

2009-01-01

Composite Overwrapped Pressure Vessel (COPVs) that have survived a long service time under pressure generally must be recertified before service is extended. Sometimes lifetime testing is performed on an actual COPV in service in an effort to validate the reliability model that is the basis for certifying the continued flight worthiness of its sisters. Currently, testing of such a Kevlar49(registered TradeMark)/epoxy COPV is nearing completion. The present paper focuses on a Bayesian statistical approach to analyze the possible failure time results of this test and to assess the implications in choosing between possible model parameter values that in the past have had significant uncertainty. The key uncertain parameters in this case are the actual fiber stress ratio at operating pressure, and the Weibull shape parameter for lifetime; the former has been uncertain due to ambiguities in interpreting the original and a duplicate burst test. The latter has been uncertain due to major differences between COPVs in the data base and the actual COPVs in service. Any information obtained that clarifies and eliminates uncertainty in these parameters will have a major effect on the predicted reliability of the service COPVs going forward. The key result is that the longer the vessel survives, the more likely the more optimistic stress ratio is correct. At the time of writing, the resulting effect on predicted future reliability is dramatic, increasing it by about one nine , that is, reducing the probability of failure by an order of magnitude. However, testing one vessel does not change the uncertainty on the Weibull shape parameter for lifetime since testing several would be necessary.

Integrated orbital servicing study follow-on. Volume 3: Engineering test unit and controls

NASA Technical Reports Server (NTRS)

1978-01-01

A one-g servicing demonstration system which can be used to investigate and develop, in a real time hands-on situation, a wide variety of the mechanism and control system aspects of orbital servicing in the form of module exchange is described including the engineering test unit and the servicer servo drive console. A series of recommendations for future work is given concerning the control problem and more efficient module exchanges, mechanical elements, and electronics.

Annotated Bibliography of Psychomotor Testing.

DTIC Science & Technology

1987-03-01

of observation and comparison were administered four times in one week to 394 adolescent boys enrolled in a trade school. Observations and subjective...44 Time Production Test: 15 Torque Test: 48,49,64,65 Tremor: 2 U Underwater depth, effects of: 2,3,11 U.S. Employment Service Pegboard: 16 V Videogame

21 CFR 864.7275 - Euglobulin lysis time tests.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Euglobulin lysis time tests. 864.7275 Section 864.7275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... evaluates natural fibrinolysis (destruction of a blood clot after bleeding has been arrested). The test also...

Designing Human Immunodeficiency Virus Counselling and Testing Services to Maximize Uptake Among High School Learners in South Africa: What Matters?

PubMed

Strauss, Michael; George, Gavin; Rhodes, Bruce

2017-05-01

Increasing human immunodeficiency virus (HIV) testing in South Africa is vital for the HIV response. Targeting young people is important as they become sexually active and because HIV risk rapidly increases as youth enter their 20s. This study aims to increase the understanding of high school learners' preferences regarding the characteristics of HIV testing service delivery models and to inform policy makers and implementers regarding potential barriers to and facilitators of HIV testing. An attitudinal survey was used to examine HIV testing preferences among 248 high school learners in KwaZulu-Natal. Statistical tests were used to identify the most favored characteristics of testing service delivery models and examine key differences in preferences based on demographic characteristics and testing history. Most learners were found to prefer testing offered at a clinic on a Saturday (43%), using a finger prick test (59%), conducted by a doctor (61%) who also provides individual counselling (60%). Shorter testing times were preferred, as well as a monetary incentive to cover any associated expenses. Time, location, the type of test, and who conducts the test were most important. However, stratified analysis suggests that preferences diverge, particularly around gender, grade, but also sexual history and previous testing experience. Human immunodeficiency virus testing services can be improved in line with preferences, but there is no single optimal design that caters to the preferences of all learners. It is unlikely that a "one-size-fits-all" approach will be effective to reach HIV testing targets. A range of options may be required to maximize coverage.

Applying Total Quality Management in Cooperative Extension.

ERIC Educational Resources Information Center

Fredendall, Lawrence D.; Lippert, Robert M.

1995-01-01

South Carolina's Agricultural Service Laboratory received responses from 252 of 500 farmers who currently use the soil testing service; 97% were pleased with accuracy, 89% with turnaround time, 18% thought the fee too high. Nonusers (100 of 520) were mainly dissatisfied with turnaround time. Total quality management methods were used to improve…

Implementation of a chest pain management service improves patient care and reduces length of stay.

PubMed

Scott, Adam C; O'Dwyer, Kristina M; Cullen, Louise; Brown, Anthony; Denaro, Charles; Parsonage, William

2014-03-01

Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

Impact of nurse-delivered community-based CD4 services on facilitating pre-ART care in rural South Africa.

PubMed

Kompala, T; Moll, A P; Mtungwa, N; Brooks, R P; Friedland, G H; Shenoi, S V

2016-08-11

HIV testing, diagnosis and treatment programs have expanded globally, particularly in resource-limited settings. Diagnosis must be followed by determination of treatment eligibility and referral to care prior to initiation of antiretroviral treatment (ART). However, barriers and delays along these early steps in the treatment cascade may impede successful ART initiation. New strategies are needed to facilitate the treatment cascade. We evaluated the role of on site CD4+ T cell count phlebotomy services by nurses in facilitating pre-ART care in a community-based voluntary counseling and testing program (CBVCT) in rural South Africa. We retrospectively evaluated CBVCT services during five continuous time periods over three years: three periods when a nurse was present on site, and two periods when the nurse was absent. When a nurse was present, CD4 count phlebotomy was performed immediately after HIV testing to determine ART eligibility. When a nurse was absent, patients were referred to their local primary care clinic for CD4 testing. For each period, we determined the proportion of HIV-positive community members who completed CD4 testing, received notification of CD4 count results, as well as the time to test completion and result notification. Between 2010 and 2013, 7213 individuals accessed CBVCT services; of these, 620 (8.6 %) individuals were HIV-positive, 205 (33.1 %) were eligible for ART according to South African national CD4 count criteria, and 78 (38.0 % of those eligible) initiated ART. During the periods when a professional nurse was available to provide CD4 phlebotomy services, HIV-positive clients were significantly more likely to complete CD4 testing than during periods when these services were not available (85.5 % vs. 37.3 %, p < 0.001). Additionally, when nurses were present, individuals were significantly more likely to be notified of CD4 results (60.6 % vs. 26.7 %, p <0.001). The time from HIV screening to CD4 test completion was also significantly shorter during nurse presence than nurse absence (median 8 days (IQR 4-19) vs. 35 days (IQR 15-131), p < 0.001). These findings indicate that in addition to CBVCT, availability of on site CD4 phlebotomy may reduce loss along the pre-ART care cascade and facilitate timely entry into HIV care.

Prediction of toxicity and comparison of alternatives using WebTEST (Web-services Toxicity Estimation Software Tool)

EPA Science Inventory

A Java-based web service is being developed within the US EPA’s Chemistry Dashboard to provide real time estimates of toxicity values and physical properties. WebTEST can generate toxicity predictions directly from a simple URL which includes the endpoint, QSAR method, and ...

Prediction of toxicity and comparison of alternatives using WebTEST (Web-services Toxicity Estimation Software Tool)(Bled Slovenia)

EPA Science Inventory

A Java-based web service is being developed within the US EPA’s Chemistry Dashboard to provide real time estimates of toxicity values and physical properties. WebTEST can generate toxicity predictions directly from a simple URL which includes the endpoint, QSAR method, and ...

Selective testing of women based on age for genital Chlamydia trachomatis and Neisseria gonorrhoeae infection in a centralized regional microbiology laboratory.

PubMed

Church, Deirdre L; Amante, L; Semeniuk, H; Gregson, D B

2007-04-01

Calgary Laboratory Services, Alberta, Canada, provides microbiology services via a centralized laboratory to the Calgary Health Region. A selective genital Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) testing policy for women >35 years was implemented. The changes in physician ordering practice, the rate of detection of infections, and the test turnaround times were monitored. The volume of tests, the cost/test, and the total service costs accrued in the year before and after this policy change were compared. An immediate impact was a 30% decrease in tests performed due to the laboratory rejecting samples from older women. Subsequently, physicians' practice changed so that tests were ordered when test criteria were met. Detection rates did not change in any age group. A 27.9% decrease in the total service costs resulted in a labor reduction of 0.2 FTE. Selective testing of women >35 years with a low prevalence of CT/GC infection is clinically relevant and cost-effective.

21 CFR 864.7750 - Prothrombin time test.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prothrombin time test. 864.7750 Section 864.7750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7750 Prothrombin time...

21 CFR 864.7750 - Prothrombin time test.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prothrombin time test. 864.7750 Section 864.7750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7750 Prothrombin time...

21 CFR 864.7750 - Prothrombin time test.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prothrombin time test. 864.7750 Section 864.7750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7750 Prothrombin time...

21 CFR 864.7750 - Prothrombin time test.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prothrombin time test. 864.7750 Section 864.7750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7750 Prothrombin time...

Regional and supraregional biochemistry services in Scotland: a survey of hospital laboratory users.

PubMed Central

Murphy, M J; Dryburgh, F J; Shepherd, J

1994-01-01

AIM--To ascertain the views of Scottish hospital laboratory users on aspects of regional and supraregional biochemical services offered by the Institute of Biochemistry at Glasgow Royal Infirmary. METHODS--A questionnaire was circulated asking questions or inviting opinions under various headings, including current patterns of usage of the services provided, availability of information on specimen collection requirements and reference ranges, current arrangements for transport of specimens, turnaround times for delivery of reports, layout and content of request and report forms, quantity and quality of interpretive advice, potential changes in laboratory services, and overall impression of the services provided. Opportunities were provided for free text comment. The questionnaire was circulated in 1992 to heads of department in 23 Scottish hospital biochemistry laboratories. RESULTS--Twenty one replies were received. Services used widely included trace metals/vitamins (n = 20) and specialised endocrine tests (n = 19). Other services also used included specialised lipid tests (n = 13), toxicology (n = 12), thyroid function tests (n = nine), and tumour markers (n = eight). Fifteen laboratories used one or more of the services at least weekly. Most (n = 20) welcomed the idea of a handbook providing information on specimen collection and reference ranges. Nine identified loss of specimens as a problem. Other perceived problems included the absence of reference ranges from report forms, quantity and quality of interpretive advice, and turnaround times of some tests. Overall impressions of the service(s) offered were very good (n = 12); adequate (n = seven); poor (n = one). CONCLUSIONS--Useful information was obtained about patterns of use and transport arrangements. Areas identified as requiring follow up included provision of information, alternative ways of communicating reports, and improvement in quantity and quality of interpretive advice. PMID:8027390

Impact of direct-to-consumer advertising for hereditary breast cancer testing on genetic services at a managed care organization: a naturally-occurring experiment.

PubMed

Mouchawar, Judy; Hensley-Alford, Sharon; Laurion, Suzanne; Ellis, Jennifer; Kulchak-Rahm, Alanna; Finucane, Melissa L; Meenan, Richard; Axell, Lisen; Pollack, Rebecca; Ritzwoller, Debra

2005-03-01

To describe the impact of Myriad Genetics, Inc.'s direct-to-consumer advertising (DTC-ad) campaign on cancer genetic services within two Managed Care Organizations, Kaiser Permanente Colorado (KPCO), Denver, Colorado, where the ad campaign occurred, and Henry Ford Health System (HFHS), Detroit, Michigan, where there were no advertisements. The main outcome measures were the changes in number and pretest mutation probability of referrals approved for cancer genetic services at KPCO and HFHS during the campaign versus the year prior, and mutation probability of those undergoing testing. At KPCO, referrals increased 244% during the DTC-ad compared to the same time period a year earlier (P value<0.001). The proportion of referrals at high pretest probability of a mutation (10% or greater) dropped from 69% the previous year to 48% during the campaign (P value<0.001). There was no significant change in pretest mutation probability among women who underwent testing between the two time periods. HFHS reported no significant change between the two time periods for numbers or mutation probability of referrals, or for mutation probability of women tested. The DTC-ad caused significant increase in demand for cancer genetic services. In the face of potential future DTC-ad for inherited cancer risk, providers and payers need to consider the delivery of genetic services and genetic education for persons of all risk levels.

Estimating implementation and operational costs of an integrated tiered CD4 service including laboratory and point of care testing in a remote health district in South Africa.

PubMed

Cassim, Naseem; Coetzee, Lindi M; Schnippel, Kathryn; Glencross, Deborah K

2014-01-01

An integrated tiered service delivery model (ITSDM) has been proposed to provide 'full-coverage' of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing < 30-40 samples from 8-10 health-clinics; Tier-3/Community laboratories servicing ∼ 50 health-clinics, processing < 150 samples/day; high-volume centralized laboratories (Tier-4 and Tier-5) processing < 300 or > 600 samples/day and serving > 100 or > 200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of > 24-48 hours. Full service coverage with TAT < 6-hours could be achieved with placement of twenty-seven Tier-1/POC or eight Tier-2/POC-hubs, at a cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured 'full service coverage' and < 24 hour LTR-TAT for the district at $7.42 per-test. Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼ 12-24-hour LTR-TAT, is ∼ $2 more than existing referred services per-test, but 2-4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4 services.

PrismTech Data Distribution Service Java API Evaluation

NASA Technical Reports Server (NTRS)

Riggs, Cortney

2008-01-01

My internship duties with Launch Control Systems required me to start performance testing of an Object Management Group's (OMG) Data Distribution Service (DDS) specification implementation by PrismTech Limited through the Java programming language application programming interface (API). DDS is a networking middleware for Real-Time Data Distribution. The performance testing involves latency, redundant publishers, extended duration, redundant failover, and read performance. Time constraints allowed only for a data throughput test. I have designed the testing applications to perform all performance tests when time is allowed. Performance evaluation data such as megabits per second and central processing unit (CPU) time consumption were not easily attainable through the Java programming language; they required new methods and classes created in the test applications. Evaluation of this product showed the rate that data can be sent across the network. Performance rates are better on Linux platforms than AIX and Sun platforms. Compared to previous C++ programming language API, the performance evaluation also shows the language differences for the implementation. The Java API of the DDS has a lower throughput performance than the C++ API.

20 CFR 404.447 - Evaluation of factors involved in substantial services test.

Code of Federal Regulations, 2010 CFR

2010-04-01

... business includes all the time spent by the individual in any activity, whether physical or mental, at the... business which cannot reasonably be considered unrelated to business activities is considered time devoted... significant reduction in the amount or importance of services rendered in the business tends to show that the...

Mobile Cloud Computing with SOAP and REST Web Services

NASA Astrophysics Data System (ADS)

Ali, Mushtaq; Fadli Zolkipli, Mohamad; Mohamad Zain, Jasni; Anwar, Shahid

2018-05-01

Mobile computing in conjunction with Mobile web services drives a strong approach where the limitations of mobile devices may possibly be tackled. Mobile Web Services are based on two types of technologies; SOAP and REST, which works with the existing protocols to develop Web services. Both the approaches carry their own distinct features, yet to keep the constraint features of mobile devices in mind, the better in two is considered to be the one which minimize the computation and transmission overhead while offloading. The load transferring of mobile device to remote servers for execution called computational offloading. There are numerous approaches to implement computational offloading a viable solution for eradicating the resources constraints of mobile device, yet a dynamic method of computational offloading is always required for a smooth and simple migration of complex tasks. The intention of this work is to present a distinctive approach which may not engage the mobile resources for longer time. The concept of web services utilized in our work to delegate the computational intensive tasks for remote execution. We tested both SOAP Web services approach and REST Web Services for mobile computing. Two parameters considered in our lab experiments to test; Execution Time and Energy Consumption. The results show that RESTful Web services execution is far better than executing the same application by SOAP Web services approach, in terms of execution time and energy consumption. Conducting experiments with the developed prototype matrix multiplication app, REST execution time is about 200% better than SOAP execution approach. In case of energy consumption REST execution is about 250% better than SOAP execution approach.

Anticipating the potential for positive uptake and adaptation in the implementation of a publicly funded online STBBI testing service: a qualitative analysis.

PubMed

Chabot, Cathy; Gilbert, Mark; Haag, Devon; Ogilvie, Gina; Hawe, Penelope; Bungay, Vicky; Shoveller, Jean A

2018-01-30

Online health services are a rapidly growing aspect of public health provision, including testing for sexually transmitted and other blood-borne infections (STBBI). Generally, healthcare providers, policymakers, and clients imbue online approaches with great positive potential (e.g., encouraging clients' agency; providing cost-effective services to more clients). However, the promise of online health services may vary across contexts and be perceived in negative or ambiguous ways (e.g., risks to 'gold standard' care provision; loss of provider control over an intervention; uncertainty related to budget implications). This study examines attitudes and perceptions regarding the development of a novel online STBBI testing service in Vancouver, Canada. We examine the perceptions about the intervention's potential by interviewing practitioners and planners who were engaged in the development and initial implementation of this testing service. We conducted in-depth interviews with 37 healthcare providers, administrators, policymakers, and community-based service providers engaged in the design and launch of the new online STBBI testing service. We also conducted observations during planning and implementation meetings for the new service. Thematic analysis techniques were employed to identify codes and broader discursive themes across the interview transcripts and observation notes. Some study participants expressed concern that the potential popularity of the new testing service might increase demand on existing sexual health services or become fiscally unsustainable. However, most participants regarded the new service as having the potential to improve STBBI testing in several ways, including reducing waiting times, enhancing privacy and confidentiality, appealing to more tech-savvy sub-populations, optimizing the redistribution of demands on face-to-face service provision, and providing patient-centred technology to empower clients to seek testing. Participants perceived this online STBBI testing service to have the potential to improve sexual health care provision. But, they also anticipated actions-and-reactions, revealing a need to monitor ongoing implementation dynamics. They also identified the larger, potentially system-transforming dimension of the new technology, which enables new system drivers (consumers) and reduces the amount of control health care providers have over online STBBI testing compared to conventional in-person testing.

Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness

PubMed Central

Severin, Franziska; Borry, Pascal; Cornel, Martina C; Daniels, Norman; Fellmann, Florence; Victoria Hodgson, Shirley; Howard, Heidi C; John, Jürgen; Kääriäinen, Helena; Kayserili, Hülya; Kent, Alastair; Koerber, Florian; Kristoffersson, Ulf; Kroese, Mark; Lewis, Celine; Marckmann, Georg; Meyer, Peter; Pfeufer, Arne; Schmidtke, Jörg; Skirton, Heather; Tranebjærg, Lisbeth; Rogowski, Wolf H

2015-01-01

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management. PMID:25248395

Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness.

PubMed

Severin, Franziska; Borry, Pascal; Cornel, Martina C; Daniels, Norman; Fellmann, Florence; Victoria Hodgson, Shirley; Howard, Heidi C; John, Jürgen; Kääriäinen, Helena; Kayserili, Hülya; Kent, Alastair; Koerber, Florian; Kristoffersson, Ulf; Kroese, Mark; Lewis, Celine; Marckmann, Georg; Meyer, Peter; Pfeufer, Arne; Schmidtke, Jörg; Skirton, Heather; Tranebjærg, Lisbeth; Rogowski, Wolf H

2015-06-01

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management.

Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India.

PubMed

Beattie, Tara S H; Bhattacharjee, Parinita; Suresh, M; Isac, Shajy; Ramesh, B M; Moses, Stephen

2012-10-01

Despite high HIV prevalence rates among most-at-risk groups, utilisation of HIV testing, treatment and care services was relatively low in Karnataka prior to 2008. The authors aimed to understand the barriers to and identify potential solutions for improving HIV service utilisation. Focus group discussions were carried out among homogeneous groups of female sex workers, men who have sex with men and transgenders, and programme peer educators in six districts across Karnataka in March and April 2008. 26 focus group discussions were conducted, involving 302 participants. Participants had good knowledge about HIV and HIV voluntary counselling and testing (VCT) services, but awareness of other HIV services was low. The fear of the psychological impact of a positive HIV test result and the perceived repercussions of being seen accessing HIV services were key personal and interpersonal barriers to HIV service utilisation. Previous experiences of discrimination at government healthcare services, coupled with discriminatory attitudes and behaviours by VCT staff, were key structural barriers to VCT service uptake among those who had not been HIV tested. Among those who had used government-managed prevention of parent to child transmission and antiretroviral treatment services, poor physical facilities, long waiting times, lack of available treatment, the need to give bribes to receive care and discriminatory attitudes of healthcare staff presented additional structural barriers. Embedding some HIV care services within existing programmes for vulnerable populations, as well as improving service quality at government facilities, are suggested to help overcome the multiple barriers to service utilisation. Increasing the uptake of HIV testing, treatment and care services is key to improving the quality and longevity of the lives of HIV-infected individuals.

Minimizing the Total Service Time of Discrete Dynamic Berth Allocation Problem by an Iterated Greedy Heuristic

PubMed Central

2014-01-01

Berth allocation is the forefront operation performed when ships arrive at a port and is a critical task in container port optimization. Minimizing the time ships spend at berths constitutes an important objective of berth allocation problems. This study focuses on the discrete dynamic berth allocation problem (discrete DBAP), which aims to minimize total service time, and proposes an iterated greedy (IG) algorithm to solve it. The proposed IG algorithm is tested on three benchmark problem sets. Experimental results show that the proposed IG algorithm can obtain optimal solutions for all test instances of the first and second problem sets and outperforms the best-known solutions for 35 out of 90 test instances of the third problem set. PMID:25295295

76 FR 73494 - Airworthiness Directives; Turbomeca S.A. Arriel 2B Turboshaft Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-29

... identified in the MCAI. The one-time functional test required by the service bulletin is not a normal engine run-up test: the one-time functional test involves additional requirements including mode switching, that are not part of a normal engine run-up after start. FAA's Determination and Requirements of This...

The Audit Commission review of diabetes services in England and Wales, 1998-2001.

PubMed

Fitzsimons, B; Wilton, L; Lamont, T; McCulloch, L; Boyce, J

2002-07-01

AIMS OF THE AUDIT COMMISSION: The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.

20 CFR 1002.193 - Does the reemployment position include elements such as seniority, status, and rate of pay?

Code of Federal Regulations, 2010 CFR

2010-04-01

... during service is based on a skills test or examination, then the employer should give him or her a reasonable amount of time to adjust to the employment position and then give a skills test or examination. No... difficulty of the test itself, the typical time necessary to prepare or study for the test, the duties and...

HIV Testing, HIV Positivity, and Linkage and Referral Services in Correctional Facilities in the United States, 2009–2013

PubMed Central

Seth, Puja; Figueroa, Argelia; Wang, Guoshen; Reid, Laurie; Belcher, Lisa

2016-01-01

Background Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)–funded HIV testing and service delivery in correctional facilities. Methods Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. Results Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. Conclusions Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease. PMID:26462190

Comparison Quality of Health Services between Public and Private Providers: The Iranian People's Perspective.

PubMed

Alijanzadeh, Mehran; Zare, Seyed Ali Moosaniaye; Rajaee, Roya; Fard, Seyed Mohammad Ali Mousavi; Asefzadeh, Saeed; Alijanzadeh, Mahnaz; Gholami, Soheyla

2016-09-01

Health services quality has been the most important criteria of judging, and its improvement causes people's satisfaction of health systems. In a health system, public and private sectors provide services and typically have been effective in promoting health services quality of community. The aim of this study was to compare the quality of health services in both public and private sectors from the perspective of residents in Qazvin (Iran). This cross-sectional study was conducted in 2014. The study population included all residents of Qazvin Province, and the sample size was estimated to 1002. The research tool was a perceptions of services quality standard questionnaire. Data were collected by trained interviewers visiting homes and were analyzed by IBM-SPSS software version 22 and t-test and linear regression. Cronbach's alpha coefficient was 0.91 and test-re-test coefficient was 83%. 741 people (74%) in their last visit to receive services were referred to the public sector. Between the perception of people participating in the study about medical equipment and supplies, welfare facilities, competence and experience of doctor, waiting time, rapid reception, and access to doctor in public and private sectors, significant differences were observed (p < 0.05). In the tangible realm in perception of health services, there was a significant difference in quality between the public and private sectors (p < 0.05). In addition, place of receiving services, waiting time, education, occupation, and type of received services were affecting factors in regards to perceptions of health services from the perspective of Iran's population (p < 0.05). The results showed the importance of a tangible realm on people's satisfaction of health services. It seems that the public sector should pay more attention to this issue.

Evaluation of direct-to-consumer low-volume lab tests in healthy adults.

PubMed

Kidd, Brian A; Hoffman, Gabriel; Zimmerman, Noah; Li, Li; Morgan, Joseph W; Glowe, Patricia K; Botwin, Gregory J; Parekh, Samir; Babic, Nikolina; Doust, Matthew W; Stock, Gregory B; Schadt, Eric E; Dudley, Joel T

2016-05-02

Clinical laboratory tests are now being prescribed and made directly available to consumers through retail outlets in the USA. Concerns with these test have been raised regarding the uncertainty of testing methods used in these venues and a lack of open, scientific validation of the technical accuracy and clinical equivalency of results obtained through these services. We conducted a cohort study of 60 healthy adults to compare the uncertainty and accuracy in 22 common clinical lab tests between one company offering blood tests obtained from finger prick (Theranos) and 2 major clinical testing services that require standard venipuncture draws (Quest and LabCorp). Samples were collected in Phoenix, Arizona, at an ambulatory clinic and at retail outlets with point-of-care services. Theranos flagged tests outside their normal range 1.6× more often than other testing services (P < 0.0001). Of the 22 lab measurements evaluated, 15 (68%) showed significant interservice variability (P < 0.002). We found nonequivalent lipid panel test results between Theranos and other clinical services. Variability in testing services, sample collection times, and subjects markedly influenced lab results. While laboratory practice standards exist to control this variability, the disparities between testing services we observed could potentially alter clinical interpretation and health care utilization. Greater transparency and evaluation of testing technologies would increase their utility in personalized health management. This work was supported by the Icahn Institute for Genomics and Multiscale Biology, a gift from the Harris Family Charitable Foundation (to J.T. Dudley), and grants from the NIH (R01 DK098242 and U54 CA189201, to J.T. Dudley, and R01 AG046170 and U01 AI111598, to E.E. Schadt).

Evaluation of direct-to-consumer low-volume lab tests in healthy adults

PubMed Central

Kidd, Brian A.; Hoffman, Gabriel; Zimmerman, Noah; Li, Li; Morgan, Joseph W.; Glowe, Patricia K.; Botwin, Gregory J.; Parekh, Samir; Babic, Nikolina; Doust, Matthew W.; Stock, Gregory B.; Schadt, Eric E.; Dudley, Joel T.

2016-01-01

BACKGROUND. Clinical laboratory tests are now being prescribed and made directly available to consumers through retail outlets in the USA. Concerns with these test have been raised regarding the uncertainty of testing methods used in these venues and a lack of open, scientific validation of the technical accuracy and clinical equivalency of results obtained through these services. METHODS. We conducted a cohort study of 60 healthy adults to compare the uncertainty and accuracy in 22 common clinical lab tests between one company offering blood tests obtained from finger prick (Theranos) and 2 major clinical testing services that require standard venipuncture draws (Quest and LabCorp). Samples were collected in Phoenix, Arizona, at an ambulatory clinic and at retail outlets with point-of-care services. RESULTS. Theranos flagged tests outside their normal range 1.6× more often than other testing services (P < 0.0001). Of the 22 lab measurements evaluated, 15 (68%) showed significant interservice variability (P < 0.002). We found nonequivalent lipid panel test results between Theranos and other clinical services. Variability in testing services, sample collection times, and subjects markedly influenced lab results. CONCLUSION. While laboratory practice standards exist to control this variability, the disparities between testing services we observed could potentially alter clinical interpretation and health care utilization. Greater transparency and evaluation of testing technologies would increase their utility in personalized health management. FUNDING. This work was supported by the Icahn Institute for Genomics and Multiscale Biology, a gift from the Harris Family Charitable Foundation (to J.T. Dudley), and grants from the NIH (R01 DK098242 and U54 CA189201, to J.T. Dudley, and R01 AG046170 and U01 AI111598, to E.E. Schadt). PMID:27018593

Fault Tree Based Diagnosis with Optimal Test Sequencing for Field Service Engineers

NASA Technical Reports Server (NTRS)

Iverson, David L.; George, Laurence L.; Patterson-Hine, F. A.; Lum, Henry, Jr. (Technical Monitor)

1994-01-01

When field service engineers go to customer sites to service equipment, they want to diagnose and repair failures quickly and cost effectively. Symptoms exhibited by failed equipment frequently suggest several possible causes which require different approaches to diagnosis. This can lead the engineer to follow several fruitless paths in the diagnostic process before they find the actual failure. To assist in this situation, we have developed the Fault Tree Diagnosis and Optimal Test Sequence (FTDOTS) software system that performs automated diagnosis and ranks diagnostic hypotheses based on failure probability and the time or cost required to isolate and repair each failure. FTDOTS first finds a set of possible failures that explain exhibited symptoms by using a fault tree reliability model as a diagnostic knowledge to rank the hypothesized failures based on how likely they are and how long it would take or how much it would cost to isolate and repair them. This ordering suggests an optimal sequence for the field service engineer to investigate the hypothesized failures in order to minimize the time or cost required to accomplish the repair task. Previously, field service personnel would arrive at the customer site and choose which components to investigate based on past experience and service manuals. Using FTDOTS running on a portable computer, they can now enter a set of symptoms and get a list of possible failures ordered in an optimal test sequence to help them in their decisions. If facilities are available, the field engineer can connect the portable computer to the malfunctioning device for automated data gathering. FTDOTS is currently being applied to field service of medical test equipment. The techniques are flexible enough to use for many different types of devices. If a fault tree model of the equipment and information about component failure probabilities and isolation times or costs are available, a diagnostic knowledge base for that device can be developed easily.

Time-temperature-stress capabilities of composite materials for advanced supersonic technology application, phase 1

NASA Technical Reports Server (NTRS)

Kerr, J. R.; Haskins, J. F.

1980-01-01

Implementation of metal and resin matrix composites into supersonic vehicle usage is contingent upon accelerating the demonstration of service capacity and design technology. Because of the added material complexity and lack of extensive service data, laboratory replication of the flight service will provide the most rapid method of documenting the airworthiness of advanced composite systems. A program in progress to determine the time temperature stress capabilities of several high temperature composite materials includes thermal aging, environmental aging, fatigue, creep, fracture, and tensile tests as well as real time flight simulation exposure. The program has two parts. The first includes all the material property determinations and aging and simulation exposures up through 10,000 hours. The second continues these tests up to 50,000 cumulative hours. Results are presented of the 10,000 hour phase, which has now been completed.

Impact of SMS/GPRS Printers in Reducing Time to Early Infant Diagnosis Compared With Routine Result Reporting: A Systematic Review and Meta-Analysis

PubMed Central

Markby, Jessica; Boeke, Caroline; Penazzato, Martina; Urick, Brittany; Ghadrshenas, Anisa; Harris, Lindsay; Ford, Nathan; Peter, Trevor

2017-01-01

Background: Despite significant gains made toward improving access, early infant diagnosis (EID) testing programs suffer from long test turnaround times that result in substantial loss to follow-up and mortality associated with delays in antiretroviral therapy initiation. These delays in treatment initiation are particularly impactful because of significant HIV-related infant mortality observed by 2–3 months of age. Short message service (SMS) and general packet radio service (GPRS) printers allow test results to be transmitted immediately to health care facilities on completion of testing in the laboratory. Methods: We conducted a systematic review and meta-analysis to assess the benefit of using SMS/GPRS printers to increase the efficiency of EID test result delivery compared with traditional courier paper–based results delivery methods. Results: We identified 11 studies contributing data for over 16,000 patients from East and Southern Africa. The test turnaround time from specimen collection to result received at the health care facility with courier paper–based methods was 68.0 days (n = 6835), whereas the test turnaround time with SMS/GPRS printers was 51.1 days (n = 6711), resulting in a 2.5-week (25%) reduction in the turnaround time. Conclusions: Courier paper–based EID test result delivery methods are estimated to add 2.5 weeks to EID test turnaround times in low resource settings and increase the risk that infants receive test results during or after the early peak of infant mortality. SMS/GPRS result delivery to health care facility printers significantly reduced test turnaround time and may reduce this risk. SMS/GPRS printers should be considered for expedited delivery of EID and other centralized laboratory test results. PMID:28825941

75 FR 73110 - Part C Early Intervention Services Grant under the Ryan White HIV/AIDS Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-29

... Intervention Services Grant under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of a non-competitive one-time replacement award from Ryan White HIV... HIV/AIDS, including primary medical care, laboratory testing, oral health care, outpatient mental...

Testing of electrical equipment for a commercial grade dedication program

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

Brown, J.L.; Srinivas, N.

1995-10-01

The availability of qualified safety related replacement parts for use in nuclear power plants has decreased over time. This has caused many nuclear power plants to purchase commercial grade items (CGI) and utilize the commercial grade dedication process to qualify the items for use in nuclear safety related applications. The laboratories of Technical and Engineering Services (the testing facility of Detroit Edison) have been providing testing services for verification of critical characteristics of these items. This paper presents an overview of the experience in testing electrical equipment with an emphasis on fuses.

Estimating Implementation and Operational Costs of an Integrated Tiered CD4 Service including Laboratory and Point of Care Testing in a Remote Health District in South Africa

PubMed Central

Cassim, Naseem; Coetzee, Lindi M.; Schnippel, Kathryn; Glencross, Deborah K.

2014-01-01

Background An integrated tiered service delivery model (ITSDM) has been proposed to provide ‘full-coverage’ of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing <30–40 samples from 8–10 health-clinics; Tier-3/Community laboratories servicing ∼50 health-clinics, processing <150 samples/day; high-volume centralized laboratories (Tier-4 and Tier-5) processing <300 or >600 samples/day and serving >100 or >200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Methods Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. Results The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of >24–48 hours. Full service coverage with TAT <6-hours could be achieved with placement of twenty-seven Tier-1/POC or eight Tier-2/POC-hubs, at a cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured ‘full service coverage’ and <24 hour LTR-TAT for the district at $7.42 per-test. Conclusion Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼12–24-hour LTR-TAT, is ∼$2 more than existing referred services per-test, but 2–4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4 services. PMID:25517412

Network time synchronization servers at the US Naval Observatory

NASA Technical Reports Server (NTRS)

Schmidt, Richard E.

1995-01-01

Responding to an increased demand for reliable, accurate time on the Internet and Milnet, the U.S. Naval Observatory Time Service has established the network time servers, tick.usno.navy.mil and tock.usno.navy.mil. The system clocks of these HP9000/747i industrial work stations are synchronized to within a few tens of microseconds of USNO Master Clock 2 using VMEbus IRIG-B interfaces. Redundant time code is available from a VMEbus GPS receiver. UTC(USNO) is provided over the network via a number of protocols, including the Network Time Protocol (NTP) (DARPA Network Working Group Report RFC-1305), the Daytime Protocol (RFC-867), and the Time protocol (RFC-868). Access to USNO network time services is presently open and unrestricted. An overview of USNO time services and results of LAN and WAN time synchronization tests will be presented.

Interactive internet-based clinical education: an efficient and cost-savings approach to point-of-care test training.

PubMed

Knapp, Herschel; Chan, Kee; Anaya, Henry D; Goetz, Matthew B

2011-06-01

We successfully created and implemented an effective HIV rapid testing training and certification curriculum using traditional in-person training at multiple sites within the U.S. Department of Veterans Affairs (VA) Healthcare System. Considering the multitude of geographically remote facilities in the nationwide VA system, coupled with the expansion of HIV diagnostics, we developed an alternate training method that is affordable, efficient, and effective. Using materials initially developed for in-person HIV rapid test in-services, we used a distance learning model to offer this training via live audiovisual online technology to educate clinicians at a remote outpatient primary care VA facility. Participants' evaluation metrics showed that this form of remote education is equivalent to in-person training; additionally, HIV testing rates increased considerably in the months following this intervention. Although there is a one-time setup cost associated with this remote training protocol, there is potential cost savings associated with the point-of-care nurse manager's time productivity by using the Internet in-service learning module for teaching HIV rapid testing. If additional in-service training modules are developed into Internet-based format, there is the potential for additional cost savings. Our cost analysis demonstrates that the remote in-service method provides a more affordable and efficient alternative compared with in-person training. The online in-service provided training that was equivalent to in-person sessions based on first-hand supervisor observation, participant satisfaction surveys, and follow-up results. This method saves time and money, requires fewer personnel, and affords access to expert trainers regardless of geographic location. Further, it is generalizable to training beyond HIV rapid testing. Based on these consistent implementation successes, we plan to expand use of online training to include remote VA satellite facilities spanning several states for a variety of diagnostic devices. Ultimately, Internet-based training has the potential to provide "big city" quality of care to patients at remote (rural) clinics.

Bayes Analysis and Reliability Implications of Stress-Rupture Testing a Kevlar/Epoxy COPV Using Temperature and Pressure Acceleration

NASA Technical Reports Server (NTRS)

Phoenix, S. Leigh; Kezirian, Michael T.; Murthy, Pappu L. N.

2009-01-01

Composite Overwrapped Pressure Vessels (COPVs) that have survived a long service time under pressure generally must be recertified before service is extended. Flight certification is dependent on the reliability analysis to quantify the risk of stress rupture failure in existing flight vessels. Full certification of this reliability model would require a statistically significant number of lifetime tests to be performed and is impractical given the cost and limited flight hardware for certification testing purposes. One approach to confirm the reliability model is to perform a stress rupture test on a flight COPV. Currently, testing of such a Kevlar49 (Dupont)/epoxy COPV is nearing completion. The present paper focuses on a Bayesian statistical approach to analyze the possible failure time results of this test and to assess the implications in choosing between possible model parameter values that in the past have had significant uncertainty. The key uncertain parameters in this case are the actual fiber stress ratio at operating pressure, and the Weibull shape parameter for lifetime; the former has been uncertain due to ambiguities in interpreting the original and a duplicate burst test. The latter has been uncertain due to major differences between COPVs in the database and the actual COPVs in service. Any information obtained that clarifies and eliminates uncertainty in these parameters will have a major effect on the predicted reliability of the service COPVs going forward. The key result is that the longer the vessel survives, the more likely the more optimistic stress ratio model is correct. At the time of writing, the resulting effect on predicted future reliability is dramatic, increasing it by about one "nine," that is, reducing the predicted probability of failure by an order of magnitude. However, testing one vessel does not change the uncertainty on the Weibull shape parameter for lifetime since testing several vessels would be necessary.

HIV Prevention Services and Testing Utilization Behaviors among Men Who Have Sex with Men at Elevated Risk for HIV in Chongqing, China

PubMed Central

Hu, Yifei; Wu, Guohui; Jia, Yujiang; Lu, Rongrong; Xiao, Yan; Raymond, H. F.; Ruan, Yuhua; Sun, Jiangping

2014-01-01

Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services. PMID:24783195

HIV prevention services and testing utilization behaviors among men who have sex with men at elevated risk for HIV in Chongqing, China.

PubMed

Huang, Dayong; Hu, Yifei; Wu, Guohui; Jia, Yujiang; Lu, Rongrong; Xiao, Yan; Raymond, H F; McFarland, Willi; Ruan, Yuhua; Ma, Wei; Sun, Jiangping

2014-01-01

To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2-15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services.

21 CFR 864.7925 - Partial thromboplastin time tests.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Partial thromboplastin time tests. 864.7925 Section 864.7925 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7925 Partial...

21 CFR 864.7925 - Partial thromboplastin time tests.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Partial thromboplastin time tests. 864.7925 Section 864.7925 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7925 Partial...

21 CFR 864.7925 - Partial thromboplastin time tests.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Partial thromboplastin time tests. 864.7925 Section 864.7925 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7925 Partial...

21 CFR 864.7925 - Partial thromboplastin time tests.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Partial thromboplastin time tests. 864.7925 Section 864.7925 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7925 Partial...

21 CFR 864.7925 - Partial thromboplastin time tests.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Partial thromboplastin time tests. 864.7925 Section 864.7925 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Hematology Kits and Packages § 864.7925 Partial...

The Relationship between the Role of the School Psychologist and Post-Secondary School Outcomes for Special Education Students

ERIC Educational Resources Information Center

Sher, Robert

2012-01-01

Since the federal law IDEIA of 2004 allowed for the determination of LD eligibility for Special Education services, it was expected that School Psychologists would have begun spending less time devoted to standardized tests, and more time providing other services such as counseling, consultation, and interventions. Moreover, any benefit that these…

Evaluating weather factors and material response during outdoor exposure to determine accelerated test protocols for predicting service life

Treesearch

R. Sam Williams; Steven Lacher; Corey Halpin; Christopher White

2005-01-01

To develop service life prediction methods for the study of sealants, a fully instrumented weather station was installed at an outdoor test site near Madison, WI. Temperature, relative humidiy, rainfall, ultraviolet (UV) radiation at 18 wavelengths, and wind speed and direction are being continuously measured and stored. The weather data can be integrated over time to...

Comparison of traditional methods for testing paint service life with new methods for service life prediction

Treesearch

R. Sam Williams; Steve Lacher; Jerrold E. Winandy; Corey Halpin; William C. Feist; Christopher White

2004-01-01

Western redcedar siding was "preweathered" by placing it outdoors for 1, 2, 4, 8, or 16 weeks prior to being painted. Panels were painted following the preweathering and tested for paint adhesion. The amount of time these panels were exposed (preweathered) directly affected paint adhesion. As much as 50% paint adhesion loss was shown for specimens...

Physician Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 81 Institutions.

PubMed

McCall, Shannon J; Souers, Rhona J; Blond, Barbara; Massie, Larry

2016-10-01

-Assessment of customer satisfaction is a vital component of the laboratory quality improvement program. -To survey the level of physician satisfaction with hospital clinical laboratory services. -Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor). -Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient "STAT" (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents). -There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.

Estimating the Cost of Standardized Student Testing in the United States.

ERIC Educational Resources Information Center

Phelps, Richard P.

2000-01-01

Describes and contrasts different methods of estimating costs of standardized testing. Using a cost-accounting approach, compares gross and marginal costs and considers testing objects (test materials and services, personnel and student time, and administrative/building overhead). Social marginal costs of replacing existing tests with a national…

Benefits of Sign Language Interpreting and Text Alternatives for Deaf Students' Classroom Learning

PubMed Central

Marschark, Marc; Leigh, Greg; Sapere, Patricia; Burnham, Denis; Convertino, Carol; Stinson, Michael; Knoors, Harry; Vervloed, Mathijs P. J.; Noble, William

2006-01-01

Four experiments examined the utility of real-time text in supporting deaf students' learning from lectures in postsecondary (Experiments 1 and 2) and secondary classrooms (Experiments 3 and 4). Experiment 1 compared the effects on learning of sign language interpreting, real-time text (C-Print), and both. Real-time text alone led to significantly higher performance by deaf students than the other two conditions, but performance by deaf students in all conditions was significantly below that of hearing peers who saw lectures without any support services. Experiment 2 compared interpreting and two forms of real-time text, C-Print and Communication Access Real-Time Translation, at immediate testing and after a 1-week delay (with study notes). No significant differences among support services were obtained at either testing. Experiment 3 also failed to reveal significant effects at immediate or delayed testing in a comparison of real-time text, direct (signed) instruction, and both. Experiment 4 found no significant differences between interpreting and interpreting plus real-time text on the learning of either new words or the content of television programs. Alternative accounts of the observed pattern of results are considered, but it is concluded that neither sign language interpreting nor real-time text have any inherent, generalized advantage over the other in supporting deaf students in secondary or postsecondary settings. Providing deaf students with both services simultaneously does not appear to provide any generalized benefit, at least for the kinds of materials utilized here. PMID:16928778

Benefits of sign language interpreting and text alternatives for deaf students' classroom learning.

PubMed

Marschark, Marc; Leigh, Greg; Sapere, Patricia; Burnham, Denis; Convertino, Carol; Stinson, Michael; Knoors, Harry; Vervloed, Mathijs P J; Noble, William

2006-01-01

Four experiments examined the utility of real-time text in supporting deaf students' learning from lectures in postsecondary (Experiments 1 and 2) and secondary classrooms (Experiments 3 and 4). Experiment 1 compared the effects on learning of sign language interpreting, real-time text (C-Print), and both. Real-time text alone led to significantly higher performance by deaf students than the other two conditions, but performance by deaf students in all conditions was significantly below that of hearing peers who saw lectures without any support services. Experiment 2 compared interpreting and two forms of real-time text, C-Print and Communication Access Real-Time Translation, at immediate testing and after a 1-week delay (with study notes). No significant differences among support services were obtained at either testing. Experiment 3 also failed to reveal significant effects at immediate or delayed testing in a comparison of real-time text, direct (signed) instruction, and both. Experiment 4 found no significant differences between interpreting and interpreting plus real-time text on the learning of either new words or the content of television programs. Alternative accounts of the observed pattern of results are considered, but it is concluded that neither sign language interpreting nor real-time text have any inherent, generalized advantage over the other in supporting deaf students in secondary or postsecondary settings. Providing deaf students with both services simultaneously does not appear to provide any generalized benefit, at least for the kinds of materials utilized here.

Impact of landfill liner time-temperature history on the service life of HDPE geomembranes.

PubMed

Rowe, R Kerry; Islam, M Z

2009-10-01

The observed temperatures in different landfills are used to establish a number of idealized time-temperature histories for geomembrane liners in municipal solid waste (MSW) landfills. These are then used for estimating the service life of different HDPE geomembranes. The predicted antioxidant depletion times (Stage I) are between 7 and 750 years with the large variation depending on the specific HDPE geomembrane product, exposure conditions, and most importantly, the magnitude and duration of the peak liner temperature. The higher end of the range corresponds to data from geomembranes aged in simulated landfill liner tests and a maximum liner temperature of 37 degrees C. The lower end of the range corresponds to a testing condition where geomembranes were immersed in a synthetic leachate and a maximum liner temperature of 60 degrees C. The total service life of the geomembranes was estimated to be between 20 and 3300 years depending on the time-temperature history examined. The range illustrates the important role that time-temperature history could play in terms of geomembrane service life. The need for long-term monitoring of landfill liner temperature and for geomembrane ageing studies that will provide improved data for assessing the likely long-term performance of geomembranes in MSW landfills are highlighted.

KSC-08pd0089

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, technicians monitor equipment during testing of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0081

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, elements of the ARES I-X Roll Control System, or RoCS, will undergo testing. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0092

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, technicians monitor equipment during testing of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0087

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, a technician adjusts equipment during testing of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0090

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, a technician (right) adjusts equipment during testing of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0088

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, technicians monitor equipment during testing of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0085

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, a technician monitors equipment during testing of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0091

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, a technician adjusts equipment during testing of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0084

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, technicians get ready to begin testing elements of the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

Iterated local search algorithm for solving the orienteering problem with soft time windows.

PubMed

Aghezzaf, Brahim; Fahim, Hassan El

2016-01-01

In this paper we study the orienteering problem with time windows (OPTW) and the impact of relaxing the time windows on the profit collected by the vehicle. The way of relaxing time windows adopted in the orienteering problem with soft time windows (OPSTW) that we study in this research is a late service relaxation that allows linearly penalized late services to customers. We solve this problem heuristically by considering a hybrid iterated local search. The results of the computational study show that the proposed approach is able to achieve promising solutions on the OPTW test instances available in the literature, one new best solution is found. On the newly generated test instances of the OPSTW, the results show that the profit collected by the OPSTW is better than the profit collected by the OPTW.

Integrating HIV testing and care into tuberculosis services in Benin: programmatic aspects.

PubMed

Ferroussier, O; Dlodlo, R A; Capo-Chichi, D; Boillot, F; Gninafon, M; Trébucq, A; Fujiwara, P I

2013-11-01

Between 2005 and 2008, the diagnosis and care of human immunodeficiency virus (HIV) infection and tuberculosis (TB) services were integrated in Benin. The appointment of a TB-HIV Coordinator by the National Tuberculosis Control Programme and quarterly supervisory visits to TB clinics have bolstered the implementation of integrated HIV-TB activities. HIV testing and cotrimoxazole preventive therapy were integrated smoothly into the TB services. The strategy chosen to facilitate access of HIV-positive TB patients to antiretroviral treatment contributed to greater integration over time, but perpetuated, for some, the burden of attending two facilities. The integration and decentralisation of TB and HIV care services at national level in Benin resulted in a high uptake of HIV services among TB patients.

Attitudes towards HIV testing via home-sampling kits ordered online (RUClear pilots 2011-12).

PubMed

Ahmed-Little, Y; Bothra, V; Cordwell, D; Freeman Powell, D; Ellis, D; Klapper, P; Scanlon, S; Higgins, S; Vivancos, R

2016-09-01

The burden of disease relating to undiagnosed HIV infection is significant in the UK. BHIVA (British HIV Association) recommends population screening in high prevalence areas, expanding outside traditional antenatal/GUM settings. RUClear 2011-12 piloted expanding HIV testing outside traditional settings using home-sampling kits (dry-blood-spot testing) ordered online. Greater Manchester residents (≥age 16) could request testing via an established, online chlamydia testing service (www.ruclear.co.uk). Participant attitudes towards this new service were assessed. Qualitative methods (thematic analysis) were used to analyse free-text data submitted by participants via hard copy questionnaires issued in all testing kits. 79.9% (2447/3062) participants completed questionnaires, of which 30.9% (756/2447) provided free-text data. Participants overwhelmingly supported the service, valuing particularly accessibility and convenience, allowing individuals to order tests any time of day and self-sample comfortably at home; avoiding the invasive nature of venipuncture and avoiding the need for face-to-face interaction with health services. The pilot was also clinically and cost-effective. Testing via home-sampling kits ordered online (dry-blood-spot testing) was felt to be an acceptable and convenient method for accessing a HIV test. Many individuals undertook HIV testing where they would otherwise not have been tested at all. Expansion of similar services may increase the uptake of HIV testing. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.

PubMed

Upshur, Ross E G; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

2006-03-01

The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements. There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data. Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

PubMed Central

Upshur, Ross EG; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

2006-01-01

Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery. PMID:16509992

A Framework for Analyzing and Testing the Performance of Software Services

NASA Astrophysics Data System (ADS)

Bertolino, Antonia; de Angelis, Guglielmo; di Marco, Antinisca; Inverardi, Paola; Sabetta, Antonino; Tivoli, Massimo

Networks "Beyond the 3rd Generation" (B3G) are characterized by mobile and resource-limited devices that communicate through different kinds of network interfaces. Software services deployed in such networks shall adapt themselves according to possible execution contexts and requirement changes. At the same time, software services have to be competitive in terms of the Quality of Service (QoS) provided, or perceived by the end user.

19 CFR 151.4 - Time of examination.

Code of Federal Regulations, 2014 CFR

2014-04-01

.... Authorized employees of the Customs Service, Food and Drug Administration, Animal and Plant Health Inspection... (CONTINUED) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE General § 151.4 Time of examination. Imported...

19 CFR 151.4 - Time of examination.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Authorized employees of the Customs Service, Food and Drug Administration, Animal and Plant Health Inspection... (CONTINUED) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE General § 151.4 Time of examination. Imported...

19 CFR 151.4 - Time of examination.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Authorized employees of the Customs Service, Food and Drug Administration, Animal and Plant Health Inspection... (CONTINUED) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE General § 151.4 Time of examination. Imported...

19 CFR 151.4 - Time of examination.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... Authorized employees of the Customs Service, Food and Drug Administration, Animal and Plant Health Inspection... (CONTINUED) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE General § 151.4 Time of examination. Imported...

19 CFR 151.4 - Time of examination.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Authorized employees of the Customs Service, Food and Drug Administration, Animal and Plant Health Inspection... (CONTINUED) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE General § 151.4 Time of examination. Imported...

30 CFR 250.434 - What are the recordkeeping requirements for diverter actuations and tests?

Code of Federal Regulations, 2010 CFR

2010-07-01

... diverter actuations and tests? 250.434 Section 250.434 Mineral Resources MINERALS MANAGEMENT SERVICE... for diverter actuations and tests? You must record the time, date, and results of all diverter actuations and tests in the driller's report. In addition, you must: (a) Record the diverter pressure test on...

Testing, Testing...Managing Electronic Access in Disparate Times.

ERIC Educational Resources Information Center

Carrington, Bessie M.

1996-01-01

Duke University's Perkins Library (North Carolina) tests electronic resources and services for remote accessibility by examining capabilities on various platforms, operating systems, communications software, and World Wide Web browsers. Problems occur in establishing connections, screen display, navigation or retrieval, keyboard variations, and in…

Case study of supply induced demand: the case of provision of imaging scans (computed tomography and magnetic resonance) at Unimed-Manaus.

PubMed

Andrade, Edson de Oliveira; Andrade, Elizabeth Nogueira de; Gallo, José Hiran

2011-01-01

To present the experience of a health plan operator (Unimed-Manaus) in Manaus, Amazonas, Brazil, with the accreditation of imaging services and the demand induced by the supply of new services (Roemer's Law). This is a retrospective work studying a time series covering the period from January 1998 to June 2004, in which the computed tomography and the magnetic resonance imaging services were implemented as part of the services offered by that health plan operator. Statistical analysis consisted of a descriptive and an inferential part, with the latter using a mean parametric test (Student T-test and ANOVA) and the Pearson correlation test. A 5% alpha and a 95% confidence interval were adopted. At Unimed-Manaus, the supply of new imaging services, by itself, was identified as capable of generating an increased service demand, thus characterizing the phenomenon described by Roemer. The results underscore the need to be aware of the fact that the supply of new health services could bring about their increased use without a real demand.

Pilot study: incorporation of pharmacogenetic testing in medication therapy management services.

PubMed

Haga, Susanne B; Allen LaPointe, Nancy M; Moaddeb, Jivan; Mills, Rachel; Patel, Mahesh; Kraus, William E

2014-11-01

Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered medication therapy management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.

Strengthening Health Systems at Facility-Level: Feasibility of Integrating Antiretroviral Therapy into Primary Health Care Services in Lusaka, Zambia

PubMed Central

Topp, Stephanie M.; Chipukuma, Julien M.; Giganti, Mark; Mwango, Linah K.; Chiko, Like M.; Tambatamba-Chapula, Bushimbwa; Wamulume, Chibesa S.; Reid, Stewart

2010-01-01

Introduction HIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Methods Integration involved three key modifications: i) amalgamation of space and patient flow; ii) standardization of medical records and iii) introduction of routine provider initiated testing and counseling (PITC). Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Qualitative data on patient/provider perceptions was also collected. Findings Provider and patient interviews at both sites indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. Over six months in Clinic 1, PITC was provided to 2760 patients; 1485 (53%) accepted testing, 192 (13%) were HIV positive and 80 (42%) enrolled. Median OPD patient-provider contact time increased 55% (6.9 vs. 10.7 minutes; p<0.001) and decreased 1% for ART patients (27.9 vs. 27.7 minutes; p = 0.94). Median waiting times increased by 36 (p<0.001) and 23 minutes (p<0.001) for ART and OPD patients respectively. In Clinic 2, PITC was offered to 1510 patients, with 882 (58%) accepting testing, 208 (24%) HIV positive and 121 (58%) enrolled. Median OPD patient-provider contact time increased 110% (6.1 vs. 12.8 minutes; p<0.001) and decreased for ART patients by 23% (23 vs. 17.7 minutes; p<0.001). Median waiting times increased by 47 (p<0.001) and 34 minutes (p<0.001) for ART and OPD patients, respectively. Conclusions Integrating vertical ART and OPD services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is urgently required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalizability. PMID:20644629

Is Neighborhood Access to Health Care Provision Associated with Individual-Level Utilization and Satisfaction?

PubMed Central

Hiscock, Rosemary; Pearce, Jamie; Blakely, Tony; Witten, Karen

2008-01-01

Objective To explore whether travel time access to the nearest general practitioner (GP) surgery (which is equivalent to U.S. primary care physician [PCP] office) and pharmacy predicts individual-level health service utilization and satisfaction. Data Sources GP and pharmacy addresses were obtained from the New Zealand Ministry of Health in 2003 and merged with a geographic boundaries data set. Travel times derived from these data were appended to the 2002/03 New Zealand Health Survey (N = 12,529). Study Design Multilevel logistic regression was used to model the relationship between travel time access and five health service outcomes: GP consultation, blood pressure test, cholesterol test, visit to pharmacy, and satisfaction with latest GP consultation. Data Collection/Extraction Travel times between each census meshblock centroid and the nearest GP and pharmacy were calculated using Geographical Information System. Principal Findings When travel times were long, blood pressure tests were less likely in urban areas (odds ratio [OR] 0.75 [0.59–0.97]), GP consultations were less likely in rural centers (OR 0.42 [0.22–0.78]) and pharmacy visits were less likely in highly rural areas (OR 0.36 [0.13–0.99]). There was some evidence of lower utilization in rural areas. Conclusions Locational access to GP surgeries and pharmacies appears to sometimes be associated with health service use but not satisfaction. PMID:18671752

A low-cost mobile adaptive tracking system for chronic pulmonary patients in home environment.

PubMed

Işik, Ali Hakan; Güler, Inan; Sener, Melahat Uzel

2013-01-01

The main objective of this study is presenting a real-time mobile adaptive tracking system for patients diagnosed with diseases such as asthma or chronic obstructive pulmonary disease and application results at home. The main role of the system is to support and track chronic pulmonary patients in real time who are comfortable in their home environment. It is not intended to replace the doctor, regular treatment, and diagnosis. In this study, the Java 2 micro edition-based system is integrated with portable spirometry, smartphone, extensible markup language-based Web services, Web server, and Web pages for visualizing pulmonary function test results. The Bluetooth(®) (Bluetooth SIG, Kirkland, WA) virtual serial port protocol is used to obtain the test results from spirometry. General packet radio service, wireless local area network, or third-generation-based wireless networks are used to send the test results from a smartphone to the remote database. The system provides real-time classification of test results with the back propagation artificial neural network algorithm on a mobile smartphone. It also provides the generation of appropriate short message service-based notification and sending of all data to the Web server. In this study, the test results of 486 patients, obtained from Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital in Ankara, Turkey, are used as the training and test set in the algorithm. The algorithm has 98.7% accuracy, 97.83% specificity, 97.63% sensitivity, and 0.946 correlation values. The results show that the system is cheap (900 Euros) and reliable. The developed real-time system provides improvement in classification accuracy and facilitates tracking of chronic pulmonary patients.

78 FR 65653 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-01

... nine minutes calculation is based on a previous timed pre-test with six volunteer audiologists. There... received needed hearing tests and follow up services after their hospital discharges. The 2011 national...

Service evaluation of aluminum-brazed titanium (ABTi). [aircraft structures

NASA Technical Reports Server (NTRS)

Elrod, S. D.

1981-01-01

Long term creep-rupture, flight service and jet engine exhaust tests on aluminum-brazed titanium (ABTi), originally initiated under the DOT/SST follow-on program, were completed. These tests included exposure to natural airline service environments for up to 6 years. The results showed that ABTi has adequate corrosion resistance for long time commercial airplane structural applications. Special precautions are required for those sandwich structures designed for sound attenuation that utilize perforated skins. ABTi was also shown to have usable creep-rupture strength and to be metallurgically stable at temperatures up to 425 C (800 F).

Reliability of biologic indicators in a mail-return sterilization-monitoring service: a review of 3 years.

PubMed

Andrés, M T; Tejerina, J M; Fierro, J F

1995-12-01

Most mail-return sterilization-monitoring services use spore strips to test sterilizers in dental clinics, but factors such as delay caused by mailing to the laboratory could cause false negatives. The aims of this study were to determine the influence of poststerilization time and temperature on the biologic indicator recovery system and to evaluate sterilization failure and its possible causes in dental clinics subscribing to a mail-return sterilization-monitoring service. Spore strips used in independent tests revealed the poststerilization time and temperature after a 7-day delay to have no significant influence. Sixty-six dental clinics that received quarterly biologic indicators to evaluate the effectiveness of their sterilizers had sterilization failure rates of 28.7% in 1992, 18.1% in 1993, and 9.1% in 1994, a statistically significant decrease in sterilization failure during the 3-year period. The usual causes of failure were operator error in wrapping of instruments, loading, operating temperature, or exposure time.

Are happy employees healthy employees? Researching the effects of employee engagement on absenteeism.

PubMed

Hoxsey, Dann

2010-01-01

In 2007, a survey was conducted to measure the levels of workplace engagement for British Columbian civil servants. Following the Heskett et al. model of the “service profit chain” (1994, 2002), the government's primary concerns were the increasing attrition rates and their effects on service delivery. Essentially, the model demonstrated that employees who were more engaged were more committed to their work and more likely to stay within the civil service and that this culminated in improved customer service. Under the joint rubrics of absenteeism and job satisfaction, this study uses a construct of engagement (i.e., job satisfaction) to test whether different levels of engagement have any effect on the amount of sick time (absenteeism) an employee incurs. Specifically, the author looks at whether there is any correlation between the amount of sick time used and an individual's level of engagement and proposes that there is an inverse negative relationship: as job engagement increases, sick time used decreases. Testing the old adage “A happy employee is a healthy employee,” this research demonstrates that, though a more engaged employee may use less sick time, the differences in use between highly engaged employees and those not engaged are fairly marginal and that correlations are further confounded by a host of other (often missing) factors.

Development of a powered outdoor sealant fatigue test apparatus

Treesearch

Steven Lacher; R. Sam Williams; Corey Halpin; Christopher White

2005-01-01

This chapter describes a new cyclic fatigue test apparatus (CFTA) developed at the USDA Forest Service, Forest Products Laboratory. The new CFTA is computer controlled and powered by electric linear actuators. Computer control allows the CFTA to subject specimens to specific strain/time profiles or replicate input strain data in real time from thermal and/or moisture...

Models of service delivery for cancer genetic risk assessment and counseling.

PubMed

Trepanier, Angela M; Allain, Dawn C

2014-04-01

Increasing awareness of and the potentially concomitant increasing demand for cancer genetic services is driving the need to explore more efficient models of service delivery. The aims of this study were to determine which service delivery models are most commonly used by genetic counselors, assess how often they are used, compare the efficiency of each model as well as impact on access to services, and investigate the perceived benefits and barriers of each. Full members of the NSGC Familial Cancer Special Interest Group who subscribe to its listserv were invited to participate in a web-based survey. Eligible respondents were asked which of ten defined service delivery models they use and specific questions related to aspects of model use. One-hundred ninety-two of the approximately 450 members of the listserv responded (42.7%); 177 (92.2%) had provided clinical service in the last year and were eligible to complete all sections of the survey. The four direct care models most commonly used were the (traditional) face-to-face pre- and post-test model (92.2%), the face-to-face pretest without face-to-face post-test model (86.5%), the post-test counseling only for complex results model (36.2%), and the post test counseling for all results model (18.3%). Those using the face-to-face pretest only, post-test all, and post-test complex models reported seeing more new patients than when they used the traditional model and these differences were statistically significantly. There were no significant differences in appointment wait times or distances traveled by patients when comparing use of the traditional model to the other three models. Respondents recognize that a benefit of using alternative service delivery models is increased access to services; however, some are concerned that this may affect quality of care.

Implementation of Point-of-Care Diagnostics Leads to Variable Uptake of Syphilis, Anemia and CD4+ T-Cell Count Testing in Rural Maternal and Child Health Clinics.

PubMed

De Schacht, Caroline; Lucas, Carlota; Sitoe, Nádia; Machekano, Rhoderick; Chongo, Patrina; Temmerman, Marleen; Tobaiwa, Ocean; Guay, Laura; Kassaye, Seble; Jani, Ilesh V

2015-01-01

Anemia, syphilis and HIV are high burden diseases among pregnant women in sub-Saharan Africa. A quasi-experimental study was conducted in four health facilities in Southern Mozambique to evaluate the effect of point-of-care technologies for hemoglobin quantification, syphilis testing and CD4+ T-cell enumeration performed within maternal and child health services on testing and treatment coverage, and assessing acceptability by health workers. Demographic and testing data on women attending first antenatal care services were extracted from existing records, before (2011; n = 865) and after (2012; n = 808) introduction of point-of-care testing. Study outcomes per health facility were compared using z-tests (categorical variables) and Wilcoxon rank-sum test (continuous variables), while inverse variance weights were used to adjust for possible cluster effects in the pooled analysis. A structured acceptability-assessment interview was conducted with health workers before (n = 22) and after (n = 19). After implementation of point-of-care testing, there was no significant change in uptake of overall hemoglobin screening (67.9% to 83.0%; p = 0.229), syphilis screening (80.8% to 87.0%; p = 0.282) and CD4+ T-cell testing (84.9% to 83.5%; p = 0.930). Initiation of antiretroviral therapy for treatment eligible women was similar in the weighted analysis before and after, with variability among the sites. Time from HIV diagnosis to treatment initiation decreased (median of 44 days to 17 days; p<0.0001). A generally good acceptability for point-of-care testing was seen among health workers. Point-of-care CD4+ T-cell enumeration resulted in a decreased time to initiation of antiretroviral therapy among treatment eligible women, without significant increase in testing coverage. Overall hemoglobin and syphilis screening increased. Despite the perception that point-of-care technologies increase access to health services, the variability in results indicate the potential for detrimental effects in some settings. Local context needs to be considered and services restructured to accommodate innovative technologies in order to improve service delivery to expectant mothers.

KSC-08pd0083

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, technicians look at some of the elements to be tested in the Ares I-X Roll Control System, or RoCS. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

KSC-08pd0082

NASA Image and Video Library

2008-01-24

KENNEDY SPACE CENTER, FLA. -- In the hypergolic maintenance facility at NASA's Kennedy Space Center, some of the internal elements seen here of the ARES I-X Roll Control System, or RoCS, will undergo testing. The RoCS Servicing Simulation Test is to gather data that will be used to help certify the ground support equipment design and validate the servicing requirements and processes. The RoCS is part of the Interstage structure, the lowest axial segment of the Upper Stage Simulator. In an effort to reduce costs and meet the schedule, most of the ground support equipment that will be used for the RoCS servicing is of space shuttle heritage. This high-fidelity servicing simulation will provide confidence that servicing requirements can be met with the heritage system. At the same time, the test will gather process data that will be used to modify or refine the equipment and processes to be used for the actual flight element. Photo credit: NASA/Kim Shiflett

[Introduction of rapid syphilis and HIV testing in prenatal care in Colombia: qualitative analysis].

PubMed

Ochoa-Manjarrés, María Teresa; Gaitán-Duarte, Hernando Guillermo; Caicedo, Sidia; Gómez, Berta; Pérez, Freddy

2016-12-01

Interpret perceptions of Colombian health professionals concerning factors that obstruct and facilitate the introduction of rapid syphilis and HIV testing in prenatal care services. A qualitative study based on semi-structured interviews was carried out. A convenience sample was selected with 37 participants, who included health professionals involved in prenatal care services, programs for pregnant women, clinical laboratories, and directors of health care units or centers, as well as representatives from regional departments and the Ministry of Health. Colombia does not do widespread screening with rapid syphilis and HIV tests in prenatal care. The professionals interviewed stated they did not have prior experience in the use of rapid tests-except for laboratory staff-or in the course of action in response to a positive result. The insurance system hinders access to timely diagnosis and treatment. Health authorities perceive a need to review existing standards, strengthen the first level of care, and promote comprehensive prenatal care starting with contracts between insurers and health service institutional providers. Participants recommended staff training and integration between health-policymaking and academic entities for updating training programs. The market approach and the characteristics of the Colombian health system constitute the main barriers to implementation of rapid testing as a strategy for elimination of mother-to-child transmission of syphilis and HIV. Measures identified include making changes in contracts between insurers and health service institutional providers, adapting the timing and duration of prenatal care procedures, and training physicians and nurses involved in prenatal care.

Structural Area Inspection Frequency Evaluation (SAIFE). Volume III. Demonstration Input, Inspection Survey, and MRR Data

DTIC Science & Technology

1978-04-01

3 1.7 Production Rate Change Time . . . . 3 1.8 Time of Fatigue Test Start . ..... 3 1.9 Fatigue Test Acceleration Factor . 3 1.10 Corrosion...simulation logic. SAIFE accounts for the following factors : (1) aircraft design analysis; (2) component and full-scale fatigue testing; (3) production ...reliability; production , servi ce,Information Service, Springfield, and corrosion defects; crack or corrosi on Virginia 22151 detection probability; crack

Use of GetCheckedOnline, a Comprehensive Web-based Testing Service for Sexually Transmitted and Blood-Borne Infections

PubMed Central

Salway, Travis; Haag, Devon; Fairley, Christopher K; Wong, Jason; Grennan, Troy; Uddin, Zhaida; Buchner, Christopher S; Wong, Tom; Krajden, Mel; Tyndall, Mark; Shoveller, Jean; Ogilvie, Gina

2017-01-01

Background The British Columbia Centre for Disease Control implemented a comprehensive Web-based testing service GetCheckedOnline (GCO) in September 2014 in Vancouver, Canada. GCO’s objectives are to increase testing for sexually transmitted and blood-borne infections (STBBIs), reach high-prevalence populations facing testing barriers, and increase clinical STI service capacity. GCO was promoted through email invitations to provincial STI clinic clients, access codes to clients unable to access immediate clinic-based testing (deferred testers), and a campaign to gay, bisexual, and other men who have sex with men (MSM). Objective The objective of the study was to report on characteristics of GCO users, use and test outcomes (overall and by promotional strategy) during this pilot phase. Methods We used GCO program data, website metrics, and provincial STI clinic records to describe temporal trends, progression through the service pathway, and demographic, risk, and testing outcomes for individuals creating GCO accounts during the first 15 months of implementation. Results Of 868 clients creating accounts, 318 (36.6%) submitted specimens, of whom 96 (30.2%) tested more than once and 10 (3.1%) had a positive STI diagnosis. The proportion of clients submitting specimens increased steadily over the course of the pilot phase following introduction of deferred tester codes. Clients were diverse with respect to age, gender, and ethnicity, although youth and individuals of nonwhite ethnicity were underrepresented. Of the 506 clients completing risk assessments, 215 (42.5%) were MSM, 89 (17.6%) were symptomatic, 47 (9.3%) were STI contacts, 232 (45.8%) reported condomless sex, 146 (28.9%) reported ≥4 partners in the past 3 months, and 76 (15.0%) reported a recent STI. A total of 63 (12.5%) GCO clients were testing for the first time. For 868 accounts created, 337 (38.8%) were by clinic invitations (0 diagnoses), 298 (34.3%) were by deferred testers (6 diagnoses), 194 (22.4%) were by promotional campaign (3 diagnoses), and 39 (4.5%) were by other means (1 diagnosis). Conclusions Our evaluation suggests that GCO is an acceptable and feasible approach to engage individuals in testing. Use by first-time testers, repeated use, and STI diagnosis of individuals unable to access immediate clinic-based testing suggest GCO may facilitate uptake of STBBI testing and earlier diagnosis. Use by MSM and individuals reporting sexual risk suggests GCO may reach populations with a higher risk of STI. Motivation to test (eg, unable to access clinical services immediately) appears a key factor underlying GCO use. These findings identify areas for refinement of the testing model, further promotion, and future research (including understanding reasons for drop-off through the service pathway and more comprehensive evaluation of effectiveness). Increased uptake and diagnosis corresponding with expansion of the service within British Columbia will permit future evaluation of this service across varying populations and settings. PMID:28320690

Hazard Assessment of Personal Protective Clothing for Hydrogen Peroxide Service

NASA Technical Reports Server (NTRS)

Greene, Ben; McClure, Mark B.; Johnson, Harry T.

2004-01-01

Selection of personal protective equipment (PPE) for hydrogen peroxide service is an important part of the hazard assessment process. But because drip testing of chemical protective clothing for hydrogen peroxide service has not been reported for about 40 years, it is of great interest to test new protective clothing materials with new, high-concentration hydrogen peroxide following similar procedures. The suitability of PPE for hydrogen peroxide service is in part determined by observations made when hydrogen peroxide is dripped onto swatches of protective clothing material. Protective clothing material was tested as received, in soiled condition, and in grossly soiled condition. Materials were soiled by pretreating the material with potassium permanganate (KMnO4) solution then drying to promote a reaction. Materials were grossly soiled with solid KMnO4 to greatly promote reaction. Observations of results including visual changes to the hydrogen peroxide and materials, times to ignition, and self-extinguishing characteristics of the materials are reported.

Multileaf collimator performance monitoring and improvement using semiautomated quality control testing and statistical process control.

PubMed

Létourneau, Daniel; Wang, An; Amin, Md Nurul; Pearce, Jim; McNiven, Andrea; Keller, Harald; Norrlinger, Bernhard; Jaffray, David A

2014-12-01

High-quality radiation therapy using highly conformal dose distributions and image-guided techniques requires optimum machine delivery performance. In this work, a monitoring system for multileaf collimator (MLC) performance, integrating semiautomated MLC quality control (QC) tests and statistical process control tools, was developed. The MLC performance monitoring system was used for almost a year on two commercially available MLC models. Control charts were used to establish MLC performance and assess test frequency required to achieve a given level of performance. MLC-related interlocks and servicing events were recorded during the monitoring period and were investigated as indicators of MLC performance variations. The QC test developed as part of the MLC performance monitoring system uses 2D megavoltage images (acquired using an electronic portal imaging device) of 23 fields to determine the location of the leaves with respect to the radiation isocenter. The precision of the MLC performance monitoring QC test and the MLC itself was assessed by detecting the MLC leaf positions on 127 megavoltage images of a static field. After initial calibration, the MLC performance monitoring QC test was performed 3-4 times/week over a period of 10-11 months to monitor positional accuracy of individual leaves for two different MLC models. Analysis of test results was performed using individuals control charts per leaf with control limits computed based on the measurements as well as two sets of specifications of ± 0.5 and ± 1 mm. Out-of-specification and out-of-control leaves were automatically flagged by the monitoring system and reviewed monthly by physicists. MLC-related interlocks reported by the linear accelerator and servicing events were recorded to help identify potential causes of nonrandom MLC leaf positioning variations. The precision of the MLC performance monitoring QC test and the MLC itself was within ± 0.22 mm for most MLC leaves and the majority of the apparent leaf motion was attributed to beam spot displacements between irradiations. The MLC QC test was performed 193 and 162 times over the monitoring period for the studied units and recalibration had to be repeated up to three times on one of these units. For both units, rate of MLC interlocks was moderately associated with MLC servicing events. The strongest association with the MLC performance was observed between the MLC servicing events and the total number of out-of-control leaves. The average elapsed time for which the number of out-of-specification or out-of-control leaves was within a given performance threshold was computed and used to assess adequacy of MLC test frequency. A MLC performance monitoring system has been developed and implemented to acquire high-quality QC data at high frequency. This is enabled by the relatively short acquisition time for the images and automatic image analysis. The monitoring system was also used to record and track the rate of MLC-related interlocks and servicing events. MLC performances for two commercially available MLC models have been assessed and the results support monthly test frequency for widely accepted ± 1 mm specifications. Higher QC test frequency is however required to maintain tighter specification and in-control behavior.

Mechanical behavior and failure analysis of prosthetic retaining screws after long-term use in vivo. Part 3: Preload and tensile fracture load testing.

PubMed

Al Jabbari, Youssef S; Fournelle, Raymond; Ziebert, Gerald; Toth, Jeffrey; Iacopino, Anthony M

2008-04-01

The aim of this study was to determine the preload and tensile fracture load values of prosthetic retaining screws after long-term use in vivo compared to unused screws (controls). Additionally, the investigation addressed whether the preload and fracture load values of prosthetic retaining screws reported by the manufacturer become altered after long-term use in vivo. For preload testing, 10 new screws (controls) from Nobel Biocare (NB) and 73 used retaining screws [58 from NB and 15 from Sterngold (SG)] were subjected to preload testing. For tensile testing, eight controls from NB and 58 used retaining screws (46 from NB and 12 from SG) were subjected to tensile testing. Used screws for both tests were in service for 18-120 months. A custom load frame, load cell, and torque wrench setup were used for preload testing. All 83 prosthetic screws were torqued once to 10 Ncm, and the produced preload value was recorded (N) using an X-Y plotter. Tensile testing was performed on a universal testing machine and the resulting tensile fracture load value was recorded (N). Preload and tensile fracture load values were analyzed with 2-way ANOVA and Tukey post-hoc tests. There was a significant difference between preload values for screws from NB and screws from SG (p < 0.001). The preload values for gold alloy screws from NB decreased as the number of years in service increased. There was a significant difference between tensile fracture values for the three groups (gold alloy screws from NB and SG and palladium alloy screws from NB) at p < 0.001. The tensile fracture values for gold alloy screws from NB and SG decreased as the number of years in service increased. In fixed detachable hybrid prostheses, perhaps as a result of galling, the intended preload values of prosthetic retaining screws may decrease with increased in-service time. The reduction of the fracture load value may be related to the increase of in-service time; however, the actual determination of this relationship is not possible from this study alone.

Technique for finding and identifying filters that cut off OTDR lights in front of ONU from a central office

NASA Astrophysics Data System (ADS)

Takaya, Masaaki; Honda, Hiroyasu; Narita, Yoshihiro; Yamamoto, Fumihiko; Arakawa, Koji

2006-04-01

We report on a newly developed in-service measurement technique that can be used from a central office to find and identify any filter in front of an ONU on an optical fiber access network. Using this system, in-service tests can be performed because the test lights are modulated at a high frequency. Moreover, by using the equipment we developed, this confirmation operation can be performed continuously and automatically with existing automatic fiber testing systems. The developed technique is effective for constructing a fiber line testing system with an optical time domain reflectometer.

System Mean-Time-between-Failure versus Life-Cycle Logistics Cost Subject to the Introduction of Line-Replaceable-Unit Redundancy

DTIC Science & Technology

1988-03-18

Design Confiquration 6 ......... 805 Appendix 9 SCRAPIRONS’s Output For Design Confiquration 7 ......... 90 Appendix 10 SCRAPIRONS’s Output For fesign ...17umb~r of men per contact support crew 2.00e0j _______ TVRO IV test equipment). 293 Name-285) TRC D~own-time in hours per service demanda4 equipment...to service for servicing further _____LUs. 297 14iaeeC28F) T~mE used in concepts GM. GO. and CR which 84.rje1 cal;.for LRU and: mtue ear atGeneral S

Accessibility and distribution of the Norwegian National Air Emergency Service: 1988-1998.

PubMed

Heggestad, Torhild; Børsheim, Knut Yngve

2002-01-01

To evaluate the accessibility and distribution of the Norwegian National Air Emergency Service in the 10-year period from 1988 to 1998. The primary material was annual standardized activity data that included all helicopter missions. A multivariate model of determinants for use of the helicopter service was computed by linear regression. Accessibility was measured as the percentage of the population reached in different flying times, and we evaluated the service using a simulation of alternative locations for the helicopter bases. The helicopter service (HEMS) has short access times, with a mean reaction time of 8 minutes and a mean response time of 26 minutes for acute missions. Nearly all patients (98%) are reached within 1 hour. A simulation that tested alternative locations of the helicopter bases compared with current locations showed no increase in accessibility. The use of the service shows large regional differences. Multivariate analyses showed that the distances of the patients from the nearest helicopter base and the nearest hospital are significant determinants for the use of HEMS. Establishment of a national service has given the Norwegian population better access to highly qualified prehospital emergency services. Furthermore, the HEMS has a compensating effect in adjusting for differences in traveling distances to a hospital. Safety, cost-containment, and gatekeeper functions remain challenges.

Post-Test Inspection of NASA's Evolutionary Xenon Thruster Long-Duration Test Hardware: Discharge and Neutralizer Cathodes

NASA Technical Reports Server (NTRS)

Shastry, Rohit; Soulas, George C.

2016-01-01

The NEXT Long-Duration Test is part of a comprehensive thruster service life assessment intended to demonstrate overall throughput capability, validate service life models, quantify wear rates as a function of time and operating condition, and identify any unknown life-limiting mechanisms. The test was voluntarily terminated in April 2014 after demonstrating 51,184 hours of high-voltage operation, 918 kg of propellant throughput, and 35.5 MN-s of total impulse. The post-test inspection of the thruster hardware began shortly afterwards with a combination of non-destructive and destructive analysis techniques, and is presently nearing completion. This presentation presents relevant results of the post-test inspection for both discharge and neutralizer cathodes.

Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance.

PubMed

Blick, Kenneth E

2013-08-01

To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.

"Where Is My Answer?": A Customer Service Status Report.

ERIC Educational Resources Information Center

Marcinko, Randy

1997-01-01

Describes the results of a study that tested the customer service responses from 11 companies selling online information including online hosts, database producers, and World Wide Web search engine companies. Highlights include content-oriented issues, costs, training, human interaction, and the use of technology to save time and increase…

Durability of building joint sealants

Treesearch

Christopher C. White; Kar Tean Tan; Donald L. Hunston; R. Sam Williams

2009-01-01

Predicting the service life of building joint sealants exposed to service environments in less than real time has been a need of the sealant community for many decades. Despite extensive research efforts to design laboratory accelerated tests to duplicate the failure modes occurring in field exposures, little success has been achieved using conventional durability...

Virtual Service, Real Data: Results of a Pilot Study.

ERIC Educational Resources Information Center

Kibbee, Jo; Ward, David; Ma, Wei

2002-01-01

Describes a pilot project at the University of Illinois at Urbana-Champaign reference and undergraduate libraries to test the feasibility of offering real-time online reference service via their Web site. Discusses software selection, policies and procedures, promotion and marketing, user interface, training and staffing, data collection, and…

Michigan School Privatization Survey 2008

ERIC Educational Resources Information Center

Hohman, James M.; Freeland, William L. E.

2008-01-01

Privatization of school support services is a time-tested means for lowering educational costs. The three major services that school districts in Michigan contract out for are food, custodial and transportation. The Mackinac Center for Public Policy's survey of privatization is the longest running and most comprehensive source of school support…

Assessing the costs of mobile voluntary counseling and testing at the work place versus facility based voluntary counseling and testing in Namibia.

PubMed

de Beer, Ingrid; Chani, Kudakwashe; Feeley, Frank G; Rinke de Wit, Tobias F; Sweeney-Bindels, Els; Mulongeni, Pancho

2015-01-01

Bophelo! is a mobile voluntary counseling and testing (VCT) and wellness screening program operated by PharmAccess at workplaces in Namibia, funded from both public and private resources. Publicly funded fixed site New Start centers provide similar services in Namibia. At this time of this study, no comparative information on the cost effectiveness of mobile versus fixed site service provision was available in Namibia to inform future programming for scale-up of VCT. The objectives of the study were to assess the costs of mobile VCT and wellness service delivery in Namibia and to compare the costs and effectiveness with fixed site VCT testing in Namibia. The full direct costs of all resources used by the mobile and fixed site testing programs and data on people tested and outcomes were obtained from PharmAccess and New Start centers in Namibia. Data were also collected on the source of funding, both public donor funding and private funding through contributions from employers. The data were analyzed using Microsoft Excel to determine the average cost per person tested for HIV. In 2009, the average cost per person tested for HIV at the Bophelo! mobile clinic was an estimated US$60.59 (US$310,451 for the 5124 people tested). Private employer contributions to the testing costs reduced the public cost per person tested to US$37.76. The incremental cost per person associated with testing for conditions other than HIV infection was US$11.35, an increase of 18.7%, consisting of the costs of additional tests (US$8.62) and staff time (US$2.73). The cost of testing one person for HIV in 2009 at the New Start centers was estimated at US$58.21 (US$4,082,936 for the 70 143 people tested). Mobile clinics can provide cost-effective wellness testing services at the workplace and have the potential to mobilize local private funding sources. Providing wellness testing in addition to VCT can help address the growing issue of non-communicable diseases.

The stratification of military service and combat exposure, 1934–1994*

PubMed Central

MacLean, Alair

2010-01-01

Previous research has suggested that men who were exposed to combat during wartime differed from those who were not. Yet little is known about how selection into combat has changed over time. This paper estimates sequential logistic models using data from the Panel Study of Income Dynamics to examine the stratification of military service and combat exposure in the US during the last six decades of the twentieth century. It tests potentially overlapping hypotheses drawn from two competing theories, class bias and dual selection. It also tests a hypothesis, drawn from the life course perspective, that the processes by which people came to see combat have changed historically. The findings show that human capital, institutional screening, and class bias all determined who saw combat. They also show that, net of historical change in the odds of service and combat, the impact of only one background characteristic, race, changed over time. PMID:21113325

REAL-TIME TRACER MONITORING OF RESERVOIR STIMULATION PROCEDURES VIA ELECTRONIC WIRELINE AND TELEMETRY DATA TRANSMISSION

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

George L. Scott III

2005-01-01

Finalized Phase 2-3 project work has field-proven two separate real-time reservoir processes that were co-developed via funding by the National Energy Technology Laboratory (NETL). Both technologies are presently patented in the United States and select foreign markets; a downhole-commingled reservoir stimulation procedure and a real-time tracer-logged fracturing diagnostic system. Phase 2 and early Phase 3 project work included the research, development and well testing of a U.S. patented gamma tracer fracturing diagnostic system. This stimulation logging process was successfully field-demonstrated; real-time tracer measurement of fracture height while fracturing was accomplished and proven technically possible. However, after the initial well tests,more » there were several licensing issues that developed between service providers that restricted and minimized Realtimezone's (RTZ) ability to field-test the real-time gamma diagnostic system as was originally outlined for this project. Said restrictions were encountered after when one major provider agreed to license their gamma logging tools to another. Both of these companies previously promised contributory support toward Realtimezone's DE-FC26-99FT40129 project work, however, actual support was less than desired when newly-licensed wireline gamma logging tools from one company were converted by the other from electric wireline into slickline, batter-powered ''memory'' tools for post-stimulation logging purposes. Unfortunately, the converted post-fracture measurement memory tools have no applications in experimentally monitoring real-time movement of tracers in the reservoir concurrent with the fracturing treatment. RTZ subsequently worked with other tracer gamma-logging tool companies for basic gamma logging services, but with lessened results due to lack of multiple-isotope detection capability. In addition to real-time logging system development and well testing, final Phase 2 and Phase 3 project work included the development of a real-time reservoir stimulation procedure, which was successfully field-demonstrated and is presently patented in the U.S. and select foreign countries, including Venezuela, Brazil and Canada. Said patents are co-owned by RTZ and the National Energy Technology Lab (NETL). In 2002, Realtimezone and the NETL licensed said patents to Halliburton Energy Services (HES). Additional licensing agreements (LA) are anticipated with other service industry companies in 2005. Final Phase 3 work has led to commercial applications of the real-time reservoir stimulation procedure. Four successfully downhole-mixed well tests were conducted with commercially expected production results. The most recent, fourth field test was a downhole-mixed stimulated well completed in June, 2004, which currently produces 11 BOPD with 90 barrels of water per day. Conducted Phase 2 and Phase 3 field-test work to date has resulted in the fine-tuning of a real-time enhanced stimulation system that will significantly increase future petroleum well recoveries in the United States and foreign petroleum fields, both onshore and offshore, and in vertical and horizontal wells.« less

The Test Collection at ETS: 34 Years and Still Growing

ERIC Educational Resources Information Center

McQuillen, Karen

2009-01-01

This essay updates the two articles that were previously published in the Winter 1975/1976 and 1984 issues respectively of "Education Libraries," and featured the Educational Testing Service (ETS) Test Collection. At the time of the writing of the 1975/1976 article, the collection was known as The ETS Test Collection. However, since the collection…

Technology-assisted self-testing and management of oral anticoagulation therapy: a qualitative patient-focused study.

PubMed

Kuljis, Jasna; Money, Arthur G; Perry, Mark; Barnett, Julie; Young, Terry

2017-09-01

Oral anticoagulation therapy requires regular blood testing to ensure therapeutic levels are maintained and excessive bleeding/clotting is avoided. Technology-assisted self-testing and management is seen as one of the key areas in which quality of care can be improved whilst reducing costs. Nevertheless, levels of patient engagement in self-testing and management remain low. To date, little research emphasis has been placed on understanding the patients' perspectives for low engagement. The typical approach adopted by healthcare providers is to provide patient education programmes, with the expectation that individual patients will change their behaviour and adopt new self-care strategies. However, if levels of patient engagement are to be increased, healthcare providers must also develop a better understanding of how their clinical service provision is perceived by patients and make adaptations. To explore patient views, needs and expectations of an anticoagulation service and the self-testing and management services provided. Interviews were conducted with 17 patients who currently engage in international normalised ratio (INR) self-testing and management. Thematic coding and analysis were carried out on the interview transcripts. Four high-level themes emerged from interviews: (i) role of clinic, (ii) motivations for self-testing, (iii) managing INR and (iv) trust. The clinic was seen as adding value in terms of specifying testing frequency, dosage profiles and calibrating equipment. Prompt communication from clinic to patient was also valued, although more personalised/real-time communication would help avoid feelings of isolation. Patients felt more in control as self-tester/managers and often took decisions about treatment adjustments themselves. However, some also manipulated their own test results to avoid 'unnecessary' interventions. More personalised/real-time communication, pragmatic and collaborative patient-clinician partnerships and recognition of expert patient knowledge and expertise are needed if increased levels of engagement with self-testing and management service provision is to be realised. © 2016 Nordic College of Caring Science.

40 CFR 63.1365 - Test methods and initial compliance procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... design minimum and average temperature in the combustion zone and the combustion zone residence time. (B... establish the design minimum and average flame zone temperatures and combustion zone residence time, and... carbon bed temperature after regeneration, design carbon bed regeneration time, and design service life...

Trends in Receipt of Sexually Transmitted Disease Services Among Women 15 to 44 Years Old in the United States, 2002 to 2006–2010

PubMed Central

Haderxhanaj, Laura T.; Gift, Thomas L.; Loosier, Penny S.; Cramer, Ryan C.; Leichliter, Jami S.

2018-01-01

Background To describe recent trends in the receipt of sexually transmitted disease (STD) services among women (age, 15–44 years) from 2002 to 2006–2010 using the National Survey of Family Growth. Methods We analyzed trends in demographics, health insurance, and visit-related variables of women reporting receipt of STD services (counseling, testing, or treatment) in the past 12 months. We also analyzed trends in the source of STD services and the payment method used. Results Receipt of STD services reported by women in the past 12 months increased from 2002 (12.6%) to 2006–2010 (16.0%; P < 0.001). Receipt of services did not increase among adolescents (P = 0.592). Among women receiving STD services from a private doctor/HMO, the percentage with private insurance decreased over time (74.6%–66.8%), whereas the percentage with Medicaid increased (12.8%–19.7%; P = 0.020). For women receiving STD services at a public clinic or nonprimary care facility, there were no statistically significant differences by demographics, except that fewer adolescents but more young adults reported using a public clinic over time (P = 0.038). Among women who reported using Medicaid as payment, receipt of STD services at a public clinic significantly decreased (36.8%–25.4%; P = 0.019). For women who paid for STD services with private insurance, the only significant difference was an increase in having a copay over time (61.3%–70.1%; P = 0.012). Conclusions Despite a significant increase in receipt of STD services over time, many women at risk for STDs did not receive services including adolescents. In addition, we identified important shifts in payment methods during this time frame. PMID:24335746

Lower currents: a new choice for routine testing.

PubMed

Backes, John

2007-01-01

U.S. NFPA and AAMI standards both recommend a 10A ground bond test and, as has been described above, both 25A and 200mA are also recommended internationally as valid test currents for the in-service testing and inspection of medical electrical equipment. The reality is that both high and low test currents are of value to biomedical engineers and technicians in different circumstances. For benchtop testing in a workshop environment, where required test currents can be applied safely, then it seems likely that high current testing will remain the preferred option. However, for in-service test applications, where the portability and versatility of the tester is a key requirement, modern electronic technology now means that low current testing can now be applied effectively and safely. In summary, by using a low-energy, high current pulse prior to 200 mA test current, the lower test current is preferred for routine field maintenance as this can mean: Increased safety of the operator. Reduced risk of damage to the in-service medical equipment. Smaller test instruments to include valid ground bond measurements. Battery operated test equipment. Increased flexibility of the test engineer due to lightweight test equipment. Cost reduction due to reduced down time of medical equipment. More economical availability of test equipment.

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management.

PubMed

Kuupiel, Desmond; Bawontuo, Vitalis; Mashamba-Thompson, Tivani P

2017-11-29

Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

PubMed Central

Kuupiel, Desmond; Bawontuo, Vitalis

2017-01-01

Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings. PMID:29186013

Impact of intervention surveillance bias on analyses of child welfare report outcomes.

PubMed

Chaffin, Mark; Bard, David

2006-11-01

Two studies using data from child maltreatment intervention outcome evaluations were conducted examining several aspects of surveillance bias, including directly measuring rates of surveillance reporting, comparing characteristics of surveillance versus nonsurveillance reports, examining differences across service types and doses, and testing how ignoring versus removing surveillance reports in the data affects survival analysis. The net effect of surveillance bias was small in the studies examined. Home-visiting services were not biased more than center-based services, and bias was not greater among intervention compared to prevention cases. Surveillance reports were equally as severe as nonsurveillance reports, failing to support the hypothesis that surveillance serves as early detection of less severe maltreatment. However, surveillance bias was far more substantial during time periods when participants were actively engaged in services. Therefore, the net impact of surveillance could vary with service engagement rates and the relative duration of service engagement and postservice follow-up times.

A Test Run of the EGSIEM Near Real-Time Service Based on GRACE Mission Data

NASA Astrophysics Data System (ADS)

Kvas, A.; Gruber, C.; Gouweleeuw, B.; Guntner, A.; Mayer-Gürr, T.; Flechtner, F. M.

2017-12-01

To enable the use of GRACE and GRACE-FO data for rapid monitoring applications, the EGSIEM (European Gravity Service for Improved Emergency Management) project, funded by the Horizon 2020 Framework Program for Research and Innovation of the European Union, has implemented a demonstrator for a near real-time (NRT) gravity field service. The goal of this service is to provide daily gravity field solutions with a maximum latency of five days. For this purpose, two independent approaches were developed at the German Research Centre for Geosciences (GFZ) and Graz University of Technology (TUG). Based on these daily gravity field solutions, statistical flood and drought indicators are derived by the EGSIEM Hydrological Service, developed at GFZ. The NRT products are subsequently provided to the Center for Satellite based Crisis Information (ZKI) at the German Aerospace Center as well as the Global Flood Awareness System (GloFAS) at the Joint Research Center of the European Commission. In the first part of this contribution, the performance of the service based on a statistical analysis of historical flood events during the GRACE period is evaluated. Then, results from the six month long operational test run of the service which started on April 1st 2017 are presented and a comparison between historical and operational gravity products and flood indicators is made.

Cloud-Hosted Real-time Data Services for the Geosciences (CHORDS)

NASA Astrophysics Data System (ADS)

Daniels, M. D.; Graves, S. J.; Vernon, F.; Kerkez, B.; Chandra, C. V.; Keiser, K.; Martin, C.

2014-12-01

Cloud-Hosted Real-time Data Services for the Geosciences (CHORDS) Access, utilization and management of real-time data continue to be challenging for decision makers, as well as researchers in several scientific fields. This presentation will highlight infrastructure aimed at addressing some of the gaps in handling real-time data, particularly in increasing accessibility of these data to the scientific community through cloud services. The Cloud-Hosted Real-time Data Services for the Geosciences (CHORDS) system addresses the ever-increasing importance of real-time scientific data, particularly in mission critical scenarios, where informed decisions must be made rapidly. Advances in the distribution of real-time data are leading many new transient phenomena in space-time to be observed, however real-time decision-making is infeasible in many cases that require streaming scientific data as these data are locked down and sent only to proprietary in-house tools or displays. This lack of accessibility to the broader scientific community prohibits algorithm development and workflows initiated by these data streams. As part of NSF's EarthCube initiative, CHORDS proposes to make real-time data available to the academic community via cloud services. The CHORDS infrastructure will enhance the role of real-time data within the geosciences, specifically expanding the potential of streaming data sources in enabling adaptive experimentation and real-time hypothesis testing. Adherence to community data and metadata standards will promote the integration of CHORDS real-time data with existing standards-compliant analysis, visualization and modeling tools.

49 CFR 178.58 - Specification 4DA welded steel cylinders for aircraft use.

Code of Federal Regulations, 2010 CFR

2010-10-01

... stress in pounds psi; P = test pressure prescribed for water jacket test, i.e., at least 2 times service... seamless hemispheres) or a circumferentially welded cylinder (two seamless drawn shells) with a water... the wall stress at the minimum specified test pressure may not exceed 67 percent of the minimum...

40 CFR 1033.325 - Maintenance of records; submittal of information.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Production Line Testing and Audit Programs § 1033.325 Maintenance of records; submittal of information. (a... production line test or audit including: (i) The date, time, and location of each test or audit. (ii) The method by which the Green Engine Factor was calculated or the number of hours of service accumulated on...

42 CFR 84.98 - Tests during low temperature operation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Tests during low temperature operation. 84.98...-Contained Breathing Apparatus § 84.98 Tests during low temperature operation. (a) The applicant shall... apparatus will be worn in the low temperature chamber for 30 minutes, or for the service time of the...

42 CFR 84.98 - Tests during low temperature operation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Tests during low temperature operation. 84.98...-Contained Breathing Apparatus § 84.98 Tests during low temperature operation. (a) The applicant shall... apparatus will be worn in the low temperature chamber for 30 minutes, or for the service time of the...

42 CFR 84.98 - Tests during low temperature operation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Tests during low temperature operation. 84.98...-Contained Breathing Apparatus § 84.98 Tests during low temperature operation. (a) The applicant shall... apparatus will be worn in the low temperature chamber for 30 minutes, or for the service time of the...

42 CFR 84.98 - Tests during low temperature operation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Tests during low temperature operation. 84.98...-Contained Breathing Apparatus § 84.98 Tests during low temperature operation. (a) The applicant shall... apparatus will be worn in the low temperature chamber for 30 minutes, or for the service time of the...

42 CFR 84.94 - Gas flow test; closed-circuit apparatus.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Gas flow test; closed-circuit apparatus. 84.94...-Contained Breathing Apparatus § 84.94 Gas flow test; closed-circuit apparatus. (a) Where oxygen is supplied... rated service time of the apparatus. (b) Where constant flow is used in conjunction with demand flow...

42 CFR 84.94 - Gas flow test; closed-circuit apparatus.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Gas flow test; closed-circuit apparatus. 84.94...-Contained Breathing Apparatus § 84.94 Gas flow test; closed-circuit apparatus. (a) Where oxygen is supplied... rated service time of the apparatus. (b) Where constant flow is used in conjunction with demand flow...

42 CFR 84.98 - Tests during low temperature operation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Tests during low temperature operation. 84.98...-Contained Breathing Apparatus § 84.98 Tests during low temperature operation. (a) The applicant shall... apparatus will be worn in the low temperature chamber for 30 minutes, or for the service time of the...

Acceleration Disturbances onboard of Geodetic Precision Space Laboratories

NASA Astrophysics Data System (ADS)

Peterseim, Nadja; Jakob, Flury; Schlicht, Anja

Bartlomiej Oszczak, b@dgps.pl University of Warmia and Mazury in Olsztyn, Poland, Olsztyn, Poland Olga Maciejczyk, omaciejczyk@gmail.com Poland In this paper there is presented the study on the parameters of the ASG-EUPOS real-time RTK service NAWGEO such as: accuracy, availability, integrity and continuity. Author's model is used for tests. These parameters enable determination of the quality of received information and practical applications of the service. Paper includes also the subject related to the NAWGEO service and algorithms used in determination of mentioned parameters. The results of accuracy and precision analyses and study on availability demonstrated that NAWGEO service enables a user a position determination with a few centimeters accuracy with high probability in any moment of time.

Fatigue design procedure for the American SST prototype

NASA Technical Reports Server (NTRS)

Doty, R. J.

1972-01-01

For supersonic airline operations, significantly higher environmental temperature is the primary new factor affecting structural service life. Methods for incorporating the influence of temperature in detailed fatigue analyses are shown along with current test indications. Thermal effects investigated include real-time compared with short-time testing, long-time temperature exposure, and stress-temperature cycle phasing. A method is presented which allows designers and stress analyzers to check fatigue resistance of structural design details. A communicative rating system is presented which defines the relative fatigue quality of the detail so that the analyst can define cyclic-load capability of the design detail by entering constant-life charts for varying detail quality. If necessary then, this system allows the designer to determine ways to improve the fatigue quality for better life or to determine the operating stresses which will provide the required service life.

Analysis of legal high materials by ultra-performance liquid chromatography with time of flight mass spectrometry as part of a toxicology vigilance system: what are the most popular novel psychoactive substances in the UK?

PubMed

Ford, Loretta T; Berg, Jonathan D

2017-03-01

Introduction Legal highs also known as novel psychoactive substances mimic the effects of classic drugs of abuse. Challenges to developing screening services for novel psychoactive substances include identifying which novel psychoactive substances are available to target. Using new techniques such as exact mass time of flight can help identify common novel psychoactive substances to target for screening patient samples by routine methods such as tandem mass spectrometry. We demonstrate this strategy working in our own clinical toxicology laboratory after qualitative analysis of 98 suspect materials for novel psychoactive substances by ultra-performance liquid chromatography with time of flight mass spectrometry. Results From July 2014 to July 2015 we received 98 requests to test a range of different suspect materials for novel psychoactive substances including herbs, tobacco, liquids, pills and powders. Overall, 87% of the suspect materials tested positive for novel psychoactive substances, and 15% for controlled drugs. Three common novel psychoactive substances were present in 74% of the suspect materials: methiopropamine, a methamphetamine analogue; ethylphenidate, a cocaine mimic; and the third generation synthetic cannabinoid 5F-AKB-48. For the 55 branded products we tested only 24% of the stated contents matched exactly the compounds we detected. Conclusion Testing suspect materials using ultra-performance liquid chromatography with time of flight mass spectrometry has identified three common novel psychoactive substances in use in the UK, simplifying the development of a relevant novel psychoactive substances screening service to our population. By incorporating this into our routine liquid chromatography tandem mass spectrometry drugs of abuse screen, then offers a clinically relevant novel psychoactive substances service to our users. This strategy ensures our clinical toxicology service continues to remain effective to meet the challenges of the changing drug use in the UK.

The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.

PubMed

Alcalde-Rabanal, Jacqueline Elizabeth; Nigenda, Gustavo; Bärnighausen, Till; Velasco-Mondragón, Héctor Eduardo; Darney, Blair Grant

2017-08-03

The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources. The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P < 0.05). No difference was observed between available and ideal supply of nurses in either urban or rural primary health care facilities. There is a shortage of health promoters in urban primary health facilities (P < 0.05). The available supply of physicians and health promoters is lower than the ideal supply to deliver the guaranteed package of prevention and health promotion services. Policies must address the level and distribution of human resources in primary health facilities.

When access is an issue: exploring barriers to predictive testing for Huntington disease in British Columbia, Canada.

PubMed

Hawkins, Alice K; Creighton, Susan; Hayden, Michael R

2013-02-01

Predictive testing (PT) for Huntington disease (HD) requires several in-person appointments. This requirement may be a barrier to testing so that at risk individuals do not realize the potential benefits of PT. To understand the obstacles to PT in terms of the accessibility of services, as well as exploring mechanisms by which this issue may be addressed, we conducted an interview study of individuals at risk for HD throughout British Columbia, Canada. Results reveal that the accessibility of PT can be a barrier for two major reasons: distance and the inflexibility of the testing process. Distance is a structural barrier, and relates to the time and travel required to access PT, the financial and other opportunity costs associated with taking time away from work and family to attend appointments and the stress of navigating urban centers. The inflexibility of the testing process barrier relates to the emotional and psychological accessibility of PT. The results of the interview study reveal that there are access barriers to PT that deter individuals from receiving the support, information and counseling they require. What makes accessibility of PT services important is not just that it may result in differences in quality of life and care, but because these differences may be addressed with creative and adaptable solutions in the delivery of genetic services. The study findings underscore the need for us to rethink and personalize the way we deliver such services to improve access issues to prevent inequities in the health care system.

Statement by the National Executive Committee for Space-Based Positioning, Navigation, and Timing : December 14, 2011

DOT National Transportation Integrated Search

2011-12-14

Today, a government technical group reviewed the findings from last month's testing of LightSquared's : proposal to provide new broadband service. The final test report will be sent to the National Telecommunications and : Information Administration ...

HIV testing in community pharmacies and retail clinics: a model to expand access to screening for HIV infection.

PubMed

Weidle, Paul J; Lecher, Shirley; Botts, Linda W; Jones, LaDawna; Spach, David H; Alvarez, Jorge; Jones, Rhondette; Thomas, Vasavi

2014-01-01

To test the feasibility of offering rapid point-of-care human immunodeficiency virus (HIV) testing at community pharmacies and retail clinics. Pilot program to determine how to implement confidential HIV testing services in community pharmacies and retail clinics. 21 community pharmacies and retail clinics serving urban and rural patients in the United States, from August 2011 to July 2013. 106 community pharmacy and retail clinic staff members. A model was developed to implement confidential HIV counseling and testing services using community pharmacy and retail clinic staff as certified testing providers, or through collaborations with organizations that provide HIV testing. Training materials were developed and sites selected that serve patients from urban and rural areas to pilot test the model. Each site established a relationship with its local health department for HIV testing policies, developed referral lists for confirmatory HIV testing/care, secured a CLIA Certificate of Waiver, and advertised the service. Staff were trained to perform a rapid point-of-care HIV test on oral fluid, and provide patients with confidential test results and information on HIV. Patients with a preliminary positive result were referred to a physician or health department for confirmatory testing and, if needed, HIV clinical care. Number of HIV tests completed and amount of time required to conduct testing. The 21 participating sites administered 1,540 HIV tests, with 1,087 conducted onsite by staff during regular working hours and 453 conducted at 37 different HIV testing events (e.g., local health fairs). The median amount of time required for pretest counseling/consent, waiting for test results, and posttest counseling was 4, 23, and 3 minutes, respectively. A majority of the sites (17) said they planned to continue HIV testing after the project period ended and would seek assistance or support from the local health department, a community-based organization, or an AIDS service organization. This pilot project established HIV testing in several community pharmacies and retail clinics to be a feasible model for offering rapid, point-of-care HIV testing. It also demonstrated the willingness and ability of staff at community pharmacies and retail clinics to provide confidential HIV testing to patients. Expanding this model to additional sites and evaluating its feasibility and effectiveness may serve unmet needs in urban and rural settings.

Use of GetCheckedOnline, a Comprehensive Web-based Testing Service for Sexually Transmitted and Blood-Borne Infections.

PubMed

Gilbert, Mark; Salway, Travis; Haag, Devon; Fairley, Christopher K; Wong, Jason; Grennan, Troy; Uddin, Zhaida; Buchner, Christopher S; Wong, Tom; Krajden, Mel; Tyndall, Mark; Shoveller, Jean; Ogilvie, Gina

2017-03-20

The British Columbia Centre for Disease Control implemented a comprehensive Web-based testing service GetCheckedOnline (GCO) in September 2014 in Vancouver, Canada. GCO's objectives are to increase testing for sexually transmitted and blood-borne infections (STBBIs), reach high-prevalence populations facing testing barriers, and increase clinical STI service capacity. GCO was promoted through email invitations to provincial STI clinic clients, access codes to clients unable to access immediate clinic-based testing (deferred testers), and a campaign to gay, bisexual, and other men who have sex with men (MSM). The objective of the study was to report on characteristics of GCO users, use and test outcomes (overall and by promotional strategy) during this pilot phase. We used GCO program data, website metrics, and provincial STI clinic records to describe temporal trends, progression through the service pathway, and demographic, risk, and testing outcomes for individuals creating GCO accounts during the first 15 months of implementation. Of 868 clients creating accounts, 318 (36.6%) submitted specimens, of whom 96 (30.2%) tested more than once and 10 (3.1%) had a positive STI diagnosis. The proportion of clients submitting specimens increased steadily over the course of the pilot phase following introduction of deferred tester codes. Clients were diverse with respect to age, gender, and ethnicity, although youth and individuals of nonwhite ethnicity were underrepresented. Of the 506 clients completing risk assessments, 215 (42.5%) were MSM, 89 (17.6%) were symptomatic, 47 (9.3%) were STI contacts, 232 (45.8%) reported condomless sex, 146 (28.9%) reported ≥4 partners in the past 3 months, and 76 (15.0%) reported a recent STI. A total of 63 (12.5%) GCO clients were testing for the first time. For 868 accounts created, 337 (38.8%) were by clinic invitations (0 diagnoses), 298 (34.3%) were by deferred testers (6 diagnoses), 194 (22.4%) were by promotional campaign (3 diagnoses), and 39 (4.5%) were by other means (1 diagnosis). Our evaluation suggests that GCO is an acceptable and feasible approach to engage individuals in testing. Use by first-time testers, repeated use, and STI diagnosis of individuals unable to access immediate clinic-based testing suggest GCO may facilitate uptake of STBBI testing and earlier diagnosis. Use by MSM and individuals reporting sexual risk suggests GCO may reach populations with a higher risk of STI. Motivation to test (eg, unable to access clinical services immediately) appears a key factor underlying GCO use. These findings identify areas for refinement of the testing model, further promotion, and future research (including understanding reasons for drop-off through the service pathway and more comprehensive evaluation of effectiveness). Increased uptake and diagnosis corresponding with expansion of the service within British Columbia will permit future evaluation of this service across varying populations and settings. ©Mark Gilbert, Travis Salway, Devon Haag, Christopher K Fairley, Jason Wong, Troy Grennan, Zhaida Uddin, Christopher S Buchner, Tom Wong, Mel Krajden, Mark Tyndall, Jean Shoveller, Gina Ogilvie. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.03.2017.

Can Internet-Based Sexual Health Services Increase Diagnoses of Sexually Transmitted Infections (STI)? Protocol for a Randomized Evaluation of an Internet-Based STI Testing and Results Service.

PubMed

Wilson, Emma; Free, Caroline; Morris, Tim P; Kenward, Michael G; Syred, Jonathan; Baraitser, Paula

2016-01-15

Ensuring rapid access to high quality sexual health services is a key public health objective, both in the United Kingdom and internationally. Internet-based testing services for sexually transmitted infections (STIs) are considered to be a promising way to achieve this goal. This study will evaluate a nascent online STI testing and results service in South East London, delivered alongside standard face-to-face STI testing services. The aim of this study is to establish whether an online testing and results services can (1) increase diagnoses of STIs and (2) increase uptake of STI testing, when delivered alongside standard face-to-face STI testing services. This is a single-blind randomized controlled trial. We will recruit 3000 participants who meet the following eligibility criteria: 16-30 years of age, resident in the London boroughs of Lambeth and Southwark, having at least one sexual partner in the last 12 months, having access to the Internet and willing to take an STI test. People unable to provide informed consent and unable to read and understand English (the websites will be in English) will be excluded. Baseline data will be collected at enrolment. This includes participant contact details, demographic data (date of birth, gender, ethnicity, and sexual orientation), and sexual health behaviors (last STI test, service used at last STI test and number of sexual partners in the last 12 months). Once enrolled, participants will be randomly allocated either (1) to an online STI testing and results service (Sexual Health 24) offering postal self-administered STI kits for chlamydia, gonorrhoea, syphilis, and HIV; results via text message (short message service, SMS), except positive results for HIV, which will be delivered by phone; and direct referrals to local clinics for treatment or (2) to a conventional sexual health information website with signposting to local clinic-based sexual health services. Participants will be free to use any other interventions or services during the trial period. At 6 weeks from randomization we will collect self-reported follow-up data on service use, STI tests and results, treatment prescribed, and acceptability of STI testing services. We will also collect objective data from participating STI testing services on uptake of STI testing, STI diagnoses and treatment. We hypothesise that uptake of STI testing and STI diagnoses will be higher in the intervention arm. Our hypothesis is based on the assumption that the intervention is less time-consuming, more convenient, more private, and incur less stigma and embarrassment than face-to-face STI testing pathways. The primary outcome measure is diagnosis of any STI at 6 weeks from randomization and our co-primary outcome is completion of any STI test at 6 weeks from randomization. We define completion of a test, as samples returned, processed, and results delivered to the intervention and/or clinic settings. We will use risk ratios to calculate the effect of the intervention on our primary outcomes with 95% confidence intervals. All analyses will be based on the intention-to-treat (ITT) principle. This study is funded by Guy's and St Thomas' Charity and it has received ethical approval from NRES Committee London-Camberwell St Giles (Ref 14/LO/1477). Research and Development approval has been obtained from Kings College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust. Results are expected in June 2016. This study will provide evidence on the effectiveness of an online STI testing and results service in South East London. Our findings may also be generalizable to similar populations in the United Kingdom. International Standard Randomized Controlled Trial Number (ISRCTN): 13354298; http://www.isrctn.com/ISRCTN13354298 (Archived by WebCite at http://www.webcitation.org/6d9xT2bPj).

Multileaf collimator performance monitoring and improvement using semiautomated quality control testing and statistical process control

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

Létourneau, Daniel, E-mail: daniel.letourneau@rmp.uh.on.ca; McNiven, Andrea; Keller, Harald

2014-12-15

Purpose: High-quality radiation therapy using highly conformal dose distributions and image-guided techniques requires optimum machine delivery performance. In this work, a monitoring system for multileaf collimator (MLC) performance, integrating semiautomated MLC quality control (QC) tests and statistical process control tools, was developed. The MLC performance monitoring system was used for almost a year on two commercially available MLC models. Control charts were used to establish MLC performance and assess test frequency required to achieve a given level of performance. MLC-related interlocks and servicing events were recorded during the monitoring period and were investigated as indicators of MLC performance variations. Methods:more » The QC test developed as part of the MLC performance monitoring system uses 2D megavoltage images (acquired using an electronic portal imaging device) of 23 fields to determine the location of the leaves with respect to the radiation isocenter. The precision of the MLC performance monitoring QC test and the MLC itself was assessed by detecting the MLC leaf positions on 127 megavoltage images of a static field. After initial calibration, the MLC performance monitoring QC test was performed 3–4 times/week over a period of 10–11 months to monitor positional accuracy of individual leaves for two different MLC models. Analysis of test results was performed using individuals control charts per leaf with control limits computed based on the measurements as well as two sets of specifications of ±0.5 and ±1 mm. Out-of-specification and out-of-control leaves were automatically flagged by the monitoring system and reviewed monthly by physicists. MLC-related interlocks reported by the linear accelerator and servicing events were recorded to help identify potential causes of nonrandom MLC leaf positioning variations. Results: The precision of the MLC performance monitoring QC test and the MLC itself was within ±0.22 mm for most MLC leaves and the majority of the apparent leaf motion was attributed to beam spot displacements between irradiations. The MLC QC test was performed 193 and 162 times over the monitoring period for the studied units and recalibration had to be repeated up to three times on one of these units. For both units, rate of MLC interlocks was moderately associated with MLC servicing events. The strongest association with the MLC performance was observed between the MLC servicing events and the total number of out-of-control leaves. The average elapsed time for which the number of out-of-specification or out-of-control leaves was within a given performance threshold was computed and used to assess adequacy of MLC test frequency. Conclusions: A MLC performance monitoring system has been developed and implemented to acquire high-quality QC data at high frequency. This is enabled by the relatively short acquisition time for the images and automatic image analysis. The monitoring system was also used to record and track the rate of MLC-related interlocks and servicing events. MLC performances for two commercially available MLC models have been assessed and the results support monthly test frequency for widely accepted ±1 mm specifications. Higher QC test frequency is however required to maintain tighter specification and in-control behavior.« less

Measurement of patient satisfaction with community pharmacy services: a review.

PubMed

Naik Panvelkar, Pradnya; Saini, Bandana; Armour, Carol

2009-10-01

The aim of this review is to conduct an in-depth analysis of the available literature in order to identify and evaluate studies measuring patient satisfaction with pharmacy services delivered by pharmacists in a community setting. An extensive literature search was conducted in five databases (Medline, Scopus, Embase, Psychinfo, International Pharmaceutical Abstracts) using the search terms "patient/client/consumer satisfaction" AND "community pharmacy/pharmacies" AND "pharmacy service/pharmaceutical services/pharmacy program/intervention/intervention studies". Only those articles where the main focus was measuring patient satisfaction with services delivered in community pharmacies were included in the review. Patient satisfaction was explored with three different levels of pharmacy services -- general services, intervention services and cognitive services. Twenty-four articles measuring patient satisfaction with community pharmacy services were retrieved. Of these, eleven measured patient satisfaction with general services, six measured satisfaction with intervention services and seven measured satisfaction with cognitive services. The majority of studies reviewed had adopted and measured satisfaction as a multidimensional construct. None of the studies reviewed tested any theoretical models of satisfaction. Further a lack of consistent instruments measuring patient satisfaction was observed, with most of the reviewed studies using self developed, non-validated or ad hoc instruments with items from various previously published papers. The review also observed high levels of patient satisfaction with pharmacy services be they general, intervention or cognitive services. This review found that patient satisfaction has been measured within the community pharmacy context to a certain degree. Further research is needed to develop and test instruments based on theoretical frameworks, to test satisfaction pre and post hoc and in well designed randomized controlled trials and to measure changes in satisfaction over time. Novel approaches involving an understanding of expectations and preferences of patients and matching these to the services provided also need to be explored.

Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH.

PubMed

Molnar, Beth E; Lees, Kristin E; Roper, Kate; Byars, Natasha; Méndez-Peñate, Larisa; Moulin, Christy; McMullen, William; Wolfe, Jessica; Allen, Deborah

2018-06-16

Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers' stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N = 225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers' stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation.

Use of computerized neuropsychological testing to help determine fitness to return to combat operations when taking medication that can influence cognitive function.

PubMed

McLay, Robert; Spira, James; Reeves, Dennis

2010-12-01

Nowhere is it more important to maintain peek mental functioning than in a combat zone. Conditions ranging from pain to head injury to post-traumatic stress disorder can cause impairments in neuropsychological function and place service members at risk. Medications can sometimes help alleviate these problems, but also have the risk of further slowing cognitive function or impairing reaction time. Standard methods of neuropsychological testing are often not available in a combat environment. New technologies are being advanced that can allow portable, computerized neuropsychological testing to be performed at almost any location. We present a case that demonstrates how the use of such handheld technology can assist a military physician in assessing the influence of medication on reaction time and in determining if and when a service member is ready to return to combat.

Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi.

PubMed

Ahmed, Saeed; Sabelli, Rachael A; Simon, Katie; Rosenberg, Nora E; Kavuta, Elijah; Harawa, Mwelura; Dick, Spencer; Linzie, Frank; Kazembe, Peter N; Kim, Maria H

2017-08-01

Evaluation of a novel index case finding and linkage-to-care programme to identify and link HIV-infected children (1-15 years) and young persons (>15-24 years) to care. HIV-infected patients enrolled in HIV services were screened and those who reported untested household members (index cases) were offered home- or facility-based HIV testing and counselling (HTC) of their household by a community health worker (CHW). HIV-infected household members identified were enrolled in a follow-up programme offering home and facility-based follow-up by CHWs. Of the 1567 patients enrolled in HIV services, 1030 (65.7%) were screened and 461 (44.8%) identified as index cases; 93.5% consented to HIV testing of their households and of those, 279 (64.7%) reported an untested child or young person. CHWs tested 711 children and young persons, newly diagnosed 28 HIV-infected persons (yield 4.0%; 95% CI: 2.7-5.6), and identified an additional two HIV-infected persons not enrolled in care. Of the 30 HIV-infected persons identified, 23 (76.6%) were linked to HIV services; 18 of the 20 eligible for ART (90.0%) were initiated. Median time (IQR) from identification to enrolment into HIV services was 4 days (1-8) and from identification to ART start was 6 days (1-8). Almost half of HIV-infected patients enrolled in treatment services had untested household members, many of whom were children and young persons. Index case finding, coupled with home-based testing and tracked follow-up, is acceptable, feasible and facilitates the identification and timely linkage to care of HIV-infected children and young persons. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Reasons for seeking HIV-test: evidence from a private hospital in rural Andhra Pradesh, India.

PubMed

Sivaram, Sudha; Saluja, Gurcharan Singh; Das, Manik; Reddy, P Sudhakar; Yeldandi, Vijay

2008-12-01

This study sought to describe the development of HIV counselling and testing services in a rural private hospital and to explore the factors associated with reasons for seeking HIV testing and sexual behaviours among adults seeking testing in the rural hospital. Data for this study were drawn from a voluntary counselling and testing clinic in a private hospital in rural Andhra Pradesh state in southern India. In total, 5,601 rural residents sought HIV counselling and testing and took part in a behavioural risk-assessment survey during October 2003-June 2005. The prevalence of HIV was 1.1%. Among the two reported reasons for test-seeking--based on past sexual behaviour and based on being sick at the time of testing--men, individuals reporting risk behaviours, such as those having multiple pre- and postmarital sexual partners, individuals whose recent partner was a sex worker, and those who reported using alcohol before sex, were more likely to seek testing based on their past sexual behaviour. Men also were more likely to seek testing because they were sick. The findings from this large sample in rural India suggest that providing HIV-prevention and care services as part of an ongoing system of healthcare-delivery may benefit rural residents who otherwise may not have access to these services. The implications of involving the private sector in HIV-related service-delivery and in conducting research in rural areas are discussed. It is argued that services that are gaining prominence in urban areas, such as addressing male heterosexual behaviours and assessing the role of alcohol-use, are equally relevant areas of intervention in rural India.

The centrality of laboratory services in the HIV treatment and prevention cascade: The need for effective linkages and referrals in resource-limited settings.

PubMed

Alemnji, George; Fonjungo, Peter; Van Der Pol, Barbara; Peter, Trevor; Kantor, Rami; Nkengasong, John

2014-05-01

Strong laboratory services and systems are critical for delivering timely and quality health services that are vital to reduce patient attrition in the HIV treatment and prevention cascade. However, challenges exist in ensuring effective laboratory health systems strengthening and linkages. In particular, linkages and referrals between laboratory testing and other services need to be considered in the context of an integrated health system that includes prevention, treatment, and strategic information. Key components of laboratory health systems that are essential for effective linkages include an adequate workforce, appropriate point-of-care (POC) technology, available financing, supply chain management systems, and quality systems improvement, including accreditation. In this review, we highlight weaknesses of and gaps between laboratory testing and other program services. We propose a model for strengthening these systems to ensure effective linkages of laboratory services for improved access and retention in care of HIV/AIDS patients, particularly in low- and middle-income countries.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.

PubMed

Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

2007-08-01

To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; chi(2) test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; chi(2) test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; chi(2) test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; chi(2) test). A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

46 CFR 56.97-1 - General (replaces 137).

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (1) At no time during the hydrostatic test may any part of the piping system be subjected to a stress... cannot be safely filled with water; 1 or 1 These tests may be made with the item being tested partially filled with water, if desired. (ii) Piping subassemblies or systems are to be used in services where...

46 CFR 56.97-1 - General (replaces 137).

Code of Federal Regulations, 2011 CFR

2011-10-01

.... (1) At no time during the hydrostatic test may any part of the piping system be subjected to a stress... cannot be safely filled with water; 1 or 1 These tests may be made with the item being tested partially filled with water, if desired. (ii) Piping subassemblies or systems are to be used in services where...

49 CFR 178.58 - Specification 4DA welded steel cylinders for aircraft use.

Code of Federal Regulations, 2011 CFR

2011-10-01

... stress in pounds psi; P = test pressure prescribed for water jacket test, i.e., at least 2 times service... hemispheres) or a circumferentially welded cylinder (two seamless drawn shells) with a water capacity not over... the wall stress at the minimum specified test pressure may not exceed 67 percent of the minimum...

Atlanta congestion reduction demonstration. National evaluation : cost benefit analysis test plan.

DOT National Transportation Integrated Search

2001-01-01

Initiatives to evaluate the impact of Advanced Traveler Information Services (ATIS) over the last ten years have returned what appears to be contradictory results with respect to the time savings of ATIS users: large perceived time savings reported b...

Surveillance of HIV assisted partner services using routine health information systems in Kenya.

PubMed

Cherutich, Peter; Golden, Matthew; Betz, Bourke; Wamuti, Beatrice; Ng'ang'a, Anne; Maingi, Peter; Macharia, Paul; Sambai, Betsy; Abuna, Felix; Bukusi, David; Dunbar, Mathew; Farquhar, Carey

2016-07-20

The utilization of routine health information systems (HIS) for surveillance of assisted partner services (aPS) for HIV in sub-Saharan is sub-optimal, in part due to poor data quality and limited use of information technology. Consequently, little is known about coverage, scope and quality of HIV aPS. Yet, affordable electronic data tools, software and data transmission infrastructure are now widely accessible in sub-Saharan Africa. We designed and implemented a cased-based surveillance system using the HIV testing platform in 18 health facilities in Kenya. The components of this system included an electronic HIV Testing and Counseling (HTC) intake form, data transmission on the Global Systems for Mobile Communication (GSM), and data collection using the Open Data Kit (ODK) platform. We defined rates of new HIV diagnoses, and characterized HIV-infected cases. We also determined the proportion of clients who reported testing for HIV because a) they were notified by a sexual partner b) they were notified by a health provider, or c) they were informed of exposure by another other source. Data collection times were evaluated. Among 4351 clients, HIV prevalence was 14.2 %, ranging from 4.4-25.4 % across facilities. Regardless of other reasons for testing, only 107 (2.5 %) of all participants reported testing after being notified by a health provider or sexual partner. A similar proportion, 1.8 % (79 of 4351), reported partner notification as the only reason for seeking an HIV test. Among 79 clients who reported HIV partner services as the reason for testing, the majority (78.5 %), were notified by their sexual partners. The majority (52.8 %) of HIV-infected patients initiated their HIV testing, and 57.2 % tested in a Voluntary Counseling and Testing (VCT) site co-located in a health facility. Median time for data capture was 4 min (IQR: 3-15), with a longer duration for HIV-infected participants, and there was no reported data loss. aPS surveillance using new technologies is feasible, and could be readily expanded into HIV registries in Kenya and other sub-Saharan countries. Partner services are under-utilized in Kenya but further documentation of coverage and implementation gaps for HIV and aPS services is required.

Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma.

PubMed

Goldberg, Howard S; Paterno, Marilyn D; Grundmeier, Robert W; Rocha, Beatriz H; Hoffman, Jeffrey M; Tham, Eric; Swietlik, Marguerite; Schaeffer, Molly H; Pabbathi, Deepika; Deakyne, Sara J; Kuppermann, Nathan; Dayan, Peter S

2016-03-01

To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma. We integrated the Epic(®) electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments. Patterns of CDS review included either a delayed, near-real-time review, where the physician viewed CDS recommendations generated by the nursing assessment, or a real-time review, where the physician viewed recommendations generated by their own documentation. A backstopping, vendor-based CDS triggered with zero delay when no recommendation was available in the EHR from the web-service. We assessed the execution characteristics of the integrated system and the source of the generated recommendations viewed by physicians. The ECRS mean execution time was 0.74 ±0.72 s. Overall execution time was substantially different at the two sites, with mean total transaction times of 19.67 and 3.99 s. Of 1930 analyzed transactions from the two sites, 60% (310/521) of all physician documentation-initiated recommendations and 99% (1390/1409) of all nurse documentation-initiated recommendations originated from the remote web service. The remote CDS system was the source of recommendations in more than half of the real-time cases and virtually all the near-real-time cases. Comparisons are limited by allowable variation in user workflow and resolution of the EHR clock. With maturation and adoption of standards for CDS services, remote CDS shows promise to decrease time-to-trial for multicenter evaluations of candidate decision support interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Apollo experience report. Guidance and control systems: Command and service module stabilization and control system

NASA Technical Reports Server (NTRS)

Littleton, O. P.

1974-01-01

The concepts, design, development, testing, and flight results of the command and service module stabilization and control system are discussed. The period of time covered was from November 1961 to December 1972. Also included are a functional description of the system, a discussion of the major problems, and recommendations for future programs.

The evolution of a Ku-Band satellite network

NASA Technical Reports Server (NTRS)

Bransford, L. A.; Diebler, M.; Dutka, S. C.; Gorton, D. W.

1982-01-01

The purpose of this study was to undertake the management and development of CTS terminals and time on appropriate Ku-Band satellites was procured. A community of public service users who have readily addressable needs and resources to pay for services on an ad hoc Ku-Band network was developed and a test network for selected users was managed.

Experimental Design and Analysis for the FIST (Fire Support Team) Force Development Testing and Experimentation II.

DTIC Science & Technology

1985-10-01

median service time for a FIST IHQ to service Copperhead missions while in review mode and for mission workload (FO + ARMOR + CPH) was only 6.0...07703 Uazhin.tou, DC 20036 2 Coui-,ander 1 Comwanaer US Aruy larry Diaiaond Labs. US Army Belvoir ATTN: AIILHD- TD , Dr. Scully Research & Development

Performance Analysis of Trans-Jakarta Bus Suburban Service Move-Across Greater Jakarta

NASA Astrophysics Data System (ADS)

Tangkudung, ESW; Widyadayinta, C.

2018-03-01

Trans-Jakarta have developed their services scope as Suburban Service or Feeder move-across service that operate from greater Jakarta into Jakarta central vice versa. One of the route is Ciputat – Bundaran Hotel Indonesia (Tosari) and integrated with corridor 1 (one) and 8 (eight). This service is not travel on the exclusive lane or bus-way. Objective of Government Jakarta to provide this service is to decrease private car to enter the central of Jakarta. The objective of this study is to find the performance of the service. Survey have conducted static and dynamic on work day to get variable of travel time and delay, waiting time of passenger at the bus stop, headway and ridership of the bus. Service Standard Minimum of Trans-Jakarta have compared with the result of variable headway, travel speed, and waiting time at bus stop as concern of all the passengers. Analysis use correlation test method and linear regression model have done. The performance of Trans-Jakarta bus suburban service, based on travel speed indicator is fairly bad, only 8.1% of trip could comply with Minimum Service Standard. Bus performance based on the indicator of density in the bus is good, where all points are below the maximum limit i.e. 8 people/m2 at peak hour and 5 people/m2 at off-peak hour.

15 CFR 200.110 - Priorities and time of completion.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false Priorities and time of completion. 200..., SERVICES, PROCEDURES, AND FEES § 200.110 Priorities and time of completion. Schedule work assignments for calibrations and other tests will generally be made in the order in which confirmed requests are received...

An Open Source Tool to Test Interoperability

NASA Astrophysics Data System (ADS)

Bermudez, L. E.

2012-12-01

Scientists interact with information at various levels from gathering of the raw observed data to accessing portrayed processed quality control data. Geoinformatics tools help scientist on the acquisition, storage, processing, dissemination and presentation of geospatial information. Most of the interactions occur in a distributed environment between software components that take the role of either client or server. The communication between components includes protocols, encodings of messages and managing of errors. Testing of these communication components is important to guarantee proper implementation of standards. The communication between clients and servers can be adhoc or follow standards. By following standards interoperability between components increase while reducing the time of developing new software. The Open Geospatial Consortium (OGC), not only coordinates the development of standards but also, within the Compliance Testing Program (CITE), provides a testing infrastructure to test clients and servers. The OGC Web-based Test Engine Facility, based on TEAM Engine, allows developers to test Web services and clients for correct implementation of OGC standards. TEAM Engine is a JAVA open source facility, available at Sourceforge that can be run via command line, deployed in a web servlet container or integrated in developer's environment via MAVEN. The TEAM Engine uses the Compliance Test Language (CTL) and TestNG to test HTTP requests, SOAP services and XML instances against Schemas and Schematron based assertions of any type of web service, not only OGC services. For example, the OGC Web Feature Service (WFS) 1.0.0 test has more than 400 test assertions. Some of these assertions includes conformance of HTTP responses, conformance of GML-encoded data; proper values for elements and attributes in the XML; and, correct error responses. This presentation will provide an overview of TEAM Engine, introduction of how to test via the OGC Testing web site and description of performing local tests. It will also provide information about how to participate in the open source code development of TEAM Engine.

42 CFR 482.27 - Condition of participation: Laboratory services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... infectious blood and blood components—(1) Potentially human immunodeficiency virus (HIV) infectious blood and blood components. Potentially HIV infectious blood and blood components are prior collections from a donor— (i) Who tested negative at the time of donation but tests reactive for evidence of HIV infection...

42 CFR 482.27 - Condition of participation: Laboratory services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... infectious blood and blood components—(1) Potentially human immunodeficiency virus (HIV) infectious blood and blood components. Potentially HIV infectious blood and blood components are prior collections from a donor— (i) Who tested negative at the time of donation but tests reactive for evidence of HIV infection...

42 CFR 482.27 - Condition of participation: Laboratory services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... infectious blood and blood components—(1) Potentially human immunodeficiency virus (HIV) infectious blood and blood components. Potentially HIV infectious blood and blood components are prior collections from a donor— (i) Who tested negative at the time of donation but tests reactive for evidence of HIV infection...

42 CFR 482.27 - Condition of participation: Laboratory services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... infectious blood and blood components—(1) Potentially human immunodeficiency virus (HIV) infectious blood and blood components. Potentially HIV infectious blood and blood components are prior collections from a donor— (i) Who tested negative at the time of donation but tests reactive for evidence of HIV infection...

42 CFR 482.27 - Condition of participation: Laboratory services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... infectious blood and blood components—(1) Potentially human immunodeficiency virus (HIV) infectious blood and blood components. Potentially HIV infectious blood and blood components are prior collections from a donor— (i) Who tested negative at the time of donation but tests reactive for evidence of HIV infection...

An Integrated Tiered Service Delivery Model (ITSDM) Based on Local CD4 Testing Demands Can Improve Turn-Around Times and Save Costs whilst Ensuring Accessible and Scalable CD4 Services across a National Programme

PubMed Central

Glencross, Deborah K.; Coetzee, Lindi M.; Cassim, Naseem

2014-01-01

Background The South African National Health Laboratory Service (NHLS) responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART), has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT), to extend national coverage, improve local turn-around/(TAT) and contain programmatic costs. Methods NHLS Corporate Data Warehouse CD4 data, from 60–70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009–2012. Results An integrated tiered service delivery model (ITSDM) is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (<5 samples/day). Laboratory-based testing is extended with Tier-2/POC-Hubs (processing ≤30–40 CD4 samples/day), consolidating POCT across 8–10 health-clinics with other HIV-related testing and Tier-3/‘community’ laboratories, serving ≤40 health-clinics, processing ≤150 samples/day. Existing Tier-4/‘regional’ laboratories serve ≤100 facilities and process <350 samples/day; Tier-5 are high-volume ‘metro’/centralized laboratories (>350–1500 tests/day, serving ≥200 health-clinics). Tier-6 provides national support for standardisation, harmonization and quality across the organization. Conclusion The ITSDM offers improved local TAT by extending CD4 services into rural/remote areas with new Tier-3 or Tier-2/POC-Hub services installed in existing community laboratories, most with developed infrastructure. The advantage of lower laboratory CD4 costs and use of existing infrastructure enables subsidization of delivery of more expensive POC services, into hard-to-reach districts without reasonable access to a local CD4 laboratory. Full ITSDM implementation across 5 service tiers (as opposed to widespread implementation of POC testing to extend service) can facilitate sustainable ‘full service coverage’ across South Africa, and save>than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers. PMID:25490718

A Cross-Sectional Analytic Study of Postpartum Health Care Service Utilization in the Philippines

PubMed Central

Yamashita, Tadashi; Suplido, Sherri Ann; Ladines-Llave, Cecilia; Tanaka, Yuko; Senba, Naomi; Matsuo, Hiroya

2014-01-01

Background The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care. Methods A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed. Results The mean time of first postpartum health care visit was 5.1±5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test. Conclusion We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services. PMID:24465626

Clinical Laboratories – Production Factories or Specialized Diagnostic Centers

PubMed Central

Tóth, Judit

2016-01-01

Since a large proportion of medical decisions are based on laboratory results, clinical laboratories should meet the increasing demand of clinicians and their patients. Huge central laboratories may process over 10 million tests annually; they act as production factories, measuring emergency and routine tests with sufficient speed and accuracy. At the same time, they also serve as specialized diagnostic centers where well-trained experts analyze and interpret special test results. It is essential to improve and constantly monitor this complex laboratory service, by several methods. Sample transport by pneumatic tube system, use of an advanced laboratory information system and point-of-care testing may result in decreased total turnaround time. The optimization of test ordering may result in a faster and more cost-effective laboratory service. Autovalidation can save time for laboratory specialists, when the analysis of more complex results requires their attention. Small teams of experts responsible for special diagnostic work, and their interpretative reporting according to predetermined principles, may help to minimize subjectivity of these special reports. Although laboratory investigations have become so diversely developed in the past decades, it is essential that the laboratory can provide accurate results relatively quickly, and that laboratory specialists can support the diagnosis and monitoring of patients by adequate interpretation of esoteric laboratory methods. PMID:27683528

Effect of service exposure on fatigue crack propagation of Inconel 718 turbine disc material at elevated temperatures

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

Jeong, Dae-Ho; Choi, Myung-Je; Goto, Masahiro

In this study, the fatigue crack propagation behavior of Inconel 718 turbine disc with different service times from 0 to 4229 h was investigated at 738 and 823 K. No notable change in microstructural features, other than the increase in grain size, was observed with increasing service time. With increasing service time from 0 to 4229 h, the fatigue crack propagation rates tended to increase, while the ΔK{sub th} value decreased, in low ΔK regime and lower Paris' regime at both testing temperatures. The fractographic observation using a scanning electron microscope suggested that the elevated temperature fatigue crack propagation mechanismmore » of Inconel 718 changed from crystallographic cleavage mechanism to striation mechanism in the low ΔK regime, depending on the grain size. The fatigue crack propagation mechanism is proposed for the crack propagating through small and large grains in the low ΔK regime, and the fatigue crack propagation behavior of Inconel 718 with different service times at elevated temperatures is discussed. - Highlights: • The specimens were prepared from the Inconel 718 turbine disc used for 0 to 4229 h. • FCP rates were measured at 738 and 823 K. • The ΔK{sub th} values decreased with increasing service time. • The FCP behavior showed a strong correlation with the grain size of used turbine disc.« less

Update of the NEXT Ion Thruster Service Life Assessment with Post-Test Correlation to the Long Duration Test

NASA Technical Reports Server (NTRS)

Yim, John T.; Soulas, George C.; Shastry, Rohit; Choi, Maria; Mackey, Jonathan A.; Sarver-Verhey, Timothy R.

2017-01-01

The service life assessment for NASA's Evolutionary Xenon Thruster is updated to incorporate the results from the successful and voluntarily early completion of the 51,184 hour long duration test which demonstrated 918 kg of total xenon throughput. The results of the numerous post-test investigations including destructive interrogations have been assessed against all of the critical known and suspected failure mechanisms to update the life and throughput expectations for each major component. Analysis results of two of the most acute failure mechanisms, namely pit-and-groove erosion and aperture enlargement of the accelerator grid, are not updated in this work but will be published at a future time after analysis completion.

The CREAM-CE: First experiences, results and requirements of the four LHC experiments

NASA Astrophysics Data System (ADS)

Mendez Lorenzo, Patricia; Santinelli, Roberto; Sciaba, Andrea; Thackray, Nick; Shiers, Jamie; Renshall, Harry; Sgaravatto, Massimo; Padhi, Sanjay

2010-04-01

In terms of the gLite middleware, the current LCG-CE used by the four LHC experiments is about to be deprecated. The new CREAM-CE service (Computing Resource Execution And Management) has been approved to replace the previous service. CREAM-CE is a lightweight service created to handle job management operations at the CE level. It is able to accept requests both via the gLite WMS service and also via direct submission for transmission to the local batch system. This flexible duality provides the experiments with a large level of freedom to adapt the service to their own computing models, but at the same time it requires a careful follow up of the requirements and tests of the experiments to ensure that their needs are fulfilled before real data taking. In this paper we present the current testing results of the four LHC experiments concerning this new service. The operations procedures, which have been elaborated together with the experiment support teams will be discussed. Finally, the experiments requirements and the expectations for both the sites and the service itself are exposed in detail.

The impact of national health insurance on the utilization of health care services by pregnant women: the case in Taiwan.

PubMed

Chen, L M; Wen, S W; Li, C Y

2001-03-01

Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.

Joint Services Evaluation Plan for Preferred and Alternate Explosive Fills for Principal Munitions. Joint Services Explosive Fill Program (Long Range) Final Report on the Use of Emergency Funds. Volume 4. Joint Service Safety and Performance Manual for Qualification of Explosives for Military Use

DTIC Science & Technology

1972-09-19

Dextrinated Lead Azide. ŕ.4.2 Reports. Applied Mathematic Panel of the National Defense Research Committee (AMP Report No. t01.1R, SRG-P No. 40). 1-2 0D 44811... dextrinated lead azide. (A normal ranae for these compounds shall have been obtained at the time of testing the explosive to be qualified.) 4.3...normal lead styphnate and dextrinated lead azide obtained using the same apparatus and procedure and run at the same time. 4.3.5 Special Requirements

The Use of Technology for STD Partner Services in the United States: A Structured Review.

PubMed

Kachur, Rachel; Hall, Wendasha; Coor, Alexandra; Kinsey, Jennine; Collins, Dayne; Strona, F V

2018-05-01

Since the late 1990s, health departments and STD programs throughout the U.S. have used technologies, such as the internet and mobile phones, to provide services to persons with a sexually transmitted infection, including HIV, and their sex partners, also known as partner services. This study reviewed the published literature to assess and compare partner services outcomes as a result of using technology and to calculate cost savings through cases averted. We conducted a structured literature review of all U.S. studies that examined the use of technology to notify persons exposed to an STD (syphilis, chlamydia, gonorrhea), including HIV, by health care professionals in the U.S. from 2000 to 2017. Outcome measures, including the number of the number of partners notified, screened or tested; and new positives identified, were captured and cost savings were calculated, when data were available. Seven studies were identified. Methods used for partner services differed across studies, although email was the primary mode in 6 (83%) of the 7 studies. Only 2 of the 7 studies compared use of technology for partner services to traditional partner services. Between 10% and 97% of partners were successfully notified of their exposure through the use of technology and between 34% and 81% were screened or tested. Five studies reported on new infections identified, which ranged from 3-19. Use of technology for partner serves saved programs between $22,795 and $45,362 in direct and indirect medical costs. Use of technology for partner services increased the number of partners notified, screened or tested, and new infections found. Importantly, the use of technology allowed programs to reach partners who otherwise would not have been notified of their exposure to an STD or HIV. Improved response times and time to treatment were also seen as was re-engagement into care for previous HIV positive patients. Data and outcome measures across the studies were not standardized, making it difficult to generalize conclusions. Although not a replacement for traditional partner services, the use of technology enhances partner service outcomes.

Simulation Facilities and Test Beds for Galileo

NASA Astrophysics Data System (ADS)

Schlarmann, Bernhard Kl.; Leonard, Arian

2002-01-01

Galileo is the European satellite navigation system, financed by the European Space Agency (ESA) and the European Commission (EC). The Galileo System, currently under definition phase, will offer seamless global coverage, providing state-of-the-art positioning and timing services. Galileo services will include a standard service targeted at mass market users, an augmented integrity service, providing integrity warnings when fault occur and Public Regulated Services (ensuring a continuity of service for the public users). Other services are under consideration (SAR and integrated communications). Galileo will be interoperable with GPS, and will be complemented by local elements that will enhance the services for specific local users. In the frame of the Galileo definition phase, several system design and simulation facilities and test beds have been defined and developed for the coming phases of the project, respectively they are currently under development. These are mainly the following tools: Galileo Mission Analysis Simulator to design the Space Segment, especially to support constellation design, deployment and replacement. Galileo Service Volume Simulator to analyse the global performance requirements based on a coverage analysis for different service levels and degrades modes. Galileo System Simulation Facility is a sophisticated end-to-end simulation tool to assess the navigation performances for a complete variety of users under different operating conditions and different modes. Galileo Signal Validation Facility to evaluate signal and message structures for Galileo. Galileo System Test Bed (Version 1) to assess and refine the Orbit Determination &Time Synchronisation and Integrity algorithms, through experiments relying on GPS space infrastructure. This paper presents an overview on the so called "G-Facilities" and describes the use of the different system design tools during the project life cycle in order to design the system with respect to availability, continuity and integrity requirements. It gives more details on two of these system design tools: the Galileo Signal Validation Facility (GSVF) and the Galileo System Simulation Facility (GSSF). It will describe the operational use of these facilities within the complete set of design tools and especially the combined use of GSVF and GSSF will be described. Finally, this paper presents also examples and results obtained with these tools.

40 CFR 86.1232-96 - Vehicle preconditioning.

Code of Federal Regulations, 2013 CFR

2013-07-01

... awaiting testing, to prevent unusual loading of the canisters. During this time care must be taken to... vehicles with multiple canisters in a series configuration, the set of canisters must be preconditioned as... designed for vapor load or purge steps, the service port shall be used during testing to precondition the...

Ride through SaFIRES : lessons learned from SaFIRES - an APTS operational test in Prince William County, Virginia.

DOT National Transportation Integrated Search

2002-06-01

This interim report documents the lessons learned to date from the Smart Flex-route Integrated Real-time Enhancement System (SaFIRES) operational test in Prince William County, Virginia. This route deviation service has proven to be popular with Coun...

Time-temperature-stress capabilities of composite materials for advanced supersonic technology application

NASA Technical Reports Server (NTRS)

Kerr, James R.; Haskins, James F.

1987-01-01

Advanced composites will play a key role in the development of the technology for the design and fabrication of future supersonic vehicles. However, incorporating the material into vehicle usage is contingent on accelerating the demonstration of service capacity and design technology. Because of the added material complexity and lack of extensive data, laboratory replication of the flight service will provide the most rapid method to document the airworthiness of advanced composite systems. Consequently, a laboratory program was conducted to determine the time-temperature-stress capabilities of several high temperature composites. Tests included were thermal aging, environmental aging, fatigue, creep, fracture, tensile, and real-time flight simulation exposure. The program had two phases. The first included all the material property determinations and aging and simulation exposures up through 10,000 hours. The second continued these tests up to 50,000 cumulative hours. This report presents the results of the Phase 1 baseline and 10,000-hr aging and flight simulation studies, the Phase 2 50,000-hr aging studies, and the Phase 2 flight simulation tests, some of which extended to almost 40,000 hours.

Next-generation services for e-traceability to ionizing radiation national standards

NASA Astrophysics Data System (ADS)

Desrosiers, Marc F.; Klemick, Mark; Puhl, James M.; Uchida, David; Mallis, Steven

2004-09-01

An Internet-based system for fast, remote certification of high-dose radiation sources against the US national standard is being constructed at the National Institute of Standards and Technology (NIST). The new service will establish traceability (through transfer dosimetry) in real time at a lower cost by using automated routines and the Internet. A prototype of this service was successfully demonstrated in 2000 at the American Society for Testing and Materials (ASTM) Dosimetry Workshop in San Diego. Despite this impressive accomplishment, new developments demanded that several aspects of the service be modified. The new service has been completely redesigned to address these new demands and ensure greater accessibility. A description of the hardware and software configurations of this service as well as the communication and information management aspects will be presented. The Internet-based transfer certification program will provide industry with 24-h, 7-day-per-week, on-demand certifications, immediate turnaround times, and lower cost, ultimately improving the quality of the manufacturing process.

Equipment for testing automotive lead/acid batteries under SAE J240a conditions

NASA Astrophysics Data System (ADS)

Hamilton, J. A.; Rand, D. A. J.

Battery cycling equipment has been designed and constructed to test lead/acid batteries according to the American Society of Automotive Engineers' (SAE) J240a Standard. This life test simulates automotive service where the battery operates in a voltage-regulated charging system. The CSIRO design uses a master/slave concept to reduce both construction time and cost.

Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service.

PubMed

Shaw, Tarryn; Metras, Julie; Ting, Zoe Ang Li; Courtney, Eliza; Li, Shao-Tzu; Ngeow, Joanne

2018-05-24

The increase in demand for clinical cancer genetics services has impacted the ability to provide services timeously. Given limited resources, this often results in extended appointment waiting times. Over the last 3 years, the Cancer Genetics Service at the National Cancer Centre Singapore has continued to experience a steady increase in demand for its service. Nevertheless, significant no-show rates have been reported. This study sought to determine whether an association exists between appointment waiting times and attendance rates. Data was gathered for all participants meeting inclusion criteria. Attendance rates and appointment waiting times were calculated. The relationship between mean waiting times for those who did and did not attend their scheduled appointments was evaluated using Welch's t test and linear regression model. The results showed a significant difference in mean appointment waiting times between patients who did and did not attend (32.66 versus 43.50 days respectively; p < 0.0001). Furthermore, patients who waited for longer than 37 days were significantly less likely to attend. No-show rates increased as the waiting time increased, at a rate of 19.60% per 20 days and 21.40% per 30 days. In conclusion, appointment waiting time is a significant predictor for patient attendance. Strategies to ensure patients receive an appointment within the necessary timeframe at the desired setting are important to ensure that individuals at increased cancer risk attend their appointments in order to manage their cancer risks effectively.

Caring Enough to Teach Science: Helping Pre-Service Teachers View Science Instruction as an Ethical Responsibility

ERIC Educational Resources Information Center

Grinell, Smith; Rabin, Colette

2017-01-01

The goal of this project was to motivate pre-service elementary teachers to commit to spending significant instructional time on science in their future classrooms despite their self-assessed lack of confidence about teaching science and other impediments (e.g., high-stakes testing practices that value other subjects over science). Pre-service…

Monitoring and root cause analysis of clinical biochemistry turn around time at an academic hospital.

PubMed

Chauhan, Kiran P; Trivedi, Amit P; Patel, Dharmik; Gami, Bhakti; Haridas, N

2014-10-01

Quality can be defined as the ability of a product or service to satisfy the needs and expectations of the customer. Laboratories are more focusing on technical and analytical quality for reliability and accuracy of test results. Patients and clinicians however are interested in rapid, reliable and efficient service from laboratory. Turn around time (TAT), the timeliness with which laboratory personnel deliver test results, is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. This study is aims to provide clue for laboratory TAT monitoring and root cause analysis. In a 2 year period a total of 75,499 specimens of outdoor patient department were monitor, of this a total of 4,142 specimens exceeded TAT. With consistent efforts to monitor, root cause analysis and corrective measures, we are able to decreased the specimens exceeding TAT from 7-8 to 3.7 %. Though it is difficult task to monitor TAT with the help of laboratory information system, real time documentation and authentic data retrievable, along with identification of causes for delays and its remedial measures, improve laboratory TAT and thus patient satisfaction.

Remaining Gap in HIV Testing Uptake Among Female Sex Workers in Iran.

PubMed

Shokoohi, Mostafa; Noori, Atefeh; Karamouzian, Mohammad; Sharifi, Hamid; Khajehkazemi, Razieh; Fahimfar, Noushin; Hosseini-Hooshyar, Samira; Kazerooni, Parvin Afsar; Mirzazadeh, Ali

2017-08-01

We estimated the prevalence of recent HIV testing (i.e., having an HIV test during the last 12 months and knew the results) among 1295 HIV-negative Iranian female sex workers (FSW) in 2015. Overall, 70.4% (95% confidence intervals: 59.6, 79.3) of the participants reported a recent HIV testing. Concerns about their HIV status (83.2%) was reported as the most common reason for HIV testing. Incarceration history, having >5 paying partners, having >1 non-paying partner, receiving harm reduction services, utilizing healthcare services, and knowing an HIV testing site were significantly associated with recent HIV testing. In contrast, outreach participants, having one non-paying sexual partner, and self-reported inconsistent condom use reduced the likelihood of recent HIV testing. HIV testing uptake showed a ~2.5 times increase among FSW since 2010. While these findings are promising and show improvement over a short period, HIV testing programs should be expanded particularly through mobile and outreach efforts.

Reference Network Real-Time Services Control Techniques

NASA Astrophysics Data System (ADS)

Nykiel, Grzegorz; Szolucha, Marcin

2013-04-01

Differential corrections and services for real-time kinematic method (RTK) in many cases are used to support survey being base for administration decision. For that reason, services which allow to perform GNSS measurements should be constantly monitored to minimize the risk of any errors or unexpected gap in observation. System providing such control is the subject of the work carried out under a grant NR09-0010-10/2010 conducted by the Military University of Technology. This study was made to develop the concept of monitoring real-time services of Polish reference network ASG-EUPOS and the implementation of software providing users information on system accuracy. The main objectives of all concepts were: maximum use of existing infrastructure while minimizing the cost of installation of new elements, providing users calculation results via the ASG-EUPOS website. In the same time concept assume openness of the module that allow the successive development of applications and integration with existing solutions. This paper present several solutions and algorithms which have been implemented and tested. It also consist some examples of data visualization methods.

Centralization of a regional clinical microbiology service: The Calgary experience

PubMed Central

Church, Deirdre L; Hall, Paula

1999-01-01

Diagnostic laboratory services in Alberta have been dramatically restructured over the past five years. In 1994, Alberta Health embarked on an aggressive laboratory restructuring that cut back approximately 30% of the overall monies previously paid to the laboratory service sector in Calgary. A unique service delivery model consolidated all institutional and community-based diagnostic testing in a company called Calgary Laboratory Services (CLS) in late 1996. CLS was formed by a public/private partnership between the Calgary Regional Health Care Authority (CRHA) and MDS-Kasper Laboratories. By virtue of its customer service base and scope of testing, CLS provides comprehensive regional laboratory services to the entire populace. Regional microbiology services within CLS have been successfully consolidated over the past three years into a centralized high volume laboratory (HVL). Because the HVL is not located in a hospital, rapid response laboratories (RRLs) are operated at each acute care site. Although the initial principle behind the proposed test menus for the RRLs was that only procedures requiring a clinical turnaround time of more than 2 h stay on-site, many other principles had to be used to develop and implement an efficient and clinically relevant RRL model for microbiology. From these guiding principles, a detailed assessment of the needs of each institution and extensive networking with user groups, the functions of the microbiology RRLs were established and a detailed implementation plan drawn up. The experience at CLS with regards to restructuring a regional microbiology service is described herein. A post-hoc analysis provides the pros and cons of directing and operating a regionalized microbiology service. PMID:22346397

Characteristics of clients who access mobile compared to clinic HIV counselling and testing services: a matched study from Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Naidoo, Pren; Claassens, Mareli M; Lombard, Carl; Beyers, Nulda

2014-12-20

Studies within sub-Saharan African countries have shown that mobile services increase uptake of HIV counselling and testing (HCT) services when compared to clinics and are able to access different populations, but these have included provider-initiated HCT in clinics. This study aimed to compare the characteristics of clients who self-initiated HCT at either a mobile or a clinic service in terms of demographic and socio-economic variables, also comparing reasons for accessing a particular health service provider. This study took place in eight areas around Cape Town. A matched design was used with one mobile HCT service matched with one or more clinics (offering routine HCT services) within each of the eight areas. Adult clients who self-referred for an HIV test within a specified time period at either a mobile or clinic service were invited to participate in the study. Data were collected between February and April 2011 using a questionnaire. Summary statistics were calculated for each service type within a matched pair and differences of outcomes from pairs were used to calculate effect sizes and 95% confidence intervals. 1063 participants enrolled in the study with 511 from mobile and 552 from clinic HCT services. The proportion of males accessing mobile HCT significantly exceeded that of clinic HCT (p < 0.001). The mean age of participants attending mobile HCT was higher than clinic participants (p = 0.023). No significant difference was found for socio-economic variables between participants, with the exception of access to own piped water (p = 0.029). Participants who accessed mobile HCT were significantly more likely to report that they were just passing, deemed an "opportunistic" visit (p = 0.014). Participants who accessed clinics were significantly more likely to report the service being close to home or work (p = 0.035). An HCT strategy incorporating a mobile HCT service, has a definite role to play in reaching those population groups who do not typically access HCT services at a clinic, especially males and those who take advantage of the opportunity to test. Mobile HCT services can complement clinic services.

Cost analysis of two community-based HIV testing service modalities led by a Non-Governmental Organization in Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Beyers, Nulda; Burger, Ronelle

2017-12-02

In South Africa, the financing and sustainability of HIV services is a priority. Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. With insufficient estimates of the costs associated with CB-HTS provided by NGOs in South Africa, this cost analysis explored the cost to implement and provide services at two NGO-led CB-HTS modalities and calculated the costs associated with realizing key HIV outputs for each CB-HTS modality. The study took place in a peri-urban area where CB-HTS were provided from a stand-alone centre and mobile service. Using a service provider (NGO) perspective, all inputs were allocated by HTS modality with shared costs apportioned according to client volume or personnel time. We calculated the total cost of each HTS modality and the cost categories (personnel, capital and recurring goods/services) across each HTS modality. Costs were divided into seven pre-determined project components, used to examine cost drivers. HIV outputs were analysed for each HTS modality and the mean cost for each HIV output was calculated per HTS modality. The annual cost of the stand-alone and mobile modalities was $96,616 and $77,764 respectively, with personnel costs accounting for 54% of the total costs at the stand-alone. For project components, overheads and service provision made up the majority of the costs. The mean cost per person tested at stand-alone ($51) was higher than at the mobile ($25). Linkage to care cost at the stand-alone ($1039) was lower than the mobile ($2102). This study provides insight into the cost of an NGO led CB-HTS project providing HIV testing and linkage to care through two CB-HIV testing modalities. The study highlights; (1) the importance of including all applicable costs (including overheads) to ensure an accurate cost estimate that is representative of the full service implementation cost, (2) the direct link between test uptake and mean cost per person tested, and (3) the need for effective linkage to care strategies to increase linkage and thereby reduce the mean cost per person linked to HIV care.

It is more efficient to type: innovative self-registration and appointment self-arrival system improves the patient reception process.

PubMed

Knight, Vickie; Guy, Rebecca J; Handan, Wand; Lu, Heng; McNulty, Anna

2014-06-01

In 2010, we introduced an express sexually transmitted infection/HIV testing service at a large metropolitan sexual health clinic, which significantly increased clinical service capacity. However, it also increased reception staff workload and caused backlogs of patients waiting to register or check in for appointments. We therefore implemented a new electronic self-registration and appointment self-arrival system in March 2012 to increase administrative efficiency and reduce waiting time for patients. We compared the median processing time overall and for each step of the registration and arrival process as well as the completeness of patient contact information recorded, in a 1-week period before and after the redesign of the registration system. χ2 Test and rank sum tests were used. Before the redesign, the median processing time was 8.33 minutes (interquartile range [IQR], 6.82-15.43), decreasing by 30% to 5.83 minutes (IQR, 4.75-7.42) when the new electronic self-registration and appointment self-arrival system was introduced (P < 0.001). The largest gain in efficiency was in the time taken to prepare the medical record for the clinician, reducing from a median of 5.31 minutes (IQR, 4.02-8.29) to 0.57 minutes (IQR, 0.38-1) in the 2 periods. Before implementation, 20% of patients provided a postal address and 31% an e-mail address, increasing to 60% and 70% post redesign, respectively (P < 0.001). Our evaluation shows that an electronic patient self-registration and appointment self-arrival system can improve clinic efficiency and save patient time. Systems like this one could be used by any outpatient service with large patient volumes as an integrated part of the electronic patient management system or as a standalone feature.

Application of SCOPE-C to Measure Social Inclusion Among Mental Health Services Users in Hong Kong.

PubMed

Chan, Kara; Chiu, Marcus Yu-Lung; Evans, Sherrill; Huxley, Peter J; Ng, Yu-Leung

2016-11-01

This study describes the construction of the Chinese version of the Social and Communities Opportunities Profile (SCOPE), henceforth, the SCOPE-C, to measure social inclusion among mental health services users in Hong Kong. The SCOPE-C was developed based on concept-mapping and benchmarking of census questions. The questionnaire consisted of 56 items, went through a standardized linguistic validation process and was pilot tested with qualitative feedback from five users of mental health services. Altogether 168 Chinese service users were recruited through various NGO mental health services to have three times face-to-face interview between October 2013 and July 2014. Results indicated that items related to satisfaction with opportunities and perceived opportunities in various social domains had high consistency. Nearly all the Kappa statistics and Pearson correlation coefficients between the baseline and two rounds of re-test were significant. The SCOPE-C was considered a valid instrument for Hong Kong mental health user population.

Doctors' service orientation in public, private, and foreign hospitals.

PubMed

Andaleeb, Syed Saad; Siddiqui, Nazlee; Khandakar, Shahjahan

2007-01-01

The purpose of this study is to propose a doctors' service orientation (DSO) scale and uses it to compare the services received in public, private and foreign hospitals in a developing country from the patient's perspective. The scale was derived from the service quality literature and qualitative research. A questionnaire was designed next. Data were collected from patients who had used the services of doctors in a hospital. The scale demonstrated appropriate psychometric properties. Two clear patterns emerge from the study results: on 10 out of 12 measures of doctors' service orientation, there was no significant difference in their perceived behaviors between public and private hospitals and foreign doctors were "always" rated significantly higher. This study focused on one major city because of time and resource constraints. The findings are thus not generalizable to hospitals across the country. Also, because of translation and retranslation issues, the scale ought to be further tested for wider use. The scale may be used periodically in a comprehensive quality assurance program to exhort doctors to become more service oriented and to improve their performance over time.

Towards an autonomous telescope system: the Test-Bed Telescope project

NASA Astrophysics Data System (ADS)

Racero, E.; Ocaña, F.; Ponz, D.; the TBT Consortium

2015-05-01

In the context of the Space Situational Awareness (SSA) programme of ESA, it is foreseen to deploy several large robotic telescopes in remote locations to provide surveillance and tracking services for man-made as well as natural near-Earth objects (NEOs). The present project, termed Telescope Test Bed (TBT) is being developed under ESA's General Studies and Technology Programme, and shall implement a test-bed for the validation of an autonomous optical observing system in a realistic scenario, consisting of two telescopes located in Spain and Australia, to collect representative test data for precursor NEO services. It is foreseen that this test-bed environment will be used to validate future prototype software systems as well as to evaluate remote monitoring and control techniques. The test-bed system will be capable to deliver astrometric and photometric data of the observed objects in near real-time. This contribution describes the current status of the project.

Maintaining Your Passion for the Job

ERIC Educational Resources Information Center

McClellan, George S.

2012-01-01

There are times when passion for a job is seriously tested by the circumstances and conditions of the work. The accumulated effect of long hours, increasing demand for services, shrinking budgets, intractable issues, litigious environments, and what seems at times like incessant bashing of higher education for political purposes can lead to…

47 CFR 90.214 - Transient frequency behavior.

Code of Federal Regulations, 2010 CFR

2010-10-01

....214 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES... instant when a 1 kHz test signal is completely suppressed, including any capture time due to phasing. t1... the time period from the instant when the transmitter is turned off until toff. toff is the instant...

Mixed-methods evaluation of a novel online STI results service.

PubMed

Gibbs, Jo; Aicken, Catherine R H; Sutcliffe, Lorna J; Gkatzidou, Voula; Tickle, Laura J; Hone, Kate; Sadiq, S Tariq; Sonnenberg, Pam; Estcourt, Claudia S

2018-01-11

Evidence on optimal methods for providing STI test results is lacking. We evaluated an online results service, developed as part of an eSexual Health Clinic (eSHC). We evaluated the online results service using a mixed-methods approach within large exploratory studies of the eSHC. Participants were chlamydia- positive and negative users of online postal self-sampling services in six National Chlamydia Screening Programme (NCSP) areas and chlamydia-positive patients from two genitourinary medicine (GUM) clinics between 21 July 2014 and 13 March 2015. Participants received a discreetly worded National Health Service 'NHS no-reply' text message (SMS) informing them that their test results were ready and providing a weblink to a secure website. Participants logged in with their date of birth and mobile telephone or clinic number. Chlamydia-positive patients were offered online management. All interactions with the eSHC system were automatically logged and their timing recorded. Post-treatment, a service evaluation survey (n=152) and qualitative interviews (n=36) were conducted by telephone. Chlamydia-negative patients were offered a short online survey (n=274). Data were integrated. 92% (134/146) of NCSP chlamydia-positive patients, 82% (161/197) of GUM chlamydia-positive patients and 89% (1776/1997) of NCSP chlamydia-negative participants accessed test results within 7 days. 91% of chlamydia-positive patients were happy with the results service; 64% of those who had tested previously found the results service better or much better than previous experiences. 90% of chlamydia-negative survey participants agreed they would be happy to receive results this way in the future. Interviewees described accessing results with ease and appreciated the privacy and control the two-step process gave them. A discreet SMS to alert users/patients that results are available, followed by provision of results via a secure website, was highly acceptable, irrespective of test result and testing history. The eSHC results service afforded users privacy and control over when they viewed results without compromising access. © 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.

Pill testing or drug checking in Australia: Acceptability of service design features.

PubMed

Barratt, Monica J; Bruno, Raimondo; Ezard, Nadine; Ritter, Alison

2018-02-01

This study aimed to determine design features of a drug-checking service that would be feasible, attractive and likely to be used by Australian festival and nightlife attendees. Web survey of 851 Australians reporting use of psychostimulants and/or hallucinogens and attendance at licensed venues past midnight and/or festivals in the past year (70% male; median age 23 years). A drug-checking service located at festivals or clubs would be used by 94%; a fixed-site service external to such events by 85%. Most (80%) were willing to wait an hour for their result. Almost all (94%) would not use a service if there was a possibility of arrest, and a majority (64%) would not use a service that did not provide individual feedback of results. Drug-checking results were only slightly more attractive if they provided comprehensive quantitative results compared with qualitative results of key ingredients. Most (93%) were willing to pay up to $5, and 68% up to $10, per test. One-third (33%) reported willingness to donate a whole dose for testing: they were more likely to be male, younger, less experienced, use drugs more frequently and attend venues/festivals less frequently. In this sample, festival- or club-based drug-checking services with low wait times and low cost appear broadly attractive under conditions of legal amnesty and individualised feedback. Quantitative analysis of ecstasy pills requiring surrender of a whole pill may appeal to a minority in Australia where pills are more expensive than elsewhere. [Barratt MJ, Bruno R, Ezard N, Ritter A. Pill testing or drug checking in Australia: Acceptability of service design features. Drug Alcohol Rev 2017;00:000-000]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe

PubMed Central

Otobo, Eloghene; Nhongo, Kundai; Takaruza, Albert; White, Peter J; Nyamukapa, Constance Anesu; Gregson, Simon

2018-01-01

Objective Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake. Methods Data from a household survey conducted in 2009–2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression. Results HIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02–2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03–5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs’ greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy. Conclusion FSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs’ need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake. PMID:29490957

Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project.

PubMed

Egner, W; Cook, T; Harper, N; Garcez, T; Marinho, S; Kong, K L; Nasser, S; Thomas, M; Warner, A; Hitchman, J; Floss, K

2017-10-01

Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6 th National Audit Project. We compare self-declared UK practice in specialist perioperative allergy services with national recommendations. A SurveyMonkey™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology (BSACI), the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy-CG183. Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait <12 weeks). Service leads are allergists/immunologists (91%) or anaesthetists (7%). Potentially important differences were seen in: testing repertoire [10/44 (23%) lacked BSACI compliant neuromuscular blocking agent (NMBA) panels and 17/44 (39%) lacked a NAP6-defined extended panel; many failed to screen all cases for chlorhexidine 19/44 (43%) or latex 21/44 (48%)], staffing [only 26/44 (59%) had specialist nurses and 18/44 (41%) an anaesthetist] and provision of information [18/44 (41%) gave immediate information in clinic and 5/44 (11%) sign-posted support groups]. Most centres were able to provide diagnostic challenges to antibiotics [40/44 (91%]) and local anaesthetics [41/44 (93%)]. Diagnostic testing is not harmonized, with marked variability in the NMBA panels used to identify safe alternatives. Chlorhexidine and latex are not part of routine testing in many centres. Poor access to services and patient information provision require attention. Harmonization of diagnostic approach is desirable, particularly with regard to a minimum NMBA panel for identification of safe alternatives. © 2017 John Wiley & Sons Ltd.

Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation.

PubMed

Elliot, E; Rossi, M; McCormack, S; McOwan, A

2016-09-01

An estimated one in eight men who have sex with men (MSM) in London lives with HIV, of which 16% are undiagnosed. It is a public health priority to minimise time spent undiagnosed and reduce morbidity, mortality and onward HIV transmission. 'Dean Street at Home' provided an online HIV risk self-assessment and postal home HIV sampling service aimed at hard-to-reach, high-risk MSM. This 2-year service evaluation aims to determine the HIV risk behaviour of users, the uptake of offer of home sampling and the acceptability of the service. Users were invited to assess their HIV risk anonymously through messages or promotional banners on several gay social networking websites. Regardless of risk, they were offered a free postal HIV oral fluid or blood self-sampling kit. Reactive results were confirmed in clinic. A user survey was sent to first year respondents. 17 361 respondents completed the risk self-assessment. Of these, half had an 'identifiable risk' for HIV and a third was previously untested. 5696 test kits were returned. 121 individuals had a reactive sample; 82 (1.4% of returned samples) confirmed as new HIV diagnoses linked to care; 14 (0.25%) already knew their diagnosis; and 14 (0.25%) were false reactives. The median age at diagnosis was 38; median CD4 505 cells/µL and 20% were recent infections. 61/82 (78%) were confirmed on treatment at the time of writing. The post-test email survey revealed a high service acceptability rate. The service was the first of its kind in the UK. This evaluation provides evidence to inform the potential roll-out of further online strategies to enhance community HIV testing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities.

PubMed

Leff, Hugh Stephen; Chow, Clifton M; Graves, Stephen C

2017-03-01

A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ. Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations. Meta-regression was employed to explore associations between TPs and characteristics of service recipients and studies. R systems performed better than M and B systems. However, M systems did not perform better than B systems. All systems showed negative as well as positive TPs. For approximately one-third of synthesized TPs, substantial interstudy heterogeneity was noted. Associations were found between TPs and service recipient and study variables Conclusions: Conceptualizing systems as B, M, and R has potential for improving scientific understanding and systems planning. R systems appear more effective than B and M systems, although there is no "magic bullet" system for all service recipients. Interstudy heterogeneity indicates need for common approaches to reporting service recipient states, time periods for TPs, service recipient attributes, and service system characteristics. TPs found should be used in Markov simulations to project system effectiveness and costs of over time.

A regional centralized microbiology service in Calgary for the rapid diagnosis of malaria.

PubMed

Church, Deirdre L; Lichtenfeld, Angelika; Elsayed, Sameer; Kuhn, Susan; Gregson, Daniel B

2003-06-01

A regional centralized laboratory service for the rapid diagnosis of malaria was implemented 3 years ago in May 1999 within the Division of Microbiology, Calgary Laboratory Services. To describe the design and performance of this unique microbiology laboratory service. Blood specimens must arrive at the central laboratory within 2 hours of collection. Thin blood smears are read and reported from suspected acute cases within 1 hour of receipt, 24 hours per day, 7 days a week, by trained and experienced microbiology technologists. All positive malaria smears are reviewed by a medical microbiologist and confirmed by polymerase chain reaction at a reference laboratory. Calgary Laboratory Services provides integrated laboratory services to the Calgary Health Region, an urban area of more than 1 million people. Performance of the service has been continuously monitored by measuring preanalytic and analytic test turnaround times, test accuracy, clinical relevance, and the results of proficiency testing. More than 90% of blood specimens for malaria from community locations have consistently arrived within 2 hours of collection, and hospitals have reached this target within the past year. Although polymerase chain reaction was more sensitive at detecting the presence of malaria, the expert microscopists were as accurate at determining the type of Plasmodium infection. More than 95% of all positive smear results are consistently reported within 2 hours of receipt of a blood specimen. Implementation of a regional centralized microbiology service has improved our ability to make a rapid and accurate diagnosis of malaria in this region.

Spectral Filtering Criteria for U-Band Test Light for In-Service Line Monitoring in Optical Fiber Networks

NASA Astrophysics Data System (ADS)

Honda, Nazuki; Izumita, Hisashi; Nakamura, Minoru

2006-06-01

In the fiber-to-the-home era, thousands of optical fibers will have to be accommodated in the central offices of optical access networks. To reduce maintenance costs and improve the service reliability of optical fiber networks, the authors must develop an optical fiber line testing system with a function for in-service line monitoring that uses a test light with a wavelength different from the communication light wavelength. To monitor an in-service line in an optical network, the effective rejection ratio of the test light must be taken into account. This ratio depends on the spectrum of the test light from the optical time-domain reflectometer and the rejection band of the filter in front of the optical network unit. The dependence of the effective rejection ratio as a function of the sideband suppression ratio (SBSR) and of the ratio of the rejection band to the bandwidth of the sideband noise d/D is clarified. When d/D =0.1 and the target effective rejection ratio of the filter is -40 dB, the SBSR and the filter loss of the termination cable must be -70 and -43 dB, respectively, or the SBSR must be -80 dB. When d/D < 0.5 and the target effective rejection ratio of the filter is -40 dB, the SBSR is also required to be -80 dB. In-service line monitoring for a 10-Gb/s transmission using a 1650-nm test light with an SBSR of -80 dB is also demonstrated.

The Validity of College Grade Prediction Equations Over Time.

ERIC Educational Resources Information Center

Sawyer, Richard L.; Maxey, James

A sample of 260 colleges was surveyed during the years 1972-1976 to determine the validity of predicting college freshmen grades from standardized test scores and high school grades using the American College Testing (ACT) Assessment Program, an evaluative and placement service for students and educators involved in the transition from high school…

76 FR 56661 - Energy Conservation Program: Test Procedures for General Service Fluorescent Lamps, General...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-14

... designed to improve energy efficiency and established the Energy Conservation Program for Consumer Products... prescribed or amended under this section must be reasonably designed to produce test results which measure... conservation standards for GSILs which include for the first time minimum rated lifetime requirements that are...

USCG AIS Broadcast

Science.gov Websites

these cooler months. Did you know your body can cool 25 times faster in water than in air? That water Traffic Service began broadcasting Automatic Identification System (AIS) test messages to select test participants in the area via standard AIS channels. These broadcasts-originating from MMSI 003660471-are less

Elastomer Compound Developed for High Wear Applications

NASA Technical Reports Server (NTRS)

Crawford, D.; Feuer, H.; Flanagan, D.; Rodriguez, G.; Teets, A.; Touchet, P.

1993-01-01

The U.S. Army is currently spending 300 million dollars per year replacing rubber track pads. An experimental rubber compound has been developed which exhibits 2 to 3 times greater service life than standard production pad compounds. To improve the service life of the tank track pads various aspects of rubber chemistry were explored including polymer, curing and reinforcing systems. Compounds that exhibited superior physical properties based on laboratory data were then fabricated into tank pads and field tested. This paper will discuss the compounding studies, laboratory data and field testing that led to the high wear elastomer compound.

The initial impact of a workplace lead-poisoning prevention project.

PubMed Central

Bellows, J; Rudolph, L

1993-01-01

The California Department of Health Services began an occupational lead poisoning prevention project in cooperation with 275 radiator service companies. The agency developed and marketed resources to facilitate companies' own efforts, tracked the progress of each company, and urged the companies to conduct blood lead testing. Testing by participating employers increased from 9% to 95%, and 10 times as many companies with likely overexposures were identified as had been reported to the state's lead registry in the previous year. The success of this project indicates that the model should be applied more extensively. Images FIGURE 1 PMID:8438981

Life Assessment for Cr-Mo Steel Dissimilar Joints by Various Filler Metals Using Accelerated Creep Testing

NASA Astrophysics Data System (ADS)

Petchsang, S.; Phung-on, I.; Poopat, B.

2016-12-01

Accelerated creep rupture tests were performed on T22/T91 dissimilar metal joints to determine the fracture location and rupture time of different weldments. Four configurations of deposited filler metal were tested using gas tungsten arc welding to estimate the service life for Cr-Mo steel dissimilar joints at elevated temperatures in power plants. Results indicated that failure in all configurations occurred in the tempered original microstructure and tempered austenite transformation products (martensite or bainite structure) as type IV cracking at the intercritical area of the heat-affected zone (ICHAZ) for both T22 and T91 sides rather than as a consequence of the different filler metals. Creep damage occurred with the formation of precipitations and microvoids. The correlation between applied stress and the Larson-Miller parameter (PLM) was determined to predict the service life of each material configuration. Calculated time-to-failure based on the PLM and test results for both temperature and applied stress parameters gave a reasonable fit. The dissimilar joints exhibited lower creep rupture compared to the base material indicating creep degradation of the weldment.

Monitoring Score Change Patterns to Support "TOEIC"® Listening and Reading Test Quality. Research Report. ETS RR-17-54

ERIC Educational Resources Information Center

Wei, Youhua; Low, Albert

2017-01-01

In most large-scale programs of tests that aid in making high-stakes decisions, such as the "TOEIC"® family of products and service, it is not unusual for a significant portion of test takers to retake the test at multiple times.The study reported here used multilevel growth modeling to explore the score change patterns of nearly 20,000…

Physician satisfaction with clinical laboratory services: a College of American Pathologists Q-probes study of 138 institutions.

PubMed

Jones, Bruce A; Bekeris, Leonas G; Nakhleh, Raouf E; Walsh, Molly K; Valenstein, Paul N

2009-01-01

Monitoring customer satisfaction is a valuable component of a laboratory quality improvement program. To survey the level of physician satisfaction with hospital clinical laboratory services. Participating institutions provided demographic and practice information and survey results of physician satisfaction with defined aspects of clinical laboratory services, rated on a scale of 1 (poor) to 5 (excellent). One hundred thirty-eight institutions participated in this study and submitted a total of 4329 physician surveys. The overall satisfaction score for all institutions ranged from 2.9 to 5.0. The median overall score for all participants was 4.1 (10th percentile, 3.6; 90th percentile, 4.5). Physicians were most satisfied with the quality/reliability of results and staff courtesy, with median values of excellent or good ratings of 89.9%. Of the 5 service categories that received the lowest percentage values of excellent/good ratings (combined scores of 4 and 5), 4 were related to turnaround time for inpatient stat, outpatient stat, routine, and esoteric tests. Surveys from half of the participating laboratories reported that 96% to 100% of physicians would recommend the laboratory to other physicians. The category most frequently selected as the most important category of laboratory services was quality/reliability of results (31.7%). There continues to be a high level of physician satisfaction and loyalty with clinical laboratory services. Test turnaround times are persistent categories of dissatisfaction and present opportunities for improvement.

The Effects of Web-Based Patient Access to Laboratory Results in British Columbia: A Patient Survey on Comprehension and Anxiety.

PubMed

Mák, Geneviève; Smith Fowler, Heather; Leaver, Chad; Hagens, Simon; Zelmer, Jennifer

2015-08-04

Web-based patient access to personal health information is limited but increasing in Canada and internationally. This exploratory study aimed to increase understanding of how Web-based access to laboratory test results in British Columbia (Canada), which has been broadly available since 2010, affects patients' experiences. In November 2013, we surveyed adults in British Columbia who had had a laboratory test in the previous 12 months. Using a retrospective cohort design, we compared reported wait-time for results, test result comprehension, and anxiety levels of "service users" who had Web-based access to their test results (n=2047) with those of a general population panel that did not have Web-based access (n=1245). The vast majority of service users (83.99%, 95% CI 82.31-85.67) said they received their results within "a few days", compared to just over a third of the comparison group (37.84%, 95% CI 34.96-40.73). Most in both groups said they understood their test results, but the rate was lower for service users than the comparison group (75.55%, 95% CI 73.58-77.49 vs 84.69%, 95% CI 82.59-86.81). There was no significant difference between groups in levels of reported anxiety after receiving test results. While most patients who received their laboratory test results online reported little anxiety after receiving their results and were satisfied with the service, there may be opportunities to improve comprehension of results.

Epistemological Predictors of "Self Efficacy on Learning Biology" and "Test Anxiety Related to Evaluation of Learning on Biology" for Pre-Service Elementary Teachers

ERIC Educational Resources Information Center

Koksal, Mustafa Serdar

2011-01-01

The degree to which pre-service teachers learn biology is related to both motivational factors of self-regulation and factors regarding epistemological beliefs. At the same time, self-regulation and epistemological beliefs are also associated with one another. Based on this relationship, the purpose of this study was to investigate the…

GED Candidates and Their Postsecondary Educational Outcomes: A Pilot Study. GED Testing Service[R] Research Studies, 2009-5. Executive Summary

ERIC Educational Resources Information Center

Patterson, Margaret Becker; Song, Wei; Zhang, Jizhi

2009-01-01

For most high school non-completers, the GED[R] (General Educational Development) credential is the bridge to postsecondary education, but little is known about how successfully they could make that transition and whether their participation shifts across time. The American Council on Education (ACE) has begun a three-year longitudinal study to…

GED Candidates and Their Postsecondary Educational Outcomes: A Pilot Study. GED Testing Service[R] Research Studies, 2009-5

ERIC Educational Resources Information Center

Patterson, Margaret Becker; Song, Wei; Zhang, Jizhi

2009-01-01

For most high school non-completers, the GED[R] credential is the bridge to postsecondary education, but little is known about how successfully they could make that transition and whether their participation shifts across time. The American Council on Education (ACE) has begun a three-year longitudinal study to understand the effect of the GED…

40 CFR 721.6479 - Tetrahydroheteropolycycle (generic).

Code of Federal Regulations, 2013 CFR

2013-07-01

... listed in the TSCA section 5(e) consent order for this substance. The NCEL is 1.0 ug/m3 as an 8-hour time.... Requirements as specified in § 721.63 (a)(1)(i), (a)(2)(i), (a)(3), (a)(4), (a)(5)(ii) (if no data on cartridge service life testing has been reviewed and approved by EPA), (a)(5)(xii) (if data on cartridge service...

40 CFR 721.6479 - Tetrahydroheteropolycycle (generic).

Code of Federal Regulations, 2011 CFR

2011-07-01

... listed in the TSCA section 5(e) consent order for this substance. The NCEL is 1.0 ug/m3 as an 8-hour time.... Requirements as specified in § 721.63 (a)(1)(i), (a)(2)(i), (a)(3), (a)(4), (a)(5)(ii) (if no data on cartridge service life testing has been reviewed and approved by EPA), (a)(5)(xii) (if data on cartridge service...

40 CFR 721.6479 - Tetrahydroheteropolycycle (generic).

Code of Federal Regulations, 2014 CFR

2014-07-01

... listed in the TSCA section 5(e) consent order for this substance. The NCEL is 1.0 ug/m3 as an 8-hour time.... Requirements as specified in § 721.63 (a)(1)(i), (a)(2)(i), (a)(3), (a)(4), (a)(5)(ii) (if no data on cartridge service life testing has been reviewed and approved by EPA), (a)(5)(xii) (if data on cartridge service...

40 CFR 721.6479 - Tetrahydroheteropolycycle (generic).

Code of Federal Regulations, 2010 CFR

2010-07-01

... listed in the TSCA section 5(e) consent order for this substance. The NCEL is 1.0 ug/m3 as an 8-hour time.... Requirements as specified in § 721.63 (a)(1)(i), (a)(2)(i), (a)(3), (a)(4), (a)(5)(ii) (if no data on cartridge service life testing has been reviewed and approved by EPA), (a)(5)(xii) (if data on cartridge service...

40 CFR 721.6479 - Tetrahydroheteropolycycle (generic).

Code of Federal Regulations, 2012 CFR

2012-07-01

... listed in the TSCA section 5(e) consent order for this substance. The NCEL is 1.0 ug/m3 as an 8-hour time.... Requirements as specified in § 721.63 (a)(1)(i), (a)(2)(i), (a)(3), (a)(4), (a)(5)(ii) (if no data on cartridge service life testing has been reviewed and approved by EPA), (a)(5)(xii) (if data on cartridge service...

Upstairs downstairs: vertical integration of a pediatric service.

PubMed

Racine, A D; Stein, R E; Belamarich, P F; Levine, E; Okun, A; Porder, K; Rosenfeld, J L; Schechter, M

1998-07-01

The combined effects of recent changes in health care financing and training priorities have compelled academic medical centers to develop innovative structures to maintain service commitments yet conform to health care marketplace demands. In 1992, a municipal hospital in the Bronx, New York, affiliated with a major academic medical center reorganized its pediatric service into a vertically integrated system of four interdependent practice teams that provided comprehensive care in the ambulatory as well as inpatient settings. One of the goals of the new system was to conserve inpatient resources. To describe the development of a new vertically integrated pediatric service at an inner-city municipal hospital and to test whether its adoption was associated with the use of fewer inpatient resources. A descriptive analysis of the rationale, goals, implementation strategies, and structure of the vertically integrated pediatric service combined with a before-and-after comparison of in-hospital resource consumption. A before-and-after comparison was conducted for two periods: the period before vertical integration, from January 1989 to December 1991, and the period after the adoption of vertical integration, from July 1992 to December 1994. Four measures of inpatient resource use were compared after adjustment for case mix index: mean certified length of stay per case, mean number of radiologic tests per case, mean number of ancillary tests per case, and mean number of laboratory tests per case. Difference-in-differences-in-differences estimators were used to control for institution-wide trends throughout the time period and regional trends in inpatient pediatric practice occurring across institutions. Results. In 1992, the Department of Pediatrics at the Albert Einstein College of Medicine reorganized the pediatric service at Jacobi Medical Center, one of its principal municipal hospital affiliates, into a vertically integrated pediatric service that combines ambulatory and inpatient activities into four interdependent practice teams composed of attending pediatricians, allied health professionals, house officers, and social workers. The new vertically integrated service was designed to improve continuity of care for patients, provide a model of practice for professional trainees, conserve scarce resources, and create a clinical research infrastructure. The vertically integrated pediatric service augmented the role of attending pediatricians, extended the use of allied health professionals from the ambulatory to the inpatient sites, established interdisciplinary practice teams that unified the care of pediatric patients and their families, and used less inpatient resources. Controlling for trends within the study institution and trends in the practice of pediatrics across institutions throughout the time period, the vertical integration was associated with a decline in 0.6 days per case, the use of 0.62 fewer radiologic tests per case, 0.21 fewer ancillary tests per case, and 2.68 fewer laboratory tests per case. We conclude that vertical integration of a pediatric service at an inner-city municipal hospital is achievable; conveys advantages of improved continuity of care, enhanced opportunities for primary care training, and increased participation of senior clinicians; and has the potential to conserve significant amounts of inpatient resources.

Significant issues in proof testing: A critical appraisal

NASA Technical Reports Server (NTRS)

Chell, G. G.; Mcclung, R. C.; Russell, D. A.; Chang, K. J.; Donnelly, B.

1994-01-01

Issues which impact on the interpretation and quantification of proof test benefits are reviewed. The importance of each issue in contributing to the extra quality assurance conferred by proof testing components is discussed, particularly with respect to the application of advanced fracture mechanics concepts to enhance the flaw screening capability of a proof test analysis. Items covered include the role in proof testing of elastic-plastic fracture mechanics, ductile instability analysis, deterministic versus probabilistic analysis, single versus multiple cycle proof testing, and non-destructive examination (NDE). The effects of proof testing on subsequent service life are reviewed, particularly with regard to stress redistribution and changes in fracture behavior resulting from the overload. The importance of proof test conditions are also addressed, covering aspects related to test temperature, simulation of service environments, test media and the application of real-time NDE. The role of each issue in a proof test methodology is assessed with respect to its ability to: promote proof test practice to a state-of-the-art; aid optimization of proof test design; and increase awareness and understanding of outstanding issues.

Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services.

PubMed

Ngangue, Patrice; Gagnon, Marie-Pierre; Bedard, Emmanuelle

2017-04-08

The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala's district hospitals. Two primary data collection methods supported by the Donabedian's model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals' lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program.

Next step in antibiotic stewardship: Pharmacist-provided penicillin allergy testing.

PubMed

Gugkaeva, Z; Crago, J S; Yasnogorodsky, M

2017-08-01

Penicillin allergy limits therapeutic options for patients but often disappears over time, leaving patients erroneously labelled allergic and leading to the utilization of broad-spectrum and more expensive antibiotics. Penicillin allergy can be effectively assessed via skin testing. To improve patient access to penicillin allergy testing by implementing a pharmacist-provided service in a hospital setting. Beta-lactams remain a mainstream therapy for many infections due to their effectiveness, low side effects and affordability. Typically, patient access to penicillin allergy testing is limited by the availability of allergy specialists, who traditionally perform such testing. A pharmacist-provided penicillin allergy testing service was implemented at our hospital in 2015 and became a powerful antibiotic stewardship tool. Removing penicillin allergy from patient profiles significantly expanded therapeutic options, expedited discharges and reduced costs of care. Pharmacists can expand patient access to penicillin allergy testing. Pharmacist-provided penicillin allergy testing permitted optimized antibiotic treatment and expedited discharges. © 2017 John Wiley & Sons Ltd.

Zambian pre-service junior high school science teachers' chemical reasoning and ability

NASA Astrophysics Data System (ADS)

Banda, Asiana

The purpose of this study was two-fold: examine junior high school pre-service science teachers' chemical reasoning; and establish the extent to which the pre-service science teachers' chemical abilities explain their chemical reasoning. A sample comprised 165 junior high school pre-service science teachers at Mufulira College of Education in Zambia. There were 82 males and 83 females. Data were collected using a Chemical Concept Reasoning Test (CCRT). Pre-service science teachers' chemical reasoning was established through qualitative analysis of their responses to test items. The Rasch Model was used to determine the pre-service teachers' chemical abilities and item difficulty. Results show that most pre-service science teachers had incorrect chemical reasoning on chemical concepts assessed in this study. There was no significant difference in chemical understanding between the Full-Time and Distance Education pre-service science teachers, and between second and third year pre-service science teachers. However, there was a significant difference in chemical understanding between male and female pre-service science teachers. Male pre-service science teachers showed better chemical understanding than female pre-service science teachers. The Rasch model revealed that the pre-service science teachers had low chemical abilities, and the CCRT was very difficult for this group of pre-service science teachers. As such, their incorrect chemical reasoning was attributed to their low chemical abilities. These results have implications on science teacher education, chemistry teaching and learning, and chemical education research.

BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas - United States, 2009-2014.

PubMed

Kolor, Katherine; Chen, Zhuo; Grosse, Scott D; Rodriguez, Juan L; Green, Ridgely Fisk; Dotson, W David; Bowen, M Scott; Lynch, Julie A; Khoury, Muin J

2017-09-08

Genetic testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These testing results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA testing and receipt of preventive interventions after testing have not previously been examined. 2009-2014. Medical claims data from Truven Health Analytics MarketScan Commercial Claims and Encounters databases were used to estimate rates of BRCA testing and receipt of preventive interventions after BRCA testing among women aged 18-64 years with employer-sponsored health insurance in metropolitan and nonmetropolitan areas of the United States, both nationally and regionally. From 2009 to 2014, BRCA testing rates per 100,000 women aged 18-64 years with employer-sponsored health insurance increased 2.3 times (102.7 to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan areas. The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in 2014 (237.8 versus 191.3). The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased more over time in younger women than in older women and decreased in all regions except the West. Receipt of preventive services 90 days after BRCA testing in metropolitan versus nonmetropolitan areas throughout the period varied by service: the percentage of women who received a mastectomy was similar, the percentage of women who received magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who received mammography was lower in nonmetropolitan areas in earlier years but was similar in later years. Possible explanations for the 47% decrease in the relative difference in BRCA testing rates over the study period include increased access to genetic services in nonmetropolitan areas and increased demand nationally as a result of publicity. The relative differences in metropolitan and nonmetropolitan BRCA testing rates were smaller among women at younger ages compared with older ages. Improved data sources and surveillance tools are needed to gather comprehensive data on BRCA testing in the United States, monitor adherence to evidence-based guidelines for BRCA testing, and assess receipt of preventive interventions for women with BRCA mutations. Programs can build on the recent decrease in geographic disparities in receipt of BRCA testing while simultaneously educating the public and health care providers about U.S. Preventive Services Task Force recommendations and other clinical guidelines for BRCA testing and counseling.

From customer satisfaction survey to corrective actions in laboratory services in a university hospital.

PubMed

Oja, Paula I; Kouri, Timo T; Pakarinen, Arto J

2006-12-01

To find out the satisfaction of clinical units with laboratory services in a university hospital, to point out the most important problems and defects in services, to carry out corrective actions, and thereafter to identify the possible changes in satisfaction. and Senior physicians and nurses-in-charge of the clinical units at Oulu University Hospital, Finland. Customer satisfaction survey using a questionnaire was carried out in 2001, indicating the essential aspects of laboratory services. Customer-specific problems were clarified, corrective actions were performed, and the survey was repeated in 2004. In 2001, the highest dissatisfaction rates were recorded for computerized test requesting and reporting, turnaround times of tests, and the schedule of phlebotomy rounds. The old laboratory information system was not amenable to major improvements, and it was renewed in 2004-05. Several clinical units perceived turnaround times to be long, because the tests were ordered as routine despite emergency needs. Instructions about stat requesting were given to these units. However, no changes were evident in the satisfaction level in the 2004 survey. Following negotiations with the clinics, phlebotomy rounds were re-scheduled. This resulted in a distinct increase in satisfaction in 2004. Satisfaction survey is a screening tool that identifies topics of dissatisfaction. Without further clarifications, it is not possible to find out the specific problems of customers and to undertake targeted corrective actions. Customer-specific corrections are rarely seen as improvements in overall satisfaction rates.

Women's persistent depressive and perinatal grief symptoms following a miscarriage: the role of childlessness and satisfaction with healthcare services.

PubMed

deMontigny, Francine; Verdon, Chantal; Meunier, Sophie; Dubeau, Diane

2017-10-01

The objectives of this cross-sectional study were to determine whether depressive and perinatal grief symptoms vary according to time since miscarriage and to test whether childlessness and satisfaction with healthcare services influence symptom duration. A total of 245 women who had experienced a miscarriage answered a self-report questionnaire, indicating the date of their miscarriage and assessing their present level of depressive and perinatal grief symptoms. They also provided sociodemographic characteristics and indicated their level of satisfaction with healthcare services. One-way analyses of variance indicated that women who had miscarried within the past 6 months reported higher scores for depressive symptoms than did women who had miscarried between 7 and 12 months ago and more than 2 years ago. However, when controlling for childlessness and satisfaction with healthcare services, those differences became respectively marginal and non-significant, indicating that depressive symptoms are similar across time for more than 2 years after the loss. Regarding perinatal grief, results revealed that symptoms significantly decreased across time only for women with children and women who were satisfied with healthcare services. For childless women and those dissatisfied with healthcare services, perinatal grief symptoms did not vary according to time since miscarriage. Results suggest that, particularly for women who are childless and/or dissatisfied with healthcare services, depressive and perinatal grief symptoms persist long after a miscarriage. These results highlight the importance of paying particular attention to more vulnerable women and of improving healthcare services post-miscarriage.

Evolution of the health sector response to HIV in Myanmar: progress, challenges and the way forward.

PubMed

Oo, Htun Nyunt; Hone, San; Fujita, Masami; Maw-Naing, Amaya; Boonto, Krittayawan; Jacobs, Marjolein; Phyu, Sabe; Bollen, Phavady; Cheung, Jacquie; Aung, Htin; Aung Sang, May Thu; Myat Soe, Aye; Pendse, Razia; Murphy, Eamonn

2016-11-28

Critical building blocks for the response to HIV were made until 2012 despite a series of political, social and financial challenges. A rapid increase of HIV service coverage was observed from 2012 to 2015 through collaborative efforts of government and non-governmental organisations (NGOs). Government facilities, in particular, demonstrated their capacity to expand services for antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, tuberculosis and HIV co-infection and methadone-maintenance therapy (MMT). After nearly three decades into the response to HIV, Myanmar has adopted strategies to provide the right interventions to the right people in the right places to maximise impact and cost efficiency. In particular, the country is now using strategic information to classify areas into high-, medium- and low-HIV burden and risk of new infections for geographical prioritisation - as HIV remains concentrated among key population (KP) groups in specific geographical areas. Ways forward include: •Addressing structural barriers for KP to access services, and identifying and targeting KPs at higher risk;•Strengthening the network of public facilities, NGOs and general practitioners and introducing a case management approach to assist KPs and other clients with unknown HIV status, HIV-negative clients and newly diagnosed clients to access the health services across the continuum to increase the number of people testing for HIV and to reduce loss to follow-up in both prevention and treatment;•Increasing the availability of HIV testing and counselling services for KPs, clients of female sex workers (FSW), and other populations at risk, and raising the demand for timely testing including expansion of outreach and client-initiated voluntary counselling and testing (VCT) services;•Monitoring and maximising retention from HIV diagnosis to ART initiation and expanding quality HIV laboratory services, especially viral load;•Prioritising integration of HIV and related services in high-burden areas;•Increasing the proportion of PLHIV receiving testing and treatment at public facilities by improving human resources and increasing public facilities providing these services to ensure sustainability;•Obtaining intelligence and tailoring services in hard-to-reach/under-served areas;•Strengthening planning, monitoring, and coordination capacity especially at regional levels.

The impact of a closed‐loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before‐and‐after study

PubMed Central

Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

2007-01-01

Objectives To assess the impact of a closed‐loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants Before‐and‐after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention Closed‐loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results Prescribing errors were identified in 3.8% of 2450 medication orders pre‐intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non‐intravenous doses pre‐intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre‐intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre‐intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre‐intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions A closed‐loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication‐related tasks increased. PMID:17693676

Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men.

PubMed

Bourne, C; Knight, V; Guy, R; Wand, H; Lu, H; McNulty, A

2011-04-01

To evaluate the impact of a short message service (SMS) reminder system on HIV/sexually transmitted infection (STI) re-testing rates among men who have sex with men (MSM). The SMS reminder programme started in late 2008 at a large Australian sexual health clinic. SMS reminders were recommended 3-6 monthly for MSM considered high-risk based on self-reported sexual behaviour. The evaluation compared HIV negative MSM who had a HIV/STI test between 1 January and 31 August 2010 and received a SMS reminder (SMS group) with those tested in the same time period (comparison group) and pre-SMS period (pre-SMS group, 1 January 2008 and 31 August 2008) who did not receive the SMS. HIV/STI re-testing rates were measured within 9 months for each group. Baseline characteristics were compared between study groups and multivariate logistic regression used to assess the association between SMS and re-testing and control for any imbalances in the study groups. There were 714 HIV negative MSM in the SMS group, 1084 in the comparison group and 1753 in the pre-SMS group. In the SMS group, 64% were re-tested within 9 months compared to 30% in the comparison group (p<0.001) and 31% in the pre-SMS group (p<0.001). After adjusting for baseline differences, re-testing was 4.4 times more likely (95% CI 3.5 to 5.5) in the SMS group than the comparison group and 3.1 times more likely (95% CI 2.5 to 3.8) than the pre-SMS group. SMS reminders increased HIV/STI re-testing among HIV negative MSM. SMS offers a cheap, efficient system to increase HIV/STI re-testing in a busy clinical setting.

Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting.

PubMed

Kotecha, Aachal; Baldwin, Alex; Brookes, John; Foster, Paul J

2015-01-01

This article describes the development of a virtual glaucoma clinic, whereby technicians collect information for remote review by a consultant specialist. This was a hospital-based service evaluation study. Patients suitable for the stable monitoring service (SMS) were low-risk patients with "suspect", "early"-to-"moderate" glaucoma who were deemed stable by their consultant care team. Three technicians and one health care assistant ran the service. Patients underwent tests in a streamlined manner in a dedicated clinical facility, with virtual review of data by a consultant specialist through an electronic patient record. Feasibility of developing a novel service within a UK National Health Service setting and improvement of patient journey time within the service were studied. Challenges to implementation of virtual clinic include staffing issues and use of information technology. Patient journey time within the SMS averaged 51 minutes, compared with 92 minutes in the glaucoma outpatient department. Patient satisfaction with the new service was high. Implementing innovation into existing services of the National Health Service is challenging. However, the virtual clinic showed an improved patient journey time compared with that experienced within the general glaucoma outpatient department. There exists a discrepancy between patient management decisions of reviewers, suggesting that some may be more risk averse than others when managing patients seen within this model. Future work will assess the ability to detect progression of disease in this model compared with the general outpatient model of care.

Epidemiology of subclinical ketosis in early lactation dairy cattle.

PubMed

McArt, J A A; Nydam, D V; Oetzel, G R

2012-09-01

The purpose of this study was to describe the epidemiology of subclinical ketosis (SCK) in dairy cows in early lactation and determine the association of (1) days in milk (DIM) at onset of SCK, and (2) blood β-hydroxybutyrate (BHBA) concentration at onset of SCK with development of displaced abomasum (DA) and removal from herd in the first 30 DIM, conception to first service, days to conception within 150 DIM, and early lactation milk yield. Cows from 4 freestall dairy herds (2 in New York and 2 in Wisconsin) were each tested 6 times for SCK from 3 to 16 DIM using the Precision Xtra meter (Abbott Laboratories, Abbott Park, IL). Subclinical ketosis was defined as a BHBA concentration of 1.2 to 2.9 mmol/L. Mixed-effects multivariable Poisson regression was used to assess DA, removal from herd, and conception to first service. Semiparametric proportional hazards models were used to evaluate days to conception, and repeated-measures ANOVA was used to evaluate milk yield in the first 30 DIM. A total of 741 of 1,717 (43.2%) eligible cows had a least one BHBA test of 1.2 to 2.9 mmol/L. Peak incidence of SCK occurred at 5 DIM, when 22.3% of cows had their first SCK-positive test. Peak prevalence of SCK occurred at 5 DIM, when 28.9% of cows had a SCK-positive test. Median time from first positive SCK test until BHBA test <1.2 mmol/L was 5d. Cows first testing SCK positive from 3 to 5 DIM were 6.1 times more likely [95% confidence interval (CI) = 2.3 to 16.0] to develop a DA than cows first testing SCK positive at 6 DIM or later. Cows first testing SCK positive from 3 to 7 DIM were 4.5 times more likely (95% CI = 1.7 to 11.7) to be removed from the herd, were 0.7 times as likely (95% CI = 0.6 to 0.8) to conceive to first service, and produced 2.2 kg less milk per day for the first 30 DIM than cows first testing positive at 8 DIM or later. Each 0.1 mmol/L increase in BHBA at first SCK-positive test increased the risk of developing a DA by a factor of 1.1 (95% CI = 1.0 to 1.2), increased the risk of removal from herd by a factor of 1.4 (95% CI = 1.1 to 1.8), and was associated with a decrease in milk production by 0.5 kg/d for the first 30 DIM. These results show that time of onset and BHBA concentration of first SCK-positive test are important indicators of individual cow performance. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis.

PubMed

Leber, Werner; Beresford, Lee; Nightingale, Claire; Barbosa, Estela Capelas; Morris, Stephen; El-Shogri, Farah; McMullen, Heather; Boomla, Kambiz; Delpech, Valerie; Brown, Alison; Hutchinson, Jane; Apea, Vanessa; Symonds, Merle; Gilliham, Samantha; Creighton, Sarah; Shahmanesh, Maryam; Fulop, Naomi; Estcourt, Claudia; Anderson, Jane; Figueroa, Jose; Griffiths, Chris

2017-12-14

HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets). Service evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses. The chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evolution of a Collaborative Model between Nursing and Computer Science Faculty and a Community Service Organization to Develop an Information System

PubMed Central

Carson, Anne; Troy, Douglas

2007-01-01

Nursing and computer science students and faculty worked with the American Red Cross to investigate the potential for information technology to provide Red Cross disaster services nurses with improved access to accurate community resources in times of disaster. Funded by a national three-year grant, this interdisciplinary partnership led to field testing of an information system to support local community disaster preparedness at seven Red Cross chapters across the United States. The field test results demonstrate the benefits of the technology and the value of interdisciplinary research. The work also created a sustainable learning and research model for the future. This paper describes the collaborative model employed in this interdisciplinary research and exemplifies the benefits to faculty and students of well-timed interdisciplinary and community collaboration. PMID:18600129

Using Interorganizational Partnerships to Strengthen Public Health Laboratory Systems

PubMed Central

Kimsey, Paul; Buehring, Gertrude

2013-01-01

Due to the current economic environment, many local and state health departments are faced with budget reductions. Health department administrators and public health laboratory (PHL) directors need to assess strategies to ensure that their PHLs can provide the same level of service with decreased funds. Exploratory case studies of interorganizational partnerships among local PHLs in California were conducted to determine the impact on local PHL testing services and capacity. Our findings suggest that interorganizational forms of cooperation among local PHLs can help bolster laboratory capacity by capturing economies of scale, leveraging scarce resources, and ensuring access to affordable, timely, and quality laboratory testing services. Interorganizational partnerships will help local and state public health departments continue to maintain a strong and robust laboratory system that supports their role in communicable disease surveillance. PMID:23997305

Investigation of Coatings Which Prevent Molten Aluminum/Water Explosions

NASA Astrophysics Data System (ADS)

León, D. D.; Richter, R. T.; Levendusky, T. L.

The Aluminum Association contracted Alcoa in 1995 to identify and test new protective coatings for casting pits as a replacement for Porter International's 7001 (Tarset Standard). Three new coatings have been identified through a series of selection criteria including: 1) A standardized splash test used to evaluate personal protective clothing, 2) An industry-standard molten metal explosion test, 3) A multiple-exposure test to measure durability, and 4) An external shock impact test. The results of this program will be reviewed. This study only tested protective coatings at the "in-service cure time", as defined by the manufacturer. These curing times can be excessive for a production casting facility. The Aluminum Association has contracted Alcoa in a second program to investigate the effect of reduced cure times on adhesion and their effectiveness in preventing molten metal/water explosions. A status update of this new two year program is provided.

Smart Device-Supported BDS/GNSS Real-Time Kinematic Positioning for Sub-Meter-Level Accuracy in Urban Location-Based Services.

PubMed

Wang, Liang; Li, Zishen; Zhao, Jiaojiao; Zhou, Kai; Wang, Zhiyu; Yuan, Hong

2016-12-21

Using mobile smart devices to provide urban location-based services (LBS) with sub-meter-level accuracy (around 0.5 m) is a major application field for future global navigation satellite system (GNSS) development. Real-time kinematic (RTK) positioning, which is a widely used GNSS-based positioning approach, can improve the accuracy from about 10-20 m (achieved by the standard positioning services) to about 3-5 cm based on the geodetic receivers. In using the smart devices to achieve positioning with sub-meter-level accuracy, a feasible solution of combining the low-cost GNSS module and the smart device is proposed in this work and a user-side GNSS RTK positioning software was developed from scratch based on the Android platform. Its real-time positioning performance was validated by BeiDou Navigation Satellite System/Global Positioning System (BDS/GPS) combined RTK positioning under the conditions of a static and kinematic (the velocity of the rover was 50-80 km/h) mode in a real urban environment with a SAMSUNG Galaxy A7 smartphone. The results show that the fixed-rates of ambiguity resolution (the proportion of epochs of ambiguities fixed) for BDS/GPS combined RTK in the static and kinematic tests were about 97% and 90%, respectively, and the average positioning accuracies (RMS) were better than 0.15 m (horizontal) and 0.25 m (vertical) for the static test, and 0.30 m (horizontal) and 0.45 m (vertical) for the kinematic test.

A better understanding of ambulance personnel's attitude towards real-time resuscitation feedback.

PubMed

Brinkrolf, Peter; Lukas, Roman; Harding, Ulf; Thies, Sebastian; Gerss, Joachim; Van Aken, Hugo; Lemke, Hans; Schniedermeier, Udo; Bohn, Andreas

2018-03-01

High-quality chest compressions during cardiopulmonary resuscitation (CPR) play a significant role in surviving cardiac arrest. Chest-compression quality can be measured and corrected by real-time CPR feedback devices, which are not yet commonly used. This article looks at the acceptance of such systems in comparison of equipped and unequipped personnel. Two groups of emergency medical services' (EMS) personnel were interviewed using standardized questionnaires. The survey was conducted in the German cities Dortmund and Münster. Overall, 205 persons participated in the survey: 103 paramedics and emergency physicians from the Dortmund fire service and 102 personnel from the Münster service. The staff of the Dortmund service were not equipped with real-time feedback systems. The test group of equipped personnel of the ambulance service of Münster Fire brigade uses real-time feedback systems since 2007. What is the acceptance level of real-time feedback systems? Are there differences between equipped and unequipped personnel? The total sample is receptive towards real-time feedback systems. More than 80% deem the system useful. However, this study revealed concerns and prejudices by unequipped personnel. Negative ratings are significantly lower at the Münster site that is experienced with the use of the real-time feedback system in contrast to the Dortmund site where no such experience exists-the system's use in daily routine results in better evaluation than the expectations of unequipped personnel. Real-time feedback systems receive overall positive ratings. Prejudices and concerns seem to decrease with continued use of the system.

Inter-satellite time transfer: Techniques and applications

NASA Technical Reports Server (NTRS)

Detoma, Edoardo; Wardrip, S. Clark

1990-01-01

A brief review is presented of the well known time transfer techniques that have been studied and tested throughout the years. The applicability of time transfer techniques to a timing service as provided through a TDRS/DRS System, the problems related to the choice of the timing signal within the constraints imposed by the existing systems, and the possible practical implementations, including a description of the time synchronization support via TDRSS to the Gamma Ray Observatory (GRO) are discussed.

Measuring the quality of Hospital Food Services: Development and reliability of a Meal Quality Audit Tool.

PubMed

Banks, Merrilyn; Hannan-Jones, Mary; Ross, Lynda; Buckley, Ann; Ellick, Jennifer; Young, Adrienne

2017-04-01

To develop and test the reliability of a Meal Quality Audit Tool (MQAT) to audit the quality of hospital meals to assist food service managers and dietitians in identifying areas for improvement. The MQAT was developed using expert opinion and was modified over time with extensive use and feedback. A phased approach was used to assess content validity and test reliability: (i) trial with 60 dietetic students, (ii) trial with 12 food service dietitians in practice and (iii) interrater reliability study. Phases 1 and 2 confirmed content validity and informed minor revision of scoring, language and formatting of the MQAT. To assess reliability of the final MQAT, eight separate meal quality audits of five identical meals were conducted over several weeks in the hospital setting. Each audit comprised an 'expert' team and four 'test' teams (dietitians, food services and ward staff). Interrater reliability was determined using intra-class correlation analysis. There was statistically significant interrater reliability for dimensions of Temperature and Accuracy (P < 0.001) but not for Appearance or Sensory. Composition of the 'test' team appeared to influence results for Appearance and Sensory, with food service-led teams scoring higher on these dimensions. 'Test' teams reported that MQAT was clear and easy to use. MQAT was found to be reliable for Temperature and Accuracy domains, with further work required to improve the reliability of the Appearance and Sensory dimensions. The systematic use of the tool, used in conjunction with patient satisfaction, could provide pertinent and useful information regarding the quality of food services and areas for improvement. © 2017 Dietitians Association of Australia.

Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ).

PubMed

Tan, Christine L; Hassali, Mohamed A; Saleem, Fahad; Shafie, Asrul A; Aljadhey, Hisham; Gan, Vincent B

2015-01-01

(i) To develop the Pharmacy Value-Added Services Questionnaire (PVASQ) using emerging themes generated from interviews. (ii) To establish reliability and validity of questionnaire instrument. Using an extended Theory of Planned Behavior as the theoretical model, face-to-face interviews generated salient beliefs of pharmacy value-added services. The PVASQ was constructed initially in English incorporating important themes and later translated into the Malay language with forward and backward translation. Intention (INT) to adopt pharmacy value-added services is predicted by attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), knowledge and expectations. Using a 7-point Likert-type scale and a dichotomous scale, test-retest reliability (N=25) was assessed by administrating the questionnaire instrument twice at an interval of one week apart. Internal consistency was measured by Cronbach's alpha and construct validity between two administrations was assessed using the kappa statistic and the intraclass correlation coefficient (ICC). Confirmatory Factor Analysis, CFA (N=410) was conducted to assess construct validity of the PVASQ. The kappa coefficients indicate a moderate to almost perfect strength of agreement between test and retest. The ICC for all scales tested for intra-rater (test-retest) reliability was good. The overall Cronbach' s alpha (N=25) is 0.912 and 0.908 for the two time points. The result of CFA (N=410) showed most items loaded strongly and correctly into corresponding factors. Only one item was eliminated. This study is the first to develop and establish the reliability and validity of the Pharmacy Value-Added Services Questionnaire instrument using the Theory of Planned Behavior as the theoretical model. The translated Malay language version of PVASQ is reliable and valid to predict Malaysian patients' intention to adopt pharmacy value-added services to collect partial medicine supply.

Tcl as a Software Environment for a TCS

NASA Astrophysics Data System (ADS)

Terrett, David L.

2002-12-01

This paper describes how the Tcl scripting language and C API has been used as the software environment for a telescope pointing kernel so that new pointing algorithms and software architectures can be developed and tested without needing a real-time operating system or real-time software environment. It has enabled development to continue outside the framework of a specific telescope project while continuing to build a system that is sufficiently complete to be capable of controlling real hardware but expending minimum effort on replacing the services that would normally by provided by a real-time software environment. Tcl is used as a scripting language for configuring the system at startup and then as the command interface for controlling the running system; the Tcl C language API is used to provided a system independent interface to file and socket I/O and other operating system services. The pointing algorithms themselves are implemented as a set of C++ objects calling C library functions that implement the algorithms described in [2]. Although originally designed as a test and development environment, the system, running as a soft real-time process on Linux, has been used to test the SOAR mount control system and will be used as the pointing kernel of the SOAR telescope control system

Perceived reactions to race and health status in the Massachusetts Behavioral Risk Factor Surveillance System Survey.

PubMed

Zuckerman, Rachael B; Tinsley, Liane J; Hawk, Helen; Cohen, Bruce

2012-01-01

Evaluate the relationship between race, perceptions of personally mediated racism and health outcomes in the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS). Regression analysis of 8,266 respondents to the Reactions to Race module in 2006 and 2008. Questions assessing personally mediated racism were combined to measure perceptions of reactions to race. Adjusted odds ratios and 95% CI of perceived personally mediated racism, self-reported overall health, life satisfaction, health risks (smoking status, obesity, binge and heavy drinking), and preventive services (colonoscopy, flu vaccine). Black non-Hispanic respondents are 10.4 times (95% CI: 6.3-17.3; P<.001) and Hispanics 5.8 times (95% CI: 3.6-9.4; P<.001) more likely to report being treated worse than other races compared to White non-Hispanic respondents. Respondents of all races reporting being treated worse than other races are 3.2 times (95% CI: 1.9-5.4; P<.001) more likely to have fair/poor health and 4.1 times (95% CI: 2.1-7.9; P<.001) more likely to report life dissatisfaction than those treated the same or better than other races. There is no statistically significant association between perceived personally mediated racism and health risks or preventive services tested. Perceptions of personally mediated racism are significantly associated with fair/poor overall health and life dissatisfaction, but none of the health risks or preventive services tested.

Boron/aluminum skins for the DC-10 aft pylon

NASA Technical Reports Server (NTRS)

Elliott, S. Y.

1975-01-01

Boron/aluminum pylon boat tail skins were designed and fabricated and installed on the DC-10 aircraft for a 5-year flight service demonstration test. Inspection and tests of the exposed skins will establish the ability of the boron/aluminum composite to withstand long time flight service conditions, which include exposure to high temperatures, sonic fatigue, and flutter. The results of a preliminary testing program yield room temperature and elevated temperature data on the tension, compression, in-plane shear, interlaminar shear, bolt bearing, and tension fatigue properties of the boron/aluminum laminates. Present technology was used in the fabrication of the skins. Although maximum weight saving was not sought, weight of the constant thickness boron/aluminum skin is 26% less than the chemically milled titanium skin.

Accelerated testing technique for evaluating performance of chemical air filters for DUV photolithographic equipment

NASA Astrophysics Data System (ADS)

Kishkovich, Oleg P.; Bolgov, Dennis; Goodwin, William

1999-06-01

In this paper, the authors discuss the requirements for chemical air filtration system used in conjunction with modern DUV photolithography equipment. Among the topics addressed are the scope of pollutants, their respective internal and external sources, and an overview of different types of filtration technologies currently in use. Key filtration parameters, including removal efficiency, service life, and spill protection capacity, are discussed and supported by actual data, reflection the total molecular base concentration in operational IC manufacturing facilities. The authors also describe a time-accelerated testing procedure for comparing and evaluating different filtration technologies and designs, and demonstrate how this three-day test procedure can reliably predict an effective filter service life up to ten years.

Umbilical Connect Techniques Improvement-Technology Study

NASA Technical Reports Server (NTRS)

Valkema, Donald C.

1972-01-01

The objective of this study was to develop concepts, specifications, designs, techniques, and procedures capable of significantly reducing the time required to connect and verify umbilicals for ground services to the space shuttle. The desired goal was to reduce the current time requirement of several shifts for the Saturn 5/Apollo to an elapsed time of less than one hour to connect and verify all of the space shuttle ground service umbilicals. The study was conducted in four phases: (1) literature and hardware examination, (2) concept development, (3) concept evaluation and tradeoff analysis, and (4) selected concept design. The final product of this study was a detail design of a rise-off disconnect panel prototype test specimen for a LO2/LH2 booster (or an external oxygen/hydrogen tank for an orbiter), a detail design of a swing-arm mounted preflight umbilical carrier prototype test specimen, and a part 1 specification for the umbilical connect and verification design for the vehicles as defined in the space shuttle program.

Periodical capacity setting methods for make-to-order multi-machine production systems

PubMed Central

Altendorfer, Klaus; Hübl, Alexander; Jodlbauer, Herbert

2014-01-01

The paper presents different periodical capacity setting methods for make-to-order, multi-machine production systems with stochastic customer required lead times and stochastic processing times to improve service level and tardiness. These methods are developed as decision support when capacity flexibility exists, such as, a certain range of possible working hours a week for example. The methods differ in the amount of information used whereby all are based on the cumulated capacity demand at each machine. In a simulation study the methods’ impact on service level and tardiness is compared to a constant provided capacity for a single and a multi-machine setting. It is shown that the tested capacity setting methods can lead to an increase in service level and a decrease in average tardiness in comparison to a constant provided capacity. The methods using information on processing time and customer required lead time distribution perform best. The results found in this paper can help practitioners to make efficient use of their flexible capacity. PMID:27226649

Three Steps to Mastering Multiplication Facts

ERIC Educational Resources Information Center

Kling, Gina; Bay-Williams, Jennifer M.

2015-01-01

"That was the day I decided I was bad at math." Countless times, preservice and in-service teachers make statements such as this after sharing vivid memories of learning multiplication facts. Timed tests; public competitive games, such as Around the World; and visible displays of who has and has not mastered groups of facts still…

Design of limited-stop service based on the degree of unbalance of passenger demand

PubMed Central

2018-01-01

This paper presents a limited-stop service for a bus fleet to meet the unbalanced demand of passengers on a bus route and to improve the transit service of the bus route. This strategy includes two parts: a degree assessment of unbalanced passenger demand and an optimization of the limited-stop service. The degree assessment of unbalanced passenger demand, which is based on the different passenger demand between stations and the unbalance of passengers within the station, is used to judge whether implementing the limited-stop service is necessary for a bus route. The optimization of limited-stop service considers the influence of stop skipping action and bus capacity on the left-over passengers to determine the proper skipping stations for the bus fleet serving the entire route by minimizing both the waiting time and in-vehicle time of passengers and the running time of vehicles. A solution algorithm based on genetic algorithm is also presented to evaluate the degree of unbalanced passenger demand and optimize the limited-stop scheme. Then, the proper strategy is tested on a bus route in Changchun city of China. The threshold of degree assessment of unbalanced passenger demand can be calibrated and adapted to different passenger demands. PMID:29505585

Design of limited-stop service based on the degree of unbalance of passenger demand.

PubMed

Zhang, Hu; Zhao, Shuzhi; Liu, Huasheng; Liang, Shidong

2018-01-01

This paper presents a limited-stop service for a bus fleet to meet the unbalanced demand of passengers on a bus route and to improve the transit service of the bus route. This strategy includes two parts: a degree assessment of unbalanced passenger demand and an optimization of the limited-stop service. The degree assessment of unbalanced passenger demand, which is based on the different passenger demand between stations and the unbalance of passengers within the station, is used to judge whether implementing the limited-stop service is necessary for a bus route. The optimization of limited-stop service considers the influence of stop skipping action and bus capacity on the left-over passengers to determine the proper skipping stations for the bus fleet serving the entire route by minimizing both the waiting time and in-vehicle time of passengers and the running time of vehicles. A solution algorithm based on genetic algorithm is also presented to evaluate the degree of unbalanced passenger demand and optimize the limited-stop scheme. Then, the proper strategy is tested on a bus route in Changchun city of China. The threshold of degree assessment of unbalanced passenger demand can be calibrated and adapted to different passenger demands.

Emergency Mental Health Services for Children After the Terrorist Attacks of September 11, 2001.

PubMed

Bruckner, Tim A; Kim, Yonsu; Lubens, Pauline; Singh, Amrita; Snowden, Lonnie; Chakravarthy, Bharath

2016-01-01

Much literature documents elevated psychiatric symptoms among adults after the terrorist attacks of September 11, 2001 (9/11). We, however, know of no research in children that examines emergency mental health services following 9/11. We test whether children's emergency services for crisis mental health care rose above expected values in September 2001. We applied time-series methods to California Medicaid claims (1999-2003; N = 127,200 visits). Findings in California indicate an 8.7% increase of children's emergency mental health visits statistically attributable to 9/11. Non-Hispanic white more than African American children account for this acute rise in emergency services.

An Effort to Improve Teacher Perceptions and Knowledge of Cyberbullying: A Pre-Post Assessment

ERIC Educational Resources Information Center

Nesshengel-Hopp, Marleny T.

2017-01-01

Cyberbullying is a growing concern, confounded by the limited training resources available for teachers. The problem undertaken in this study was determining the most effective way to teach teachers about cyberbullying given the limited 1-hour time constraint of a typical school in-service activity. Using a pre-test, post-test experimental…

Enhancement of the NMSU Channel Error Simulator to Provide User-Selectable Link Delays

NASA Technical Reports Server (NTRS)

Horan, Stephen; Wang, Ru-Hai

2000-01-01

This is the third in a continuing series of reports describing the development of the Space-to-Ground Link Simulator (SGLS) to be used for testing data transfers under simulated space channel conditions. The SGLS is based upon Virtual Instrument (VI) software techniques for managing the error generation, link data rate configuration, and, now, selection of the link delay value. In this report we detail the changes that needed to be made to the SGLS VI configuration to permit link delays to be added to the basic error generation and link data rate control capabilities. This was accomplished by modifying the rate-splitting VIs to include a buffer the hold the incoming data for the duration selected by the user to emulate the channel link delay. In sample tests of this configuration, the TCP/IP(sub ftp) service and the SCPS(sub fp) service were used to transmit 10-KB data files using both symmetric (both forward and return links set to 115200 bps) and unsymmetric (forward link set at 2400 bps and a return link set at 115200 bps) link configurations. Transmission times were recorded at bit error rates of 0 through 10(exp -5) to give an indication of the link performance. In these tests. we noted separate timings for the protocol setup time to initiate the file transfer and the variation in the actual file transfer time caused by channel errors. Both protocols showed similar performance to that seen earlier for the symmetric and unsymmetric channels. This time, the delays in establishing the file protocol also showed that these delays could double the transmission time and need to be accounted for in mission planning. Both protocols also showed a difficulty in transmitting large data files over large link delays. In these tests, there was no clear favorite between the TCP/IP(sub ftp) and the SCPS(sub fp). Based upon these tests, further testing is recommended to extend the results to different file transfer configurations.

Testing an Adapted Modified Delphi Method: Synthesizing Multiple Stakeholder Ratings of Health Care Service Effectiveness.

PubMed

Escaron, Anne L; Chang Weir, Rosy; Stanton, Petra; Vangala, Sitaram; Grogan, Tristan R; Clarke, Robin M

2016-03-01

The Affordable Care Act incentivizes health systems for better meeting patient needs, but often guidance about patient preferences for particular health services is limited. All too often vulnerable patient populations are excluded from these decision-making settings. A community-based participatory approach harnesses the in-depth knowledge of those experiencing barriers to health care. We made three modifications to the RAND-UCLA appropriateness method, a modified Delphi approach, involving patients, adding an advisory council group to characterize existing knowledge in this little studied area, and using effectiveness rather than "appropriateness" as the basis for rating. As a proof of concept, we tested this method by examining the broadly delivered but understudied nonmedical services that community health centers provide. This method created discrete, new knowledge about these services by defining 6 categories and 112 unique services and by prioritizing among these services based on effectiveness using a 9-point scale. Consistent with the appropriateness method, we found statistical convergence of ratings among the panelists. Challenges include time commitment and adherence to a clear definition of effectiveness of services. This diverse stakeholder engagement method efficiently addresses gaps in knowledge about the effectiveness of health care services to inform population health management. © 2015 Society for Public Health Education.

Wireless Telemetry and Command (T and C) Program

NASA Technical Reports Server (NTRS)

Jiang, Hui; Horan, Stephen

2000-01-01

The Wireless Telemetry and Command (T&C) program is to investigate methods of using commercial telecommunications service providers to support command and telemetry services between a remote user and a base station. While the initial development is based on ground networks, the development is being done with an eye towards future space communications needs. Both NASA and the Air Force have indicated a plan to consider the use of commercial telecommunications providers to support their space missions. To do this, there will need to be an understanding of the requirements and limitations of interfacing with the commercial providers. The eventual payoff will be the reduced operations cost and the ability to tap into commercial services being developed by the commercial networks. This should enable easier realization of EP services to the end points, commercial routing of data, and quicker integration of new services into the space mission operations. Therefore, the ultimate goal of this program is not just to provide wireless radio communications for T&C services but to enhance those services through wireless networking and provider enhancements that come with the networks. In the following chapters, the detailed technical procedure will be showed step by step. Chapter 2 will talk about the general idea of simulation as well as the implementation of data acquisition including sensor array data and GPS data. Chapter 3 will talk about how to use LabVEEW and Component Works to do wireless communication simulation and how to distribute the real-time information over the Internet by using Visual Basic and ActiveX controls. Also talk about the test configuration and validation. Chapter 4 will show the test results both from In-Lab test and Networking Test. Chapter 5 will summarize the whole procedure and give the perspective for the future consideration.

Evaluating the Impact of Hospital Based Drug and Alcohol Consultation Liaison Services.

PubMed

Reeve, Rebecca; Arora, Sheena; Butler, Kerryn; Viney, Rosalie; Burns, Lucinda; Goodall, Stephen; van Gool, Kees

2016-09-01

Consultation liaison (CL) services provide direct access to specialist services for support, treatment advice and assistance with the management of a given condition. Alcohol and other drugs (AOD) CL services aim to improve identification and treatment of patients with AOD morbidity. Our objective was to evaluate the costs and consequences of AOD CL services in hospitals in New South Wales, Australia. Patients were surveyed at eight hospitals and problematic AOD use was identified using the Alcohol, Smoking and Substance Involvement Screening Test (n=1615). For consenting participants, medical record data were obtained from 18 months pre- to 12 months post-survey. We used interrupted time series analyses to compare utilization and costs for patients with and without AOD problems and changes over time between those who received AOD CL and similar patients. Approximately 35% of patients surveyed had AOD problems (excluding tobacco) with 7% requiring intensive treatment. Only 24% of patients requiring intensive treatment were treated by AOD CL. Those treated had relative improvements over time in the cost of presentations to emergency departments, emergency admission performance and increased uptake of appropriate pharmaceuticals. The estimated net benefit of AOD CL services was at least AUD$100,000 savings per hospital per year. Expanding AOD CL services to address current unmet need may lead to even greater cost savings for hospitals. Copyright © 2016 Elsevier Inc. All rights reserved.

2004 termiticide report: The Forest Service continues to improve operations to meet the high demand for testing

Treesearch

Terry Wagner; Chris Peterson; Joe Mulrooney; Thomas Shelton

2005-01-01

Termiticide registrations have been newsworthy for years now, as highlighted in some of the recent USDA Forest Service termiticide reports published in this magazine. One issue driving the changes in pesticide registrations is the length of time required to bring new active ingredients to the market. This is one of several issues that affect the number of safe and...

Effects of Exposures on Superalloys for Space Applications

NASA Technical Reports Server (NTRS)

Gabb, Tim; Garg, Anita; Gayda, John

2007-01-01

The industry is demanding longer term service at high temperatures for nickel-base superalloys in gas turbine engine as well as potential space applications. However, longer term service can severely tax alloy phase stability, to the potential detriment of mechanical properties. Cast Mar-M247LC and wrought Haynes 230 superalloys were exposed and creep tested for extended times at elevated temperature. Microstructure and phase evaluations were then undertaken for comparisons.

CONVEYING AN EMPATHIC UNDERSTANDING OF THE CIVILIZATION OF THE INDIAN-PAKISTANI SUBCONTINENT THROUGH THE USE OF AN INTEGRATED SERIES OF SELECT FILMS. FINAL REPORT.

ERIC Educational Resources Information Center

LEVISON, MELVIN E.

THIS PROJECT TESTED A METHOD FOR DEVELOPING "AUDIO-VISUAL LITERACY" AND, AT THE SAME TIME, AN EMPATHIC UNDERSTANDING OF ANOTHER CIVILIZATION THROUGH THE USE OF A SERIES OF SELECT FILMS. THE POPULATION CONSISTED OF 28 TEACHERS IN AN IN-SERVICE COURSE AND CLASSES LATER TAUGHT BY IN-SERVICE TRAINED TEACHERS IN FIVE SECONDARY SCHOOLS--THREE…

42 CFR 84.104 - Gas tightness test; minimum requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 84.104 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL... times respectively. Walks at 4.8 km. (3 miles) per hour 3 5 3 4 8 12 18 Sampling and readings 2 2 2 2 2 Walks at 4.8 km. (3 miles) per hour 3 5 8 12 18 Sampling and readings 2 2 2 2 2 Walks at 4.8 km. (3...

42 CFR 84.104 - Gas tightness test; minimum requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 84.104 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL... times respectively. Walks at 4.8 km. (3 miles) per hour 3 5 3 4 8 12 18 Sampling and readings 2 2 2 2 2 Walks at 4.8 km. (3 miles) per hour 3 5 8 12 18 Sampling and readings 2 2 2 2 2 Walks at 4.8 km. (3...

42 CFR Appendix - Tables to Subpart H of Part 84

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND... Sampling and readings 2 2 2 2 Perform 1 hour test 2, 3, or 4 times respectively. Walks at 4.8 km. (3 miles) per hour 3 5 3 4 8 12 18 Sampling and readings 2 2 2 2 2 Walks at 4.8 km. (3 miles) per hour 3 5 8 12...

Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis.

PubMed

Masters, Samuel H; Burstein, Roy; Amofah, George; Abaogye, Patrick; Kumar, Santosh; Hanlon, Michael

2013-09-01

Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Service dogs in the province of Quebec: sociodemographic profile of users and the dogs' impact on functional ability.

PubMed

Vincent, Claude; Gagnon, Dany; Routhier, François; Leblond, Jean; Boucher, Pascale; Blanchet, Marie; Martin-Lemoyne, Valérie

2015-03-01

The objectives of this study were to (1) describe the sociodemographic profile of service dog users, their physical disabilities, main occupations, living environment, and use of technical aids in daily life and (2) evaluate the impact of service dogs on wheelchair travel and picking up objects. Sociodemographic and clinical data were collected and various mobility tests were conducted in the service dog users' home environment (n = 199). The service dog users had injuries to the central or peripheral nervous system (55%), spinal cord (33%), or musculoskeletal or orthopedic system (12%). In the wheelchair travel on flat terrain test (n = 67), users travelled a longer distance in a shorter time, improving their average speed to 1.28 m/s with the service dog compared to 0.75 m/s without (p < 0.001). In a wheelchair propelling up a slope, 42% improved with the service dog (n = 60). Mounting a threshold/curb in a wheelchair, 41% improved with the service dog (n = 39). In a test where walkers and wheelchair users picked up three objects off the ground, 44% improved with the service dog (n = 164). Service dogs significantly improved wheelchair travel speed and distance on flat and ascending terrain, mounting a threshold/curb and picking up objects off the ground. Implications for Rehabilitation For people with motor impairments: Service dogs are most often used as a technical aid to pick up objects (96%), open doors (36%) and pull the wheelchair during travel (34%). Clients' performance in significant travel in a wheelchair (on flat terrain, on an upslope, mounting a threshold) improved with the service dog compared to their own performance without the dog. Clients' grasping performance (picking up three significant objects off the ground) improved with the service dog compared to their own performance without the dog.

Promoting father involvement in early home visiting services for vulnerable families: Findings from a pilot study of "Dads matter".

PubMed

Guterman, Neil B; Bellamy, Jennifer L; Banman, Aaron

2018-02-01

Despite mounting evidence on the importance of fathers in children's development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the "Dads Matter" enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen's d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers' involvement with the child, maltreatment indicators, and fathers' verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers' engagement in home visiting services and promoting family and child well-being. Copyright © 2017. Published by Elsevier Ltd.

iDEAS: A web-based system for dry eye assessment.

PubMed

Remeseiro, Beatriz; Barreira, Noelia; García-Resúa, Carlos; Lira, Madalena; Giráldez, María J; Yebra-Pimentel, Eva; Penedo, Manuel G

2016-07-01

Dry eye disease is a public health problem, whose multifactorial etiology challenges clinicians and researchers making necessary the collaboration between different experts and centers. The evaluation of the interference patterns observed in the tear film lipid layer is a common clinical test used for dry eye diagnosis. However, it is a time-consuming task with a high degree of intra- as well as inter-observer variability, which makes the use of a computer-based analysis system highly desirable. This work introduces iDEAS (Dry Eye Assessment System), a web-based application to support dry eye diagnosis. iDEAS provides a framework for eye care experts to collaboratively work using image-based services in a distributed environment. It is composed of three main components: the web client for user interaction, the web application server for request processing, and the service module for image analysis. Specifically, this manuscript presents two automatic services: tear film classification, which classifies an image into one interference pattern; and tear film map, which illustrates the distribution of the patterns over the entire tear film. iDEAS has been evaluated by specialists from different institutions to test its performance. Both services have been evaluated in terms of a set of performance metrics using the annotations of different experts. Note that the processing time of both services has been also measured for efficiency purposes. iDEAS is a web-based application which provides a fast, reliable environment for dry eye assessment. The system allows practitioners to share images, clinical information and automatic assessments between remote computers. Additionally, it save time for experts, diminish the inter-expert variability and can be used in both clinical and research settings. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Improving access to services and interactions with clients in Guatemala: the value of distance learning.

PubMed

Brambila, Carlos; Lopez, Felipe; Garcia-Colindres, Julio; Donis, Marco Vinicio

2005-04-01

To develop and test a distance-learning programme to improve the quality and efficiency of family planning services in Guatemala. The setting was rural family planning services in Guatemala. The study design was quasi-experimental with one intervention and one control group and with pre- and post-intervention measures. Two staff members from each of 20 randomly selected health districts were trained as leaders of the training programme. In turn, the 40 trainers trained a total of 240 service providers, under the supervision of four health area facilitators. The results were compared with 20 randomly selected control health districts. The intervention was a distance-learning programme including 40 in-class hours followed by 120 inservice practice hours spread over a 4-month period. Distinctively, the programme used a cascade approach to training, intensive supervision, and close monitoring and evaluation. Patient flow analysis was used to determine number of contacts, waiting times, and the interaction time between service providers and clients. Consultation observations were used to assess the quality and completeness of reproductive health information and services received by clients. The intervention showed a positive impact on reducing the number of contacts before the consultation and client waiting times. More complete services and better quality services were provided at intervention clinics. Some, but not all, of the study objectives were attained. The long-term impact of the intervention is as yet unknown. Distance-learning programmes are an effective methodology for training health professionals in rural areas.

First results of the EGSIEM Near Real-Time Service

NASA Astrophysics Data System (ADS)

Kvas, Andreas; Gruber, Christian; Gouweleeuw, Ben; Chen, Qiang; Poropat, Lea; Flechtner, Frank; Mayer-Gürr, Torsten; Güntner, Andreas

2017-04-01

To enable the use of GRACE and GRACE-FO earth observation data for rapid monitoring applications, the Horizon2020 funded EGSIEM (European Gravity Service for Improved Emergency Management) project has established a demonstrator for a near real-time (NRT) gravity field service. The service aims to increase the temporal resolution of mass transport products from one month to one day and to reduce the latency from currently two months to five days. This allows the monitoring of hydrological extreme events as they occur, in contrast to a 'confirmation after occurrence' as is the situation today. The service will be jointly run by GFZ (German Research Centre for Geosciences) and Graz University of Technology, with each analysis center providing an independent solution. On-line validation will be performed by the University of Luxembourg using GNSS loading. A six-month long operational test run of the service starting in April 2017 is planned, in case GRACE Quick-Look data (provided by JPL) is still available. Within this time period, daily gravity field solutions serve as input to the EGSIEM Hydrological Service, which derives flood and drought indicators to be used within DLR's Center for Satellite Based Crisis Information and the Global Flood Awareness System (GloFAS). This contribution highlights the current status of the NRT service and the results of the preparation phase. The performance of the NRT mass transport products will be shown by comparison with independent GNSS loading and ocean bottom pressure data as well as as catchment aggregated values for hydrological extreme events.

Screening for chronic obstructive pulmonary disease using spirometry: U.S. Preventive Services Task Force recommendation statement.

PubMed

2008-04-01

New U.S. Preventive Services Task Force (USPSTF) recommendation about screening for chronic obstructive pulmonary disease (COPD) using spirometry. The USPSTF weighed the benefits (prevention of > or =1 exacerbation and improvement in respiratory-related health status measures) and harms (time and effort required by both patients and the health care system, false-positive screening tests, and adverse effects of subsequent unnecessary therapy) of COPD screening identified in the accompanying review of the evidence. The USPSTF did not consider the financial costs of spirometry testing or COPD therapies. Do not screen adults for COPD using spirometry. (Grade D recommendation).

Method, apparatus and system for managing queue operations of a test bench environment

DOEpatents

Ostler, Farrell Lynn

2016-07-19

Techniques and mechanisms for performing dequeue operations for agents of a test bench environment. In an embodiment, a first group of agents are each allocated a respective ripe reservation and a second set of agents are each allocated a respective unripe reservation. Over time, queue management logic allocates respective reservations to agents and variously changes one or more such reservations from unripe to ripe. In another embodiment, an order of servicing agents allocated unripe reservations is based on relative priorities of the unripe reservations with respect to one another. An order of servicing agents allocated ripe reservations is on a first come, first served basis.

Automatic Earth observation data service based on reusable geo-processing workflow

NASA Astrophysics Data System (ADS)

Chen, Nengcheng; Di, Liping; Gong, Jianya; Yu, Genong; Min, Min

2008-12-01

A common Sensor Web data service framework for Geo-Processing Workflow (GPW) is presented as part of the NASA Sensor Web project. This framework consists of a data service node, a data processing node, a data presentation node, a Catalogue Service node and BPEL engine. An abstract model designer is used to design the top level GPW model, model instantiation service is used to generate the concrete BPEL, and the BPEL execution engine is adopted. The framework is used to generate several kinds of data: raw data from live sensors, coverage or feature data, geospatial products, or sensor maps. A scenario for an EO-1 Sensor Web data service for fire classification is used to test the feasibility of the proposed framework. The execution time and influences of the service framework are evaluated. The experiments show that this framework can improve the quality of services for sensor data retrieval and processing.

Accelerated testing of an optimized closing system for automotive fuel tank

NASA Astrophysics Data System (ADS)

Gligor, A.; Ilie, S.; Nicolae, V.; Mitran, G.

2015-11-01

Taking into account the legal prescriptions which are in force and the new regulatory requirements that will be mandatory to implement in the near future regarding testing characteristics of automotive fuel tanks, resulted the necessity to develop a new testing methodology which allows to estimate the behaviour of the closing system of automotive fuel tank over a long period of time (10-15 years). Thus, were designed and conducted accelerated tests under extreme assembling and testing conditions (high values for initial tightening torques, extreme values of temperature and pressure). In this paper are presented two of durability tests which were performed on an optimized closing system of fuel tank: (i) the test of exposure to temperature with cyclical variation and (ii) the test of continuous exposure to elevated temperature. In these experimental tests have been used main components of the closing system manufactured of two materials variants, both based on the polyoxymethylene, material that provides higher mechanical stiffness and strength in a wide temperature range, as well as showing increased resistance to the action of chemical agents and fuels. The tested sample included a total of 16 optimized locking systems, 8 of each of 2 versions of material. Over deploying the experiments were determined various parameters such as: the initial tightening torque, the tightening torque at different time points during measurements, the residual tightening torque, defects occurred in the system components (fissures, cracks, ruptures), the sealing conditions of system at the beginning and at the end of test. Based on obtained data were plotted the time evolution diagrams of considered parameter (the residual tightening torque of the system consisting of locking nut and threaded ring), in different temperature conditions, becoming possible to make pertinent assessments on the choice between the two types of materials. By conducting these tests and interpreting the obtained results, it can be created a clear picture of the capacity of closing system of fuel tank to fulfil the functional requirements following the exposure to values of testing parameters significantly above the values that may appear throughout the entire service life of the vehicle. The proposed accelerated testing method shows the main advantage of simulation in a limited time all the situations which may be encountered in a much longer period of time, namely the service life of the vehicle.

40 CFR 63.7187 - What performance tests and other compliance procedures must I use?

Code of Federal Regulations, 2013 CFR

2013-07-01

... regeneration stream mass or volumetric flow over the period of each complete carbon bed regeneration cycle, design carbon bed temperature after regeneration, design carbon bed regeneration time, and design service...

40 CFR 63.7187 - What performance tests and other compliance procedures must I use?

Code of Federal Regulations, 2011 CFR

2011-07-01

... regeneration stream mass or volumetric flow over the period of each complete carbon bed regeneration cycle, design carbon bed temperature after regeneration, design carbon bed regeneration time, and design service...

40 CFR 63.7187 - What performance tests and other compliance procedures must I use?

Code of Federal Regulations, 2012 CFR

2012-07-01

... regeneration stream mass or volumetric flow over the period of each complete carbon bed regeneration cycle, design carbon bed temperature after regeneration, design carbon bed regeneration time, and design service...

40 CFR 63.7187 - What performance tests and other compliance procedures must I use?

Code of Federal Regulations, 2014 CFR

2014-07-01

... regeneration stream mass or volumetric flow over the period of each complete carbon bed regeneration cycle, design carbon bed temperature after regeneration, design carbon bed regeneration time, and design service...

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

NASA Astrophysics Data System (ADS)

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

2014-09-01

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

Blind tests of methods for InSight Mars mission: Open scientific challenge

NASA Astrophysics Data System (ADS)

Clinton, John; Ceylan, Savas; Giardini, Domenico; Khan, Amir; van Driel, Martin; Böse, Maren; Euchner, Fabian; Garcia, Raphael F.; Drilleau, Mélanie; Lognonné, Philippe; Panning, Mark; Banerdt, Bruce

2017-04-01

The Marsquake Service (MQS) will be the ground segment service within the InSight mission to Mars, which will deploy a single seismic station on Elysium Planitia in November 2018. The main tasks of the MQS are the identification and characterisation of seismicity, and managing the Martian seismic event catalogue. In advance of the mission, we have developed a series of single station event location methods that rely on a priori 1D and 3D structural models. In coordination with the Mars Structural Service, we expect to use iterative inversion techniques to revise these structural models and event locations. In order to seek methodological advancements and test our current approaches, we have designed a blind test case using Martian synthetics combined with realistic noise models for the Martian surface. We invite all scientific parties that are interested in single station approaches and in exploring the Martian time-series to participate and contribute to our blind test. We anticipate the test will can improve currently developed location and structural inversion techniques, and also allow us explore new single station techniques for moment tensor and magnitude determination. The waveforms for our test case are computed employing AxiSEM and Instaseis for a randomly selected 1D background model and event catalogue that is statistically consistent with our current expectation of Martian seismicity. Realistic seismic surface noise is superimposed to generate a continuous time-series spanning 6 months. The event catalog includes impacts as well as Martian quakes. The temporal distribution of the seismicity in the timeseries, as well as the true structural model, are not be known to any participating parties including MQS till the end of competition. We provide our internal tools such as event location codes, suite of background models, seismic phase travel times, in order to support researchers who are willing to use/improve our current methods. Following the deadline of our blind test in late 2017, we plan to combine all outcomes in an article with all participants as co-authors.

Enhancing nurses' roles to improve quality and efficiency of non-medical cardiac stress tests.

PubMed

Bernhardt, Lizelle; Ross, Lisa; Greaves, Claire

Myocardial perfusion imaging (MPI) is a test that aids the diagnosis of coronary heart disease, of which pharmacological stress is a key component. An increase in demand had resulted in a 42 week waiting time for MPI in Leicester. This article looks at how implementing non-medically led stress tests reduced this waiting list. It discusses the obstacles involved and the measures needed to make the service a success.

Public health services knowledge and utilization among immigrants in Greece: a cross-sectional study

PubMed Central

2013-01-01

Background During the 90s, Greece has been transformed to a host country for immigrants mostly from the Balkans and Eastern European Countries, who currently constitute approximately 9% of the total population. Despite the increasing number of the immigrants, little is known about their health status and their accessibility to healthcare services. This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece. Methods A pilot cross-sectional study was conducted from January to April 2012 in Athens, Greece. The study population consisted of 191 immigrants who were living in Greece for less than 10 years. We developed a questionnaire that included information about sociodemographic characteristics, health status, public health services knowledge and utilization and difficulties in health services access. Statistical analysis included Pearson’s ×2 test, ×2 test for trend, Student’s t-test, analysis of variance and Pearson’s correlation coefficient. Results Only 20.4% of the participants reported that they had a good/very good degree of knowledge about public health services in Greece. A considerable percentage (62.3%) of the participants needed at least once to use health services but they could not afford it, during the last year, while 49.7% used public health services in the last 12 months in Greece. Among the most important problems were long waiting times in hospitals, difficulties in communication with health professionals and high cost of health care. Increased ability to speak Greek was associated with increased health services knowledge (p<0.001). Increased family monthly income was also associated with less difficulties in accessing health services (p<0.001). Conclusions The empowerment and facilitation of health care access for immigrants in Greece is necessary. Depending on the needs of the migrant population, simple measures such as comprehensive information regarding the available health services and the terms for accessibility is an important step towards enabling better access to needed services. PMID:24034077

Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

PubMed Central

Kotecha, Aachal; Baldwin, Alex; Brookes, John; Foster, Paul J

2015-01-01

Background This article describes the development of a virtual glaucoma clinic, whereby technicians collect information for remote review by a consultant specialist. Design and Methods This was a hospital-based service evaluation study. Patients suitable for the stable monitoring service (SMS) were low-risk patients with “suspect”, “early”-to-“moderate” glaucoma who were deemed stable by their consultant care team. Three technicians and one health care assistant ran the service. Patients underwent tests in a streamlined manner in a dedicated clinical facility, with virtual review of data by a consultant specialist through an electronic patient record. Main outcome measure Feasibility of developing a novel service within a UK National Health Service setting and improvement of patient journey time within the service were studied. Results Challenges to implementation of virtual clinic include staffing issues and use of information technology. Patient journey time within the SMS averaged 51 minutes, compared with 92 minutes in the glaucoma outpatient department. Patient satisfaction with the new service was high. Conclusion Implementing innovation into existing services of the National Health Service is challenging. However, the virtual clinic showed an improved patient journey time compared with that experienced within the general glaucoma outpatient department. There exists a discrepancy between patient management decisions of reviewers, suggesting that some may be more risk averse than others when managing patients seen within this model. Future work will assess the ability to detect progression of disease in this model compared with the general outpatient model of care. PMID:26508830

Develop and pilot test smart phone/tablet app for paratransit demand-response passenger pick-up alerts to assist passengers with disabilities and reduce no-shows and dwell times.

DOT National Transportation Integrated Search

2016-12-01

This research produced an arrival notification system for paratransit passengers with disabilities. Almost all existing curb-to-curb paratransit services have significantly large pick-up time window ranging from 20 to 40 minutes from the scheduled ti...

Internal Stress Monitoring of In-Service Structural Steel Members with Ultrasonic Method

PubMed Central

Li, Zuohua; He, Jingbo; Teng, Jun; Wang, Ying

2016-01-01

Internal stress in structural steel members is an important parameter for steel structures in their design, construction, and service stages. However, it is hard to measure via traditional approaches. Among the existing non-destructive testing (NDT) methods, the ultrasonic method has received the most research attention. Longitudinal critically refracted (Lcr) waves, which propagate parallel to the surface of the material within an effective depth, have shown great potential as an effective stress measurement approach. This paper presents a systematic non-destructive evaluation method to determine the internal stress in in-service structural steel members using Lcr waves. Based on theory of acoustoelasticity, a stress evaluation formula is derived. Factor of stress to acoustic time difference is used to describe the relationship between stress and measurable acoustic results. A testing facility is developed and used to demonstrate the performance of the proposed method. Two steel members are measured by using the proposed method and the traditional strain gauge method for verification. Parametric studies are performed on three steel members and the aluminum plate to investigate the factors that influence the testing results. The results show that the proposed method is effective and accurate for determining stress in in-service structural steel members. PMID:28773347

Internal Stress Monitoring of In-Service Structural Steel Members with Ultrasonic Method.

PubMed

Li, Zuohua; He, Jingbo; Teng, Jun; Wang, Ying

2016-03-23

Internal stress in structural steel members is an important parameter for steel structures in their design, construction, and service stages. However, it is hard to measure via traditional approaches. Among the existing non-destructive testing (NDT) methods, the ultrasonic method has received the most research attention. Longitudinal critically refracted (Lcr) waves, which propagate parallel to the surface of the material within an effective depth, have shown great potential as an effective stress measurement approach. This paper presents a systematic non-destructive evaluation method to determine the internal stress in in-service structural steel members using Lcr waves. Based on theory of acoustoelasticity, a stress evaluation formula is derived. Factor of stress to acoustic time difference is used to describe the relationship between stress and measurable acoustic results. A testing facility is developed and used to demonstrate the performance of the proposed method. Two steel members are measured by using the proposed method and the traditional strain gauge method for verification. Parametric studies are performed on three steel members and the aluminum plate to investigate the factors that influence the testing results. The results show that the proposed method is effective and accurate for determining stress in in-service structural steel members.

Requirements-Based Conformance Testing of ARINC 653 Real-Time Operating Systems

NASA Astrophysics Data System (ADS)

Maksimov, Andrey

2010-08-01

Requirements-based testing is emphasized in avionics certification documents because this strategy has been found to be the most effective at revealing errors. This paper describes the unified requirements-based approach to the creation of conformance test suites for mission-critical systems. The approach uses formal machine-readable specifications of requirements and finite state machine model for test sequences generation on-the-fly. The paper also presents the test system for automated test generation for ARINC 653 services built on this approach. Possible application of the presented approach to various areas of avionics embedded systems testing is discussed.

Low-Value Service Use in Provider Organizations.

PubMed

Schwartz, Aaron L; Zaslavsky, Alan M; Landon, Bruce E; Chernew, Michael E; McWilliams, J Michael

2018-02-01

To assess whether provider organizations exhibit distinct profiles of low-value service provision. 2007-2011 Medicare fee-for-service claims and enrollment data. Use of 31 services that provide minimal clinical benefit was measured for 4,039,733 beneficiaries served by 3,137 provider organizations. Variation across organizations, persistence within organizations over time, and correlations in use of different types of low-value services within organizations were estimated via multilevel modeling, with adjustment for beneficiary sociodemographic and clinical characteristics. Organizations provided 45.6 low-value services per 100 beneficiaries on average, with considerable variation across organizations (90th/10th percentile ratio, 1.78; 95 percent CI, 1.72-1.84), including substantial between-organization variation within hospital referral regions (90th/10th percentile ratio, 1.66; 95 percent CI, 1.60-1.71). Low-value service use within organizations was highly correlated over time (r, 0.98; 95 percent CI, 0.97-0.99) and positively correlated between 13 of 15 pairs of service categories (average r, 0.26; 95 percent CI, 0.24-0.28), with the greatest correlation between low-value imaging and low-value cardiovascular testing and procedures (r, 0.54). Use of low-value services in provider organizations exhibited substantial variation, high persistence, and modest consistency across service types. These findings are consistent with organizations shaping the practice patterns of affiliated physicians. © Health Research and Educational Trust.

Raven: An On-Orbit Relative Navigation Demonstration Using International Space Station Visiting Vehicles

NASA Technical Reports Server (NTRS)

Strube, Matthew; Henry, Ross; Skeleton, Eugene; Eepoel, John Van; Gill, Nat; McKenna, Reed

2015-01-01

Since the last Hubble Servicing Mission five years ago, the Satellite Servicing Capabilities Office (SSCO) at the NASA Goddard Space Flight Center (GSFC) has been focusing on maturing the technologies necessary to robotically service orbiting legacy assets-spacecraft not necessarily designed for in-flight service. Raven, SSCO's next orbital experiment to the International Space Station (ISS), is a real-time autonomous non-cooperative relative navigation system that will mature the estimation algorithms required for rendezvous and proximity operations for a satellite-servicing mission. Raven will fly as a hosted payload as part of the Space Test Program's STP-H5 mission, which will be mounted on an external ExPRESS Logistics Carrier (ELC) and will image the many visiting vehicles arriving and departing from the ISS as targets for observation. Raven will host multiple sensors: a visible camera with a variable field of view lens, a long-wave infrared camera, and a short-wave flash lidar. This sensor suite can be pointed via a two-axis gimbal to provide a wide field of regard to track the visiting vehicles as they make their approach. Various real-time vision processing algorithms will produce range, bearing, and six degree of freedom pose measurements that will be processed in a relative navigation filter to produce an optimal relative state estimate. In this overview paper, we will cover top-level requirements, experimental concept of operations, system design, and the status of Raven integration and test activities.

HIV Risk Behavior and Access to Services: What Predicts HIV Testing among Heterosexually Active Homeless Men?

ERIC Educational Resources Information Center

Wenzel, Suzanne L.; Rhoades, Harmony; Tucker, Joan S.; Golinelli, Daniela; Kennedy, David P.; Zhou, Annie; Ewing, Brett

2012-01-01

HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV…

75 FR 53314 - Determination of Regulatory Review Period for Purposes of Patent Extension; PRISTIQ

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-31

... extended for a period of up to 5 years so long as the patented item (human drug product, animal drug... periods of time: A testing phase and an approval phase. For human drug products, the testing phase begins... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-E-0084...

77 FR 26288 - Determination of Regulatory Review Period for Purposes of Patent Extension; HALAVEN

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

... extended for a period of up to 5 years so long as the patented item (human drug product, animal drug... periods of time: A testing phase and an approval phase. For human drug products, the testing phase begins... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-E-0156...

Impact of a Pharmacist-Provided Spirometry Service on Access to Results in a Primary Care Setting.

PubMed

Mueller, Lisa A; Valentino, Alexa Sevin; Clark, Aaron D; Li, Junan

2018-01-01

The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry referrals completed with results reviewed by the ordering provider. Secondary objectives evaluated differences between internal and external referrals, medication recommendations made by the pharmacist, and revenue brought in by the service. Chart reviews were completed to determine the referral completion rates between patients who received a spirometry referral before (December 2014-September 2015) and after (January 2016-October 2016) the implementation of the pharmacy-provided spirometry service. Chart reviews were also used to determine the number and completion rate among referrals for internal and external services in the postimplementation time frame. Chart reviews also assessed medication recommendations made by the pharmacist. The results demonstrate an increase in referral completion rate from 38.1% to 47.0% ( P = .08) between the pre- and postimplementation time frames. In the postimplementation time frame, there was a statistically significant difference in the percentage of referrals completed between in-house referrals and external referrals (70.0% and 40.9%, respectively, P = .0004). Comparing clinics with and without the spirometry service, there was a statistically significant difference in the total number of spirometry referrals (1.13% and 0.59%, respectively, P < .0001) and the percent of referrals completed (0.55% and 0.27%, respectively, P = .0002). The results suggest that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to the primary care provider. Additionally, the results show that there is an increased completion rate in patients who receive an internal spirometry referral, which may be due to reduced barriers in obtaining this testing. Overall, these results demonstrate that providing spirometry in the primary care setting helps to increase spirometry results obtained and could be beneficial in other primary care settings.

Treatment delays among women with breast cancer in a low socio-economic status region in Brazil.

PubMed

Alves Soares Ferreira, Naidhia; Melo Figueiredo de Carvalho, Sionara; Engrácia Valenti, Vitor; Pinheiro Bezerra, Italla Maria; Melo Teixeira Batista, Hermes; de Abreu, Luiz Carlos; Matos, Leandro Luongo; Adami, Fernando

2017-02-21

Considering the inequalities and the areas of low socioeconomic status in Brazil, access to health services is a challenge and the delay between diagnosis and treatment represents an important factor of worse prognosis in patients with breast cancer. Herein, we describe the clinical and epidemiological profiles of women with breast cancer and evaluate their access to health services, as well as treatment delays, at a reference centre of the Cariri region, Ceará, Brazil. This is a retrospective study that included 473 women treated with breast cancer between 2009 and 2011 at the Oncology Centre of the Cariri. The majority of these patients were aged between 40 and 69 years old (65.7%), without a completed high school degree (89.2%). They were married (62.9%) and were already diagnosed but had not yet been subjected to any previous treatment (77.8%). It was observed that 91.8% were referred from the public health service, and treatment was paid for by the public health service in 92.9% of the cases. The patients whose source of referral was the public system waited longer between diagnosis and the treatment initiation (p = 0.031; Mann-Whitney's test), with a median waiting time of 71.5 days versus 39 days for those receiving referrals from private services. In addition, those with public referrals prior to diagnosis also experienced a longer waiting time between the first medical visit and treatment initiation (77 days vs. 37 days; p = 0.036; Mann-Whitney's test), with the waiting time for the biopsy being an important factor in this delay. Late diagnosis was often the result of inefficiency of the prevention policies coupled with difficulty accessing the public health network. It was commonly observed that, even after diagnosis, the patients needed to wait too long before entering the Oncology Service because of long waiting queues in the public health system.

Smart Device-Supported BDS/GNSS Real-Time Kinematic Positioning for Sub-Meter-Level Accuracy in Urban Location-Based Services

PubMed Central

Wang, Liang; Li, Zishen; Zhao, Jiaojiao; Zhou, Kai; Wang, Zhiyu; Yuan, Hong

2016-01-01

Using mobile smart devices to provide urban location-based services (LBS) with sub-meter-level accuracy (around 0.5 m) is a major application field for future global navigation satellite system (GNSS) development. Real-time kinematic (RTK) positioning, which is a widely used GNSS-based positioning approach, can improve the accuracy from about 10–20 m (achieved by the standard positioning services) to about 3–5 cm based on the geodetic receivers. In using the smart devices to achieve positioning with sub-meter-level accuracy, a feasible solution of combining the low-cost GNSS module and the smart device is proposed in this work and a user-side GNSS RTK positioning software was developed from scratch based on the Android platform. Its real-time positioning performance was validated by BeiDou Navigation Satellite System/Global Positioning System (BDS/GPS) combined RTK positioning under the conditions of a static and kinematic (the velocity of the rover was 50–80 km/h) mode in a real urban environment with a SAMSUNG Galaxy A7 smartphone. The results show that the fixed-rates of ambiguity resolution (the proportion of epochs of ambiguities fixed) for BDS/GPS combined RTK in the static and kinematic tests were about 97% and 90%, respectively, and the average positioning accuracies (RMS) were better than 0.15 m (horizontal) and 0.25 m (vertical) for the static test, and 0.30 m (horizontal) and 0.45 m (vertical) for the kinematic test. PMID:28009835

An analysis of reference laboratory (send out) testing: an 8-year experience in a large academic medical center.

PubMed

MacMillan, Donna; Lewandrowski, Elizabeth; Lewandrowski, Kent

2004-01-01

Utilization of outside reference laboratories for selected laboratory testing is common in the United States. However, relatively little data exist in the literature describing the scope and impact of these services. In this study, we reviewed use of reference laboratory testing at the Massachusetts General Hospital, a large urban academic medical center in Boston, Massachusetts. A retrospective review of hospital and laboratory administrative records over an 8-year period from fiscal years (FY) 1995-2002. Over the 8 years studied, reference laboratory expenses increased 4.2-fold and totaled 12.4% of the total laboratory budget in FY 2002. Total reference laboratory test volume increased 4-fold to 68,328 tests in FY 2002 but represented only 1.06% of the total test volume in the hospital. The menu of reference laboratory tests comprised 946 tests (65.7% of the hospital test menu) compared to 494 (34.3%) of tests performed in house. The average unit cost of reference laboratory tests was essentially unchanged but was approximately 13 times greater than the average unit cost in the hospital laboratory. Much of the growth in reference laboratory cost can be attributed to the addition of new molecular, genetic, and microbiological assays. Four of the top 10 tests with the highest total cost in 2002 were molecular diagnostic tests that were recently added to the test menu. Reference laboratory testing comprises a major component of hospital clinical laboratory services. Although send out tests represent a small percentage of the total test volume, these services account for the majority of the hospital laboratory test menu and a disproportionate percentage of laboratory costs.

Timing Discrepancies of Early Intervention Hearing Services in Urban and Rural Cochlear Implant Recipients

PubMed Central

Bush, Matthew L.; Burton, Mary; Loan, Ashley; Shinn, Jennifer B.

2013-01-01

Objective The purpose of this study was to examine the timing of early intervention diagnostic and therapeutic services in cochlear implant recipients from rural and urban areas. Study design Retrospective case series review Setting Tertiary referral center Patients Cochlear implant recipients from a single comprehensive hearing institute born with severe congenital sensorineural hearing loss were examined. Timing of diagnostic and therapeutic services was examined. Intervention(s) Diagnosis, amplification, and eventual cochlear implantation for all patients in the study Main outcome measure(s) Time points of definitive diagnosis, amplification, and cochlear implantation for children from urban and rural regions were examined. Correlation analysis of distance to testing center and timing of services was also assessed. Results 40 children born with congenital hearing loss were included in the study and were diagnosed at a median age of 13 weeks after birth. Children from rural regions obtained amplification at a median age of 47.7 weeks after birth, while urban children were amplified at 26 weeks after birth. Cochlear implantation was performed at a median age of 182 weeks after birth in those from rural areas and at 104 weeks after birth in urban-dwelling patients. A linear relationship was identified between distance to the implant center and timing of hearing aid amplification (r=0.5, p=0.033) and cochlear implantation (r=0.5, p=0.016). Conclusions Children residing outside of metro areas may be at higher risk of delayed rehabilitative services and cochlear implantation than those residing in urban areas that may be closer in proximity to tertiary care centers. PMID:24136305

Tightness of hamstring- and psoas major muscles. A prospective study of back pain in young men during their military service.

PubMed

Hellsing, A L

1988-01-01

Muscular tightness and the therapeutic effect of stretching has been widely discussed during the last few years in sports training and physiotherapy. Within a prospective study of back function and pain before and after compulsory military service, tightness of hamstring- and psoas muscles was assessed. Around 600 young men were examined three times over a period of four years. Tight hamstring muscles were found to be very common in this group. Only 43% of the right and 35% of the left legs reached an angle of at least 80 degrees from the couch during the straight-leg-raising test (Lasegue's test). The test of muscular tightness showed a significant test-retest reliability over all examinations. Tight hamstring- or psoas muscles could not be shown to correlate to current back pain or to the incidence of back pain during the follow-up period.

One network metric datastore to track them all: the OSG network metric service

NASA Astrophysics Data System (ADS)

Quick, Robert; Babik, Marian; Fajardo, Edgar M.; Gross, Kyle; Hayashi, Soichi; Krenz, Marina; Lee, Thomas; McKee, Shawn; Pipes, Christopher; Teige, Scott

2017-10-01

The Open Science Grid (OSG) relies upon the network as a critical part of the distributed infrastructures it enables. In 2012, OSG added a new focus area in networking with a goal of becoming the primary source of network information for its members and collaborators. This includes gathering, organizing, and providing network metrics to guarantee effective network usage and prompt detection and resolution of any network issues, including connection failures, congestion, and traffic routing. In September of 2015, this service was deployed into the OSG production environment. We will report on the creation, implementation, testing, and deployment of the OSG Networking Service. Starting from organizing the deployment of perfSONAR toolkits within OSG and its partners, to the challenges of orchestrating regular testing between sites, to reliably gathering the resulting network metrics and making them available for users, virtual organizations, and higher level services, all aspects of implementation will be reviewed. In particular, several higher-level services were developed to bring the OSG network service to its full potential. These include a web-based mesh configuration system, which allows central scheduling and management of all the network tests performed by the instances; a set of probes to continually gather metrics from the remote instances and publish it to different sources; a central network datastore (esmond), which provides interfaces to access the network monitoring information in close to real time and historically (up to a year) giving the state of the tests; and a perfSONAR infrastructure monitor system, ensuring the current perfSONAR instances are correctly configured and operating as intended. We will also describe the challenges we encountered in ongoing operations of the network service and how we have evolved our procedures to address those challenges. Finally we will describe our plans for future extensions and improvements to the service.

Differences in Routine Laboratory Ordering Between a Teaching Service and a Hospitalist Service at a Single Academic Medical Center.

PubMed

Ellenbogen, Michael I; Ma, Madeleine; Christensen, Nicholas P; Lee, Jungwha; O'Leary, Kevin J

2017-01-01

Studies have shown that the overutilization of laboratory tests ("labs") for hospitalized patients is common and can cause adverse health outcomes. Our objective was to compare the ordering tendencies for routine complete blood counts (CBC) and chemistry panels by internal medicine residents and hospitalists. This observational study included a survey of medicine residents and hospitalists and a retrospective analysis of labs ordering data. The retrospective data analysis comprised patients admitted to either the teaching service or nonteaching hospitalist service at a single hospital during 2014. The survey asked residents and hospitalists about their practices and preferences on labs ordering. The frequency and timing of one-time and daily CBC and basic chemistry panel ordering for teaching service and hospitalist patients were obtained from our data warehouse. The average number of CBCs per patient per day and chemistry panels per patient per day was calculated for both services and multivariate regression was performed to control for patient characteristics. Forty-four of 120 (37%) residents and 41 of 53 (77%) hospitalists responded to the survey. Forty-four (100%) residents reported ordering a daily CBC and chemistry panel rather than one-time labs at patient admission compared with 22 (54%) hospitalists ( P < 0.001). For CBCs, teaching service patients averaged 1.72/day and hospitalist service patients averaged 1.43/day ( P < 0.001). For basic chemistry panels, teaching service patients averaged 1.96/day and hospitalist service patients averaged 1.78/day ( P < 0.001). Results were similar in multivariate regression models adjusting for patient characteristics. Residents' self-reported and actual use of CBCs and chemistry panels is significantly higher than that of hospitalists in the same hospital. Our results reveal an opportunity for greater supervision and improved instruction of cost-conscious ordering practices.

Design, construction and testing of the Neal Bridge in Pittsfield, Maine.

DOT National Transportation Integrated Search

2009-10-01

Highway bridges in the US are quickly becoming deficient due to increasing traffic volumes, rapid : deterioration, extended service life, and increasing load requirements. Repair or replacement of deficient : structures is expensive, time and labor i...

On-time reliability impacts of advanced traveler information services (ATIS) : Washington, DC case study

DOT National Transportation Integrated Search

1998-09-01

Emissions Management Using ITS Technology report summarizes and interprets the results of three Intelligent Transportation Systems (ITS) Field Operational Tests (FOTs) that evaluated the use of emerging technologies to help authorities measure emissi...

Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe.

PubMed

Rhead, Rebecca; Elmes, Jocelyn; Otobo, Eloghene; Nhongo, Kundai; Takaruza, Albert; White, Peter J; Nyamukapa, Constance Anesu; Gregson, Simon

2018-02-28

Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake. Data from a household survey conducted in 2009-2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression. HIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02-2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03-5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs' greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy. FSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs' need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake. © 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.

Personalized Location-Based Recommendation Services for Tour Planning in Mobile Tourism Applications

NASA Astrophysics Data System (ADS)

Yu, Chien-Chih; Chang, Hsiao-Ping

Travel and tour planning is a process of searching, selecting, grouping and sequencing destination related products and services including attractions, accommodations, restaurants, and activities. Personalized recommendation services aim at suggesting products and services to meet users’ preferences and needs, while location-based services focus on providing information based on users’ current positions. Due to the fast growing of user needs in the mobile tourism domain, how to provide personalized location-based tour recommendation services becomes a critical research and practical issue. The objective of this paper is to propose a system architecture and design methods for facilitating the delivery of location-based recommendation services to support personalized tour planning. Based on tourists’ current location and time, as well as personal preferences and needs, various recommendations regarding sightseeing spots, hotels, restaurants, and packaged tour plans can be generated efficiently. An application prototype is also implemented to illustrate and test the system feasibility and effectiveness.

The Increased Effectiveness of HIV Preventive Intervention among Men Who Have Sex with Men and of Follow-Up Care for People Living with HIV after ‘Task-Shifting’ to Community-Based Organizations: A ‘Cash on Service Delivery’ Model in China

PubMed Central

Yan, Hongjing; Zhang, Min; Zhao, Jinkou; Huan, Xiping; Ding, Jianping; Wu, Susu; Wang, Chenchen; Xu, Yuanyuan; Liu, Li; Xu, Fei; Yang, Haitao

2014-01-01

Background A large number of men who have sex with men (MSM) and people living with HIV/AIDS (PLHA) are underserved despite increased service availability from government facilities while many community based organizations (CBOs) are not involved. We aimed to assess the feasibility and effectiveness of the task shifting from government facilities to CBOs in China. Methods HIV preventive intervention for MSM and follow-up care for PLHA were shifted from government facilities to CBOs. Based on ‘cash on service delivery’ model, 10 USD per MSM tested for HIV with results notified, 82 USD per newly HIV cases diagnosed, and 50 USD per PLHA received a defined package of follow-up care services, were paid to the CBOs. Cash payments were made biannually based on the verified results in the national web-based HIV/AIDS information system. Findings After task shifting, CBOs gradually assumed preventive intervention for MSM and follow-up care for PLHA from 2008 to 2012. HIV testing coverage among MSM increased from 4.1% in 2008 to 22.7% in 2012. The baseline median CD4 counts of newly diagnosed HIV positive MSM increased from 309 to 397 cells/µL. HIV tests among MSM by CBOs accounted for less than 1% of the total HIV tests in Nanjing but the share of HIV cases detected by CBOs was 12.4% in 2008 and 43.6% in 2012. Unit cost per HIV case detected by CBOs was 47 times lower than that by government facilities. The coverage of CD4 tests and antiretroviral therapy increased from 71.1% and 78.6% in 2008 to 86.0% and 90.1% in 2012, respectively. Conclusion It is feasible to shift essential HIV services from government facilities to CBOs, and to verify independently service results to adopt ‘cash on service delivery’ model. Services provided by CBOs are cost-effective, as compared with that by government facilities. PMID:25050797

Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System.

PubMed

Landi, Stefano; Ivaldi, Enrico; Testi, Angela

2018-04-01

In the absence of priority criteria, waiting times are an implicit rationing instrument where the absence or limited use of prices creates an excess of demand. Even in the presence of priority criteria, waiting times may be unfair because they reduce health care demand of patients in lower socio-economic conditions due to high opportunity costs of time or a decay in their health level. Significant evidence has shown a relationship between socioeconomic status and the length of waiting time. The first phase of the study involved an extensive review of the existent literature for the period of 2002-2016 in the main databases (Scopus, PubMed and Science Direct). Twenty-eight met the eligibility criteria. The 27 papers were described and classified. The e mpirical objective of this study was to determine whether socioeconomic characteristics affect waiting time for different health services in the Italian national health system. The services studied were specialist visits, diagnostics tests and elective surgeries. A classification tree and logistic regression models were implemented. Data from the 2013 Italian Health National Survey were used. The analysis found heterogeneous results for different types of service. Individuals with lower education and economic resources have a higher risk of experiencing excessive waiting times for diagnostic and specialist visits. For elective surgery, socioeconomic inequalities are present but appear to be lower. Copyright © 2018 Elsevier B.V. All rights reserved.

Impact of deploying multiple point-of-care tests with a 'sample first' approach on a sexual health clinical care pathway. A service evaluation.

PubMed

Harding-Esch, Emma M; Nori, Achyuta V; Hegazi, Aseel; Pond, Marcus J; Okolo, Olanike; Nardone, Anthony; Lowndes, Catherine M; Hay, Phillip; Sadiq, S Tariq

2017-09-01

To assess clinical service value of STI point-of-care test (POCT) use in a 'sample first' clinical pathway (patients providing samples on arrival at clinic, before clinician consultation). Specific outcomes were: patient acceptability; whether a rapid nucleic acid amplification test (NAAT) for Chlamydia trachomatis/Neisseria gonorrhoeae (CT/NG) could be used as a POCT in practice; feasibility of non-NAAT POCT implementation for Trichomonas vaginalis (TV) and bacterial vaginosis (BV); impact on patient diagnosis and treatment. Service evaluation in a south London sexual health clinic. Symptomatic female and male patients and sexual contacts of CT/NG-positive individuals provided samples for diagnostic testing on clinic arrival, prior to clinical consultation. Tests included routine culture and microscopy; CT/NG (GeneXpert) NAAT; non-NAAT POCTs for TV and BV. All 70 (35 males, 35 females) patients approached participated. The 'sample first' pathway was acceptable, with >90% reporting they were happy to give samples on arrival and receive results in the same visit. Non-NAAT POCT results were available for all patients prior to leaving clinic; rapid CT/NG results were available for only 21.4% (15/70; 5 males, 10 females) of patients prior to leaving clinic. Known negative CT/NG results led to two females avoiding presumptive treatment, and one male receiving treatment directed at possible Mycoplasma genitalium infection causing non-gonococcal urethritis. Non-NAAT POCTs detected more positives than routine microscopy (TV 3 vs 2; BV 24 vs 7), resulting in more patients receiving treatment. A 'sample first' clinical pathway to enable multiple POCT use was acceptable to patients and feasible in a busy sexual health clinic, but rapid CT/NG processing time was too long to enable POCT use. There is need for further development to improve test processing times to enable POC use of rapid NAATs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Service quality framework for clinical laboratories.

PubMed

Ramessur, Vinaysing; Hurreeram, Dinesh Kumar; Maistry, Kaylasson

2015-01-01

The purpose of this paper is to illustrate a service quality framework that enhances service delivery in clinical laboratories by gauging medical practitioner satisfaction and by providing avenues for continuous improvement. The case study method has been used for conducting the exploratory study, with focus on the Mauritian public clinical laboratory. A structured questionnaire based on the SERVQUAL service quality model was used for data collection, analysis and for the development of the service quality framework. The study confirms the pertinence of the following service quality dimensions within the context of clinical laboratories: tangibility, reliability, responsiveness, turnaround time, technology, test reports, communication and laboratory staff attitude and behaviour. The service quality framework developed, termed LabSERV, is vital for clinical laboratories in the search for improving service delivery to medical practitioners. This is a pioneering work carried out in the clinical laboratory sector in Mauritius. Medical practitioner expectations and perceptions have been simultaneously considered to generate a novel service quality framework for clinical laboratories.

The effect of an occupational therapy mental health day treatment centre on the use of inpatient services in the Western Cape, South Africa.

PubMed

Engelbrecht, Riekie; Plastow, Nicola; Botha, Ulla; Niehaus, Djh; Koen, Liezl

2018-04-27

The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in South Africa. A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24 months before and after attendance at the centre, using the hospital's electronic records. Total population sampling yielded data for 44 mental health care users who made first contact with the service between July 2009 and June 2010. Data were compared using the Kruskal-Wallis test, Wilcoxon Signed Ranks test and Mann-Whitney U test. There was a significant decrease in the number of admissions (z = -4.093, p = 0.00) and the number of days spent in hospital (z = -4.730, p = 0.00). Participants were admitted to psychiatric care 33 times less in the 24 months' post-intervention, indicating a medium effect (r = 0.436). They also spend 2569 days less in hospital, indicating a large effect (r = 0.504). The findings suggest that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa. Implications for Rehabilitation Attendance at an occupational therapy-led community day treatment centre decreases the number of admissions and number of days spent in hospital and is therefore beneficial to mental health care users and service providers. The study indicates that the successful implementation of a community day treatment centre for mental health care users on the grounds of a tertiary hospital by utilising existing resources is possible.

Influence of diurnal variation and fasting on serum iron concentrations in a community-based population.

PubMed

Nguyen, Leonard T; Buse, Joshua D; Baskin, Leland; Sadrzadeh, S M Hossein; Naugler, Christopher

2017-12-01

Serum iron is an important clinical test to help identify cases of iron deficiency or overload. Fluctuations caused by diurnal variation and diet are thought to influence test results, which may affect clinical patient management. We examined the impact of these preanalytical factors on iron concentrations in a large community-based cohort. Serum iron concentration, blood collection time, fasting duration, patient age and sex were obtained for community-based clinical testing from the Laboratory Information Service at Calgary Laboratory Services for the period of January 2011 to December 2015. A total of 276,307 individual test results were obtained. Iron levels were relatively high over a long period from 8:00 to 15:00. Mean concentrations were highest at blood collection times of 11:00 for adult men and 12:00 for adult women and children, however iron levels peaked as late as 15:00 in teenagers. With regard to fasting, iron levels required approximately 5h post-prandial time to return to a baseline, except for children and teenage females where no significant variation was seen until after 11h fasting. After 10h fasting, iron concentrations in all patient groups gradually increased to higher levels compared to earlier fasting times. Serum iron concentrations remain reasonably stable during most daytime hours for testing purposes. In adults, blood collection after 5 to 9h fasting provides a representative estimate of a patient's iron levels. For patients who have fasted overnight, i.e. ≥12h fasting, clinicians should be aware that iron concentrations may be elevated beyond otherwise usual levels. Copyright © 2017. Published by Elsevier Inc.

Data as a Service: A Seismic Web Service Pipeline

NASA Astrophysics Data System (ADS)

Martinez, E.

2016-12-01

Publishing data as a service pipeline provides an improved, dynamic approach over static data archives. A service pipeline is a collection of micro web services that each perform a specific task and expose the results of that task. Structured request/response formats allow micro web services to be chained together into a service pipeline to provide more complex results. The U.S. Geological Survey adopted service pipelines to publish seismic hazard and design data supporting both specific and generalized audiences. The seismic web service pipeline starts at source data and exposes probability and deterministic hazard curves, response spectra, risk-targeted ground motions, and seismic design provision metadata. This pipeline supports public/private organizations and individual engineers/researchers. Publishing data as a service pipeline provides a variety of benefits. Exposing the component services enables advanced users to inspect or use the data at each processing step. Exposing a composite service enables new users quick access to published data with a very low barrier to entry. Advanced users may re-use micro web services by chaining them in new ways or injecting new micros services into the pipeline. This allows the user to test hypothesis and compare their results to published results. Exposing data at each step in the pipeline enables users to review and validate the data and process more quickly and accurately. Making the source code open source, per USGS policy, further enables this transparency. Each micro service may be scaled independent of any other micro service. This ensures data remains available and timely in a cost-effective manner regardless of load. Additionally, if a new or more efficient approach to processing the data is discovered, this new approach may replace the old approach at any time, keeping the pipeline running while not affecting other micro services.

Valuing Attributes of Home Palliative Care With Service Users: A Pilot Discrete Choice Experiment.

PubMed

Gomes, Barbara; de Brito, Maja; Sarmento, Vera P; Yi, Deokhee; Soares, Duarte; Fernandes, Jacinta; Fonseca, Bruno; Gonçalves, Edna; Ferreira, Pedro L; Higginson, Irene J

2017-12-01

Discrete choice experiment (DCE) is a quantitative method that helps determine which service attributes are most valued by people and consequently improve their well-being. The objective of this study was to test a new DCE on home palliative care (HPC). Cross-sectional survey using the DCE method with adult patients and their family caregivers, users of three HPC services in Portugal. Service attributes were based on a Cochrane review, a meta-ethnography, and the few existing DCEs on HPC: 1) team's availability, 2) support for family caregivers, 3) homecare support, 4) information and planning, and 5) waiting time. The experimental design consisted in three blocks of eight choice sets where participants chose between two service alternatives that combined different levels of each attribute. We piloted the DCE using cognitive interviewing. Interviews were analyzed for difficulties using Tourangeau's model of information processing. The DCE was conducted with 21 participants of 37 eligible (10 patients with median Palliative Performance Scale score = 45, 11 caregivers). Most participants found the DCE easy (median 2 from 1 to 5), although two patients did not finish the exercise. Key difficulties related to comprehension (e.g., waiting time sometimes understood as response time for visit instead of time from referral to care start) and judgment (e.g., indecision due to similar service alternatives). The DCE method is feasible and acceptable but not all patients are able to participate. In the main study phase, we will give more attention to the explanation of the waiting time attribute. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Multi-Time Step Service Restoration for Advanced Distribution Systems and Microgrids

DOE PAGES

Chen, Bo; Chen, Chen; Wang, Jianhui; ...

2017-07-07

Modern power systems are facing increased risk of disasters that can cause extended outages. The presence of remote control switches (RCSs), distributed generators (DGs), and energy storage systems (ESS) provides both challenges and opportunities for developing post-fault service restoration methodologies. Inter-temporal constraints of DGs, ESS, and loads under cold load pickup (CLPU) conditions impose extra complexity on problem formulation and solution. In this paper, a multi-time step service restoration methodology is proposed to optimally generate a sequence of control actions for controllable switches, ESSs, and dispatchable DGs to assist the system operator with decision making. The restoration sequence is determinedmore » to minimize the unserved customers by energizing the system step by step without violating operational constraints at each time step. The proposed methodology is formulated as a mixed-integer linear programming (MILP) model and can adapt to various operation conditions. Furthermore, the proposed method is validated through several case studies that are performed on modified IEEE 13-node and IEEE 123-node test feeders.« less

Multi-Time Step Service Restoration for Advanced Distribution Systems and Microgrids

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

Chen, Bo; Chen, Chen; Wang, Jianhui

Modern power systems are facing increased risk of disasters that can cause extended outages. The presence of remote control switches (RCSs), distributed generators (DGs), and energy storage systems (ESS) provides both challenges and opportunities for developing post-fault service restoration methodologies. Inter-temporal constraints of DGs, ESS, and loads under cold load pickup (CLPU) conditions impose extra complexity on problem formulation and solution. In this paper, a multi-time step service restoration methodology is proposed to optimally generate a sequence of control actions for controllable switches, ESSs, and dispatchable DGs to assist the system operator with decision making. The restoration sequence is determinedmore » to minimize the unserved customers by energizing the system step by step without violating operational constraints at each time step. The proposed methodology is formulated as a mixed-integer linear programming (MILP) model and can adapt to various operation conditions. Furthermore, the proposed method is validated through several case studies that are performed on modified IEEE 13-node and IEEE 123-node test feeders.« less

Effect of plot and sample size on timing and precision of urban forest assessments

Treesearch

David J. Nowak; Jeffrey T. Walton; Jack C. Stevens; Daniel E. Crane; Robert E. Hoehn

2008-01-01

Accurate field data can be used to assess ecosystem services from trees and to improve urban forest management, yet little is known about the optimization of field data collection in the urban environment. Various field and Geographic Information System (GIS) tests were performed to help understand how time costs and precision of tree population estimates change with...

Facilitating Democracy in a Testing Culture: Challenges and Opportunities for School Leaders

ERIC Educational Resources Information Center

Bergmark, Ulrika; Salopek, Michelle; Kawai, Roi; Lane-Myler, Jennifer

2014-01-01

In 2010, Principal Kirk introduced Small Group Meeting (SGM) at Hillcrest Elementary. SGMs are multiage student groupings who meet with school faculty once a month to work on community building, service-learning projects, and advising. Many teachers liked the SGMs, some felt they needed more time to prepare, and others felt it was a waste of time.…

Budget Issues: Effective Oversight and Budget Discipline Are Essential--Even in a Time of Surplus

DTIC Science & Technology

2000-02-01

substantial benefit from USDA’s food safety inspection and testing services.18 In 1997, the Congress created Medicare+Choice to encourage wider availability...quality of the nation’s food is inefficient and outdated. Within USDA, the Food Safety and Inspection Service (FSIS) is responsible for the safety of...FDA, and 10 other federal agencies administer over 35 different laws that oversee food safety . The current food safety system suffers from

Atlanta congestion reduction demonstration. National evaluation : travel demand management (TDM) data test plan.

DOT National Transportation Integrated Search

2001-01-01

Internet-based Advanced Traveler Information Services (ATIS) provide the urban traveler with estimated travel times based on current roadway congestion. Survey research indicates that the vast majority of current ATIS users are satisfied consumers wh...

[Descriptive analysis of work and trends in anaesthesiology from 2005 to 2006: quantitative and qualitative aspects of effects and evaluation of anaesthesia].

PubMed

Majstorović, Branislava M; Simić, Snezana; Milaković, Branko D; Vucović, Dragan S; Aleksić, Valentina V

2010-01-01

In anaesthesiology, economic aspects have been insufficiently studied. The aim of this paper was the assessment of rational choice of the anaesthesiological services based on the analysis of the scope, distribution, trend and cost. The costs of anaesthesiological services were counted based on "unit" prices from the Republic Health Insurance Fund. Data were analysed by methods of descriptive statistics and statistical significance was tested by Student's t-test and chi2-test. The number of general anaesthesia was higher and average time of general anaesthesia was shorter, without statistical significance (t-test, p = 0.436) during 2006 compared to the previous year. Local anaesthesia was significantly higher (chi2-test, p = 0.001) in relation to planned operation in emergency surgery. The analysis of total anaesthesiological procedures revealed that a number of procedures significantly increased in ENT and MFH surgery, and ophthalmology, while some reduction was observed in general surgery, orthopaedics and trauma surgery and cardiovascular surgery (chi2-test, p = 0.000). The number of analgesia was higher than other procedures (chi2-test, p = 0.000). The structure of the cost was 24% in neurosurgery, 16% in digestive (general) surgery,14% in gynaecology and obstetrics, 13% in cardiovascular surgery and 9% in emergency room. Anaesthesiological services costs were the highest in neurosurgery, due to the length anaesthesia, and digestive surgery due to the total number of general anaesthesia performed. It is important to implement pharmacoeconomic studies in all departments, and to separate the anaesthesia services for emergency and planned operations. Disproportions between the number of anaesthesia, surgery interventions and the number of patients in surgical departments gives reason to design relation database.

Motivators and barriers to HIV testing among street-based female sex workers in St. Petersburg, Russia.

PubMed

King, Elizabeth J; Maman, Suzanne; Dudina, Victoria I; Moracco, Kathryn E; Bowling, J Michael

2017-07-01

Female sex workers are particularly susceptible to HIV-infection in Russia. However, a dearth of information exists on their utilisation of HIV services. A mixed-methods, cross-sectional study was conducted to examine motivators and barriers to HIV testing among street-based sex workers in St. Petersburg, Russia. The health belief model was the theoretical framework for the study. Twenty-nine sex workers participated in in-depth interviews, and 139 sex workers completed interviewer-administered surveys between February and September 2009. Barriers to getting an HIV test were fear of learning the results, worrying that other people would think they were sick, and the distance needed to travel to obtain services. Motivators for getting tested were protecting others from infection, wanting to know one's status and getting treatment if diagnosed. Logistic regression analysis demonstrated that knowing people living with HIV [aOR = 6.75, 95% CI (1.11, 41.10)] and length of time since start of injection drug use [aOR = 0.30, 95% CI (0.09, 0.97)] were significantly associated with recently getting tested. These results are important to consider when developing public health interventions to help female sex workers in Russia learn their HIV status and get linked to care and treatment services if needed.

An active monitoring method for flood events

NASA Astrophysics Data System (ADS)

Chen, Zeqiang; Chen, Nengcheng; Du, Wenying; Gong, Jianya

2018-07-01

Timely and active detecting and monitoring of a flood event are critical for a quick response, effective decision-making and disaster reduction. To achieve the purpose, this paper proposes an active service framework for flood monitoring based on Sensor Web services and an active model for the concrete implementation of the active service framework. The framework consists of two core components-active warning and active planning. The active warning component is based on a publish-subscribe mechanism implemented by the Sensor Event Service. The active planning component employs the Sensor Planning Service to control the execution of the schemes and models and plans the model input data. The active model, called SMDSA, defines the quantitative calculation method for five elements, scheme, model, data, sensor, and auxiliary information, as well as their associations. Experimental monitoring of the Liangzi Lake flood in the summer of 2010 is conducted to test the proposed framework and model. The results show that 1) the proposed active service framework is efficient for timely and automated flood monitoring. 2) The active model, SMDSA, is a quantitative calculation method used to monitor floods from manual intervention to automatic computation. 3) As much preliminary work as possible should be done to take full advantage of the active service framework and the active model.

Patients satisfaction with laboratory services at antiretroviral therapy clinics in public hospitals, Addis Ababa, Ethiopia.

PubMed

Mindaye, Tedla; Taye, Bineyam

2012-07-04

Despite the fact that Ethiopia has scale up antiretroviral treatment (ART) program, little is known about the patient satisfaction with ART monitoring laboratory services in health facilities. We therefore aimed to assess patient satisfaction with laboratory services at ART clinics in public hospitals. Hospital based, descriptive cross sectional study was conducted from October to November 2010 among clients attending in nine public hospitals ART clinics in Addis Ababa Ethiopia. Patients' satisfaction towards laboratory services was assessed using exit interview structured questionnaire. Data were coded and entered using EPI info 2002 (Centers for Disease Control and Prevention Atlanta, GA) and analyzed using SPSS version 15 software (SPSS INC, Chicago, IL, USA). A total of 406 clients were involved in the study. Of these 255(62.8%) were females. The overall satisfaction rate for ART monitoring laboratory services was (85.5%). Patients were satisfied with measures taken by health care providers to keep confidentiality and ability of the person drawing blood to answer question (98.3% and 96.3% respectively). Moreover, the finding of this study revealed, statistical significant associations between the overall patients' satisfaction with waiting time to get blood drawing service, availability of ordered laboratory tests and waiting time to get laboratory result with (p < 0.05). Patients receiving blood drawing service less than 30 minute were 7.59 times (95% CI AOR: 3.92-14.70) to be more satisfied with ART monitoring laboratory services compared to those who underwent for more than 30 minutes. Overall, the satisfaction survey showed, most respondents were satisfied with ART monitoring laboratory services. However, factors such as improving accessibility and availability of latrines should be taken into consideration in order to improve the overall satisfaction.

Baseline data for evaluating development trajectory and provision of ecosystem services of created fringing oyster reefs in Vermilion Bay, Louisiana

USGS Publications Warehouse

La Peyre, Megan K.; Schwarting, Lindsay; Miller, Shea

2013-01-01

Understanding the time frame in which ecosystem services (that is, water quality maintenance, shoreline protection, habitat provision) are expected to be provided is important when restoration projects are being designed and implemented. Restoration of three-dimensional shell habitats in coastal Louisiana and elsewhere presents a valuable and potentially self-sustaining approach to providing shoreline protection, enhancing nekton habitat, and providing water quality maintenance. As with most restoration projects, the development of expected different ecosystem services often occurs over varying time frames, with some services provided immediately and others taking longer to develop. This project was designed initially to compare the provision and development of ecosystem services by created fringing shoreline reefs in subtidal and intertidal environments in Vermilion Bay, Louisiana. Specifically, the goal was to test the null hypothesis that over time, the oyster recruitment and development of a sustainable oyster reef community would be similar at both intertidal and subtidal reef bases, and these sustainable reefs would in time provide similar shoreline stabilization, nekton habitat, and water quality services over similar time frames. Because the ecosystem services hypothesized to be provided by oyster reefs reflect long-term processes, fully testing the above-stated null hypothesis requires a longer-time frame than this project allowed. As such, this project was designed to provide the initial data on reef development and provision of ecosystem services, to identify services that may develop immediately, and to provide baseline data to allow for longer-term follow up studies tracking reef development over time. Unfortunately, these initially created reef bases (subtidal, intertidal) were not constructed as planned because of the Deepwater Horizon oil spill in April 2010, which resulted in reef duplicates being created 6 months apart. Further confounding the project were additional construction and restoration projects along the same shorelines which occurred between 2011 and June 2012. Because of constant activity near and around the reefs and continuing construction, development trajectories could not be compared among reef types at this time. This report presents the data collected at the sites over 3 years (2010–2012), describing only conditions and trends. In addition, these data provide an extensive and detailed dataset documenting initial conditions and initial ecosystem changes which will prove valuable in future data collection and analyses of reef development at this site. Data collection characterized the local water quality conditions (salinity, temperature, total suspended sediments, dissolved oxygen, chlorophyll a), adjacent marsh vegetation, soils, and shoreline position along the project shoreline at Vermilion Bay. During the study, marsh vegetation and soil characteristics were similar across the study area and did not change over time. Shoreline movement indicated shoreline loss at all sites, which varied by reefs. Water quality conditions followed expected seasonal patterns for this region, and no significant nonseasonal changes were measured throughout the study period. Despite oyster recruitment in fall 2010 and 2011, few if any oysters survived from the 2010 year class to 2012. At the last sampling of this project, some oysters recruited in fall 2011 survived through 2012, resulting in an on-reef density of 18.3 ± 2.1 individuals per square meter (mean size: 85.6 ± 2.2 millimeters). Because project goals were to compare reef development and provision of ecosystem services over time, as well as many of the processes identified for monitoring reflect long-term processes, results and data are presented only qualitatively, and trends or observations should be interpreted cautiously at this point. Measurable system responses to reef establishment require more time than was available for this study. These data provide a valuable baseline that can be ultimately used to help inform site selections for future restoration projects as well to further investigate the development trajectories of ecosystem provision of created reefs in this region.

Meeting Postpartum Women’s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda

PubMed Central

Dulli, Lisa S; Eichleay, Marga; Rademacher, Kate; Sortijas, Steve; Nsengiyumva, Théophile

2016-01-01

ABSTRACT Objective The primary objective of this study was to test the effectiveness of integrating family planning service components into infant immunization services to increase modern contraceptive method use among postpartum women. Methods The study was a separate sample, parallel, cluster-randomized controlled trial. Fourteen randomly selected primary health facilities were equally allocated to intervention (integrated family planning and immunization services at the same time and location) and control groups (standard immunization services only). At baseline (May–June 2010), we interviewed postpartum women attending immunization services for their infant aged 6 to 12 months using a structured questionnaire. A separate sample of postpartum women was interviewed 16 months later after implementation of the experimental health service intervention. We used linear mixed regression models to test the study hypothesis that postpartum women attending immunization services for their infants aged 6–12 months in the intervention facilities will be more likely to use a modern contraceptive method than postpartum women attending immunization services for their infants aged 6–12 months in control group facilities. Results We interviewed and analyzed data for 825 women from the intervention group and 829 women from the control group. Results showed the intervention had a statistically significant, positive effect on modern contraceptive method use among intervention group participants compared with control group participants (regression coefficient, 0.15; 90% confidence interval [CI], 0.04 to 0.26). Although we conducted a 1-sided significance test, this effect was also significant at the 2-sided test with alpha = .05. Among those women who did not initiate a contraceptive method, awaiting the return of menses was the most common reason cited for non-use of a method. Women in both study groups overwhelmingly supported the concept of integrating family planning service components into infant immunization services (97.9% in each group), and service data collected during the intervention period did not indicate that the intervention had any negative effect on infant immunization service uptake. Conclusion Integrating family planning service components into infant immunization services can be an acceptable and effective strategy to increase contraceptive use among postpartum women. Additional research is needed to examine the extent to which this integration strategy can be replicated in other health care settings. Future research should also explore persistent misconceptions regarding the relationship between return of menses and return to fertility during the postpartum period. PMID:27016545

Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ)

PubMed Central

Tan, Christine L.; Hassali, Mohamed A.; Saleem, Fahad; Shafie, Asrul A.; Aljadhey, Hisham; Gan, Vincent B.

2015-01-01

Objective: (i) To develop the Pharmacy Value-Added Services Questionnaire (PVASQ) using emerging themes generated from interviews. (ii) To establish reliability and validity of questionnaire instrument. Methods: Using an extended Theory of Planned Behavior as the theoretical model, face-to-face interviews generated salient beliefs of pharmacy value-added services. The PVASQ was constructed initially in English incorporating important themes and later translated into the Malay language with forward and backward translation. Intention (INT) to adopt pharmacy value-added services is predicted by attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), knowledge and expectations. Using a 7-point Likert-type scale and a dichotomous scale, test-retest reliability (N=25) was assessed by administrating the questionnaire instrument twice at an interval of one week apart. Internal consistency was measured by Cronbach’s alpha and construct validity between two administrations was assessed using the kappa statistic and the intraclass correlation coefficient (ICC). Confirmatory Factor Analysis, CFA (N=410) was conducted to assess construct validity of the PVASQ. Results: The kappa coefficients indicate a moderate to almost perfect strength of agreement between test and retest. The ICC for all scales tested for intra-rater (test-retest) reliability was good. The overall Cronbach’ s alpha (N=25) is 0.912 and 0.908 for the two time points. The result of CFA (N=410) showed most items loaded strongly and correctly into corresponding factors. Only one item was eliminated. Conclusions: This study is the first to develop and establish the reliability and validity of the Pharmacy Value-Added Services Questionnaire instrument using the Theory of Planned Behavior as the theoretical model. The translated Malay language version of PVASQ is reliable and valid to predict Malaysian patients’ intention to adopt pharmacy value-added services to collect partial medicine supply. PMID:26445622

Methadone Maintenance Treatment Promotes Referral and Uptake of HIV Testing and Counselling Services amongst Drug Users and Their Partners

PubMed Central

Nguyen, Lan Phuong; Nguyen, Cuong Tat; Phan, Huong Thi Thu; Latkin, Carl A.

2016-01-01

Background Methadone maintenance treatment (MMT) reduces HIV risk behaviors and improves access to HIV-related services among drug users. In this study, we assessed the uptake and willingness of MMT patients to refer HIV testing and counseling (HTC) service to their sexual partners and relatives. Methods Health status, HIV-related risk behaviors, and HTC uptake and referrals of 1,016 MMT patients in Hanoi and Nam Dinh were investigated. Willingness to pay (WTP) for HTC was elicited using a contingent valuation technique. Interval and logistic regression models were employed to determine associated factors. Results Most of the patients (94.2%) had received HTC, 6.6 times on average. The proportion of respondents willing to refer their partners, their relatives and to be voluntary peer educators was 45.7%, 35.3%, and 33.3%, respectively. Attending MMT integrated with HTC was a facilitative factor for HTC uptake, greater WTP, and volunteering as peer educators. Older age, higher education and income, and HIV positive status were positively related to willingness to refer partners or relatives, while having health problems (mobility, usual care, pain/discomfort) was associated with lower likelihood of referring others or being a volunteer. Over 90% patients were willing to pay an average of US $17.9 for HTC service. Conclusion The results highlighted the potential role of MMT patients as referrers to HTC and voluntary peer educators. Integrating HIV testing with MMT services and applying users’ fee are potential strategies to mobilize resources and encourage HIV testing among MMT patients and their partners. PMID:27046029

Health care expenditures and therapeutic outcomes of a pharmacist-managed anticoagulation service versus usual medical care.

PubMed

Hall, Deanne; Buchanan, Julianne; Helms, Bethany; Eberts, Matthew; Mark, Scott; Manolis, Chronis; Peele, Pamela; Docimo, Anne

2011-07-01

To evaluate the differences in health care expenditures and therapeutic outcomes of patients receiving warfarin therapy management by a pharmacist-managed anticoagulation service compared with those receiving warfarin management by usual medical care. Retrospective, matched-cohort study. University of Pittsburgh Medical Center (UPMC) and UPMC Health Plan. Three hundred fifty adults who received warfarin therapy; 175 were managed by the pharmacist-managed anticoagulation service for at least 2 months between October 1, 2007, and September 30, 2008, (case patients) and 175 received usual care (matched comparison group). Medical claims data compared were direct anticoagulation cost and overall medical care costs, anticoagulation-related adverse events, hospitalizations and emergency department visits, frequency of international normalized ratio (INR) testing, and quantity of warfarin refills. Operational costs of the anticoagulation service were also calculated. The INR values and time within therapeutic range were assessed through anticoagulation service reports and laboratory results. The direct anticoagulation care cost was $35,465 versus $111,586 and the overall medical care cost was $754,191 versus $1,480,661 for the anticoagulation service group versus the usual care group. Accounting for operational and drug expenditure costs, the cost savings was $647,024 for the anticoagulation service group. The anticoagulation service group had significantly fewer anticoagulation-related adverse events (14 vs 41, p<0.0001), hospital admissions (3 vs 14, p<0.00001), and emergency department visits (58 vs 134, p<0.00001). The percentage of INR values in range and the percentage of time the INR values were in range were significantly higher in the anticoagulation service group (67.2% vs 54.6%, p<0.0001, and 73.7% vs 61.3%, p<0.0001, respectively). Compared with the usual care group, the anticoagulation service group had significantly more INR tests performed but demonstrated no significant difference in the quantity of drug refills. After accounting for operational costs, pharmacist-managed anticoagulation leads to reduced health care expenditure while improving therapeutic outcomes compared with usual medical care.

A strategy for optimizing staffing to improve the timeliness of inpatient phlebotomy collections.

PubMed

Morrison, Aileen P; Tanasijevic, Milenko J; Torrence-Hill, Joi N; Goonan, Ellen M; Gustafson, Michael L; Melanson, Stacy E F

2011-12-01

The timely availability of inpatient test results is a key to physician satisfaction with the clinical laboratory, and in an institution with a phlebotomy service may depend on the timeliness of blood collections. In response to safety reports filed for delayed phlebotomy collections, we applied Lean principles to the inpatient phlebotomy service at our institution. Our goal was to improve service without using additional resources by optimizing our staffing model. To evaluate the effect of a new phlebotomy staffing model on the timeliness of inpatient phlebotomy collections. We compared the median time of morning blood collections and average number of safety reports filed for delayed phlebotomy collections during a 6-month preimplementation period and 5-month postimplementation period. The median time of morning collections was 17 minutes earlier after implementation (7:42 am preimplementation; interquartile range, 6:27-8:48 am; versus 7:25 am postimplementation; interquartile range, 6:20-8:26 am). The frequency of safety reports filed for delayed collections decreased 80% from 10.6 per 30 days to 2.2 per 30 days. Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.

Web tools concerning performance analysis and planning support for solar energy plants starting from remotely sensed optical images

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

Morelli, Marco, E-mail: marco.morelli1@unimi.it; Masini, Andrea, E-mail: andrea.masini@flyby.it; Ruffini, Fabrizio, E-mail: fabrizio.ruffini@i-em.eu

We present innovative web tools, developed also in the frame of the FP7 ENDORSE (ENergy DOwnstReam SErvices) project, for the performance analysis and the support in planning of solar energy plants (PV, CSP, CPV). These services are based on the combination between the detailed physical model of each part of the plants and the near real-time satellite remote sensing of incident solar irradiance. Starting from the solar Global Horizontal Irradiance (GHI) data provided by the Monitoring Atmospheric Composition and Climate (GMES-MACC) Core Service and based on the elaboration of Meteosat Second Generation (MSG) satellite optical imagery, the Global Tilted Irradiancemore » (GTI) or the Beam Normal Irradiance (BNI) incident on plant's solar PV panels (or solar receivers for CSP or CPV) is calculated. Combining these parameters with the model of the solar power plant, using also air temperature values, we can assess in near-real-time the daily evolution of the alternate current (AC) power produced by the plant. We are therefore able to compare this satellite-based AC power yield with the actually measured one and, consequently, to readily detect any possible malfunctions and to evaluate the performances of the plant (so-called “Controller” service). Besides, the same method can be applied to satellite-based averaged environmental data (solar irradiance and air temperature) in order to provide a Return on Investment analysis in support to the planning of new solar energy plants (so-called “Planner” service). This method has been successfully applied to three test solar plants (in North, Centre and South Italy respectively) and it has been validated by comparing satellite-based and in-situ measured hourly AC power data for several months in 2013 and 2014. The results show a good accuracy: the overall Normalized Bias (NB) is − 0.41%, the overall Normalized Mean Absolute Error (NMAE) is 4.90%, the Normalized Root Mean Square Error (NRMSE) is 7.66% and the overall Correlation Coefficient (CC) is 0.9538. The maximum value of the Normalized Absolute Error (NAE) is about 30% and occurs for time periods with highly variable meteorological conditions. - Highlights: • We developed an online service (Controller) dedicated to solar energy plants real-time monitoring • We developed an online service (Planner) that supports the planning of new solar energy plants • The services are based on the elaboration of satellite optical imagery in near real-time • The validation with respect to in-situ measured hourly AC power data for three test solar plants shows good accuracy • The maximum value of the Normalized Absolute Error is about 30% and occurs for highly variable meteorological conditions.« less

Analysis of user cost and service trade-offs in transit and paratransit services

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

Louviere, J.; Kocur, G.

1979-08-01

The Xenia Model Transit Service served as a test of several alternative transit services operated in a small city setting. Research was designed to test a new method for assessing user tradeoffs in costs and service based on attitudinal methods. Termed direct response assessment, the methods were developed in psychology and have been extended to application in utility assessment. A tradeoff survey was administered as part of a home interview survey. Data from the tradeoff survey were used to develop separate equations for each sample respondent to explain and describe their tradeoffs over transit fare, travel time, walk distance, typemore » of service, and headway. An aggregate equation was also developed, assuming that all respondents shared common tradeoffs. These equations were employed to retrospectively predict changes in transit system patronage since system inception in 1974. Both sets of models performed well, producing forecasts that were in the same direction and range of experience, although magnitudes were somewhat different. Coefficients of the individual tradeoff equations were then analyzed to see if they could be predicted on the basis of interpersonal characteristics of the respondents. Results indicated that differences in coefficients could be attributed to some differences in individuals such as income and auto ownership. Overall results were promising for policy evaluation and forecasting.« less

Development of Methodologic Tools for Planning and Managing Library Services: II. Measuring a Library's Capability for Providing Documents *

PubMed Central

Orr, Richard H.; Pings, Vern M.; Pizer, Irwin H.; Olson, Edwin E.; Spencer, Carol C.

1968-01-01

A method of measuring a library's capability for providing the documents its users need has been developed. The library is tested with a representative sample of such documents to determine how long would be required for users to obtain these documents. Test results are expressed in terms of a Capability Index, which has a maximal value of 100 only if all the sample documents are found “on shelf.” Specific tests employing samples of 300 documents have been developed that are appropriate for academic and for “reservoir” biomedical libraries. Realistic field trials have demonstrated that these two tests are practical to administer and that test results are adequately reproducible. When strict comparability is not important, a library can test itself. In assessing a reservoir library, test results are supplemented by data on its typical processing time for interlibrary loan requests. Currently these tests are being used in a national survey. The general method is applicable to other types of libraries, provided appropriate test samples are established. If their limitations are clearly understood, these “Document Delivery Tests” can be valuable tools for planning and managing library services. PMID:5665969

Description and testing of the Geo Data Portal: Data integration framework and Web processing services for environmental science collaboration

USGS Publications Warehouse

Blodgett, David L.; Booth, Nathaniel L.; Kunicki, Thomas C.; Walker, Jordan I.; Viger, Roland J.

2011-01-01

Interest in sharing interdisciplinary environmental modeling results and related data is increasing among scientists. The U.S. Geological Survey Geo Data Portal project enables data sharing by assembling open-standard Web services into an integrated data retrieval and analysis Web application design methodology that streamlines time-consuming and resource-intensive data management tasks. Data-serving Web services allow Web-based processing services to access Internet-available data sources. The Web processing services developed for the project create commonly needed derivatives of data in numerous formats. Coordinate reference system manipulation and spatial statistics calculation components implemented for the Web processing services were confirmed using ArcGIS 9.3.1, a geographic information science software package. Outcomes of the Geo Data Portal project support the rapid development of user interfaces for accessing and manipulating environmental data.

Factors influencing timely initiation and completion of gestational diabetes mellitus screening and diagnosis - a qualitative study from Tamil Nadu, India.

PubMed

Nielsen, Karoline Kragelund; Rheinländer, Thilde; Kapur, Anil; Damm, Peter; Seshiah, Veerasamy; Bygbjerg, Ib C

2017-08-01

In 2007, universal screening for gestational diabetes mellitus (GDM) was introduced in Tamil Nadu, India. To identify factors hindering or facilitating timely initiation and completion of the GDM screening and diagnosis process, our study investigated how pregnant women in rural and urban Tamil Nadu access and navigate different GDM related health services. The study was carried out in two settings: an urban private diabetes centre and a rural government primary health centre. Observations of the process of screening and diagnosis at the health centres as well as semi-structured interviews with 30 pregnant women and nine health care providers were conducted. Data was analysed using qualitative content analysis. There were significant differences in the process of GDM screening and diagnosis in the urban and rural settings. Several factors hindering or facilitating timely initiation and completion of the process were identified. Timely attendance required awareness, motivation and opportunity to attend. Women had to attend the health centre at the right time and sometimes at the right gestational age to initiate the test, wait to complete the test and obtain the test report in time to initiate further action. All these steps and requirements were influenced by factors within and outside the health system such as getting right information from health care providers, clinic timings, characteristics of the test, availability of transport, social network and support, and social norms and cultural practices. Minimising and aligning complex stepwise processes of prenatal care and GDM screening delivery and attention to the factors influencing it are important for further improving and expanding GDM screening and related services, not only in Tamil Nadu but in other similar low and middle income settings. This study stresses the importance of guidelines and diagnostic criteria which are simple and feasible on the ground.

46 CFR 56.97-38 - Initial service leak test (reproduces 137.7).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Initial service leak test (reproduces 137.7). 56.97-38... PIPING SYSTEMS AND APPURTENANCES Pressure Tests § 56.97-38 Initial service leak test (reproduces 137.7). (a) An initial service leak test and inspection is acceptable when other types of test are not...

12 CFR 195.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Service test. 195.24 Section 195.24 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT Standards for Assessing Performance § 195.24 Service test. (a) Scope of test. The service test evaluates a savings...

12 CFR 345.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Service test. 345.24 Section 345.24 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY COMMUNITY REINVESTMENT Standards for Assessing Performance § 345.24 Service test. (a) Scope of test. The service test...

12 CFR 345.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Service test. 345.24 Section 345.24 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY COMMUNITY REINVESTMENT Standards for Assessing Performance § 345.24 Service test. (a) Scope of test. The service test...

Patient empowerment by increasing the understanding of medical language for lay users.

PubMed

Topac, V; Stoicu-Tivadar, V

2013-01-01

Patient empowerment is important in order to increase the quality of medical care and the life quality of the patients. An important obstacle for empowering patients is the language barrier the lay patient encounter when accessing medical information. To design and develop a service that will help increase the understanding of medical language for lay persons. The service identifies and explains medical terminology from a given text by annotating the terms in the original text with the definition. It is based on an original terminology interpretation engine that uses a fuzzy matching dictionary. The service was implemented in two projects: a) into the server of a tele-care system (TELEASIS) with the purpose of adapting medical text assigned by medical personnel for the assisted patients. b) Into a dedicated web site that can adapt the medical language from raw text or from existing web pages. The output of the service was evaluated by a group of persons, and the results indicate that such a system can increase the understanding of medical texts. Several design decisions were driven from the evaluation, and are being considered for future development. Other tests measuring accuracy and time performance for the fuzzy terminology recognition have been performed. Test results revealed good performance for accuracy and excellent results regarding time performance. The current version of the service increases the accessibility of medical language by explaining terminology with a good accuracy, while allowing the user to easily identify errors, in order to reduce the risk of incorrect terminology recognition.

A new perspective on the incentive-blood donation relationship: partnership, congruency, and affirmation of competence.

PubMed

Chmielewski, Danielle; Bove, Liliana L; Lei, Jing; Neville, Ben; Nagpal, Anish

2012-09-01

The Motivation Crowding-out Theory suggests that incentives undermine intrinsic motivation and thus blood donation behavior. While there is strong evidence showing the negative relationship between monetary incentives and blood donation, findings on the effect of nonmonetary incentives are mixed. Set in a voluntary, nonremunerated environment, this study explores aspects of the nonmonetary incentive-blood donation relationship not captured by the crowding-out hypothesis. In-depth interviews were conducted to explore donors' attitudes toward nonmonetary incentives currently used or considered by the Australian Red Cross Blood Service (Blood Service). Transcripts were analyzed using an inductive, thematic approach. Of the nonmonetary incentives examined (i.e., health screening tests, branded tokens, paid time off work, recognition of key milestones, and postdonation refreshments), none were found to crowd out intrinsic motivation, although not all were viewed favorably. Donors who viewed branded tokens negatively considered the cost implications for the Blood Service, while donors who responded positively considered the public benefit of tokens in raising the profile of the Blood Service. Other nonmonetary incentives-paid time off work, postdonation refreshments, and health screening tests-were viewed positively because donors perceived them to be congruent to the effort expended in donating blood. Finally, donors expressed a preference for private over public recognition when acknowledging significant contributions. When operating in a voluntary, nonremunerated environment, blood services should view donors as supply partners rather than customers, only consider nonmonetary incentives that are congruent with the act of donation, and provide private rather than public recognition of key milestones. © 2012 American Association of Blood Banks.

Implementing the European Neutron Monitor Service for the ESA SSA Program

NASA Astrophysics Data System (ADS)

Mavromichalaki, H.; Papaioannou, A.; Souvatzoglou, G.; Dimitroulakos, J.; Paschalis, P.; Gerontidou, M.; Sarlanis, Ch.

2013-09-01

Ground level enhancements (GLEs) are observed as significant intensity increases at neutron monitor measurements, followed by an intense solar flare and/or a very energetic coronal mass ejection. Due to their space weather impact it is crucial to establish a real-time operational system that would be in place to issue reliable and timely GLE Alerts. Such a Neutron Monitor Service that will be made available via the Space Weather Portal operated by the European Space Agency (ESA), under the Space Situational Awareness (SSA) Program, is currently under development. The ESA Neutron Monitor Service will provide two products: a web interface providing data from multiple Neutron Monitor stations as well as an upgraded GLE Alert. Both services are now under testing and validation and will probably enter to an operational phase next year. The core of this Neutron Monitor Service is the GLE Alert software, and therefore, the main goal of this research effort is to upgrade the existing GLE Alert software and to minimize the probability of false alarms. The ESA Neutron Monitor Service is building upon the infrastructure made available with the implementation of the High-Resolution Neutron Monitor Database (NMDB). In this work the structure of the ESA Neutron Monitor Service, the core of the novel GLE Alert Service and its validation results will be presented and further discussed.

A Retrospective Exploration of the Impact of the 'Angelina Jolie Effect' on the Single State-Wide Familial Cancer Program in Perth, Western Australia.

PubMed

Freedman, Rebecca; Mountain, Helen; Karina, Dian; Schofield, Lyn

2017-02-01

Global media has the power to influence the ways the public engage with health services. On May 14th 2013, Angelina Jolie published an article in the New York Times magazine, outlining her decision to undergo BRCA mutation testing due to a family history of cancer; then proceed with a mastectomy. The article evoked significant interest from the media and the public. During the months that followed, the Familial Cancer Program (FCP) at Genetic Services of Western Australia (GSWA) experienced a significant increase in referrals and enquiries. Resources were overstretched and it became clear we needed to adjust work practices to manage the escalating numbers. New strategies were devised to cope with the influx of enquiries, albeit without the benefit of additional resources. We conducted an audit of referrals to the FCP made between January 2012 and December 2014. This included a comparison of the months prior to and following the New York Times article. The aim of the audit was to quantify the impact of the "Angelina Jolie effect" on referrals to the FCP. Whilst the increased awareness of the role of genetic services in risk assessment and testing for familial breast and ovarian cancer was considered positive, pre-referral risk assessment at the primary health level to evaluate the appropriateness of their patients for referral could have been helpful. Potentially, many inappropriate referrals to FCP may have been avoided with primary health evaluation thus lessening the burden on our service and preventing unnecessary worry in well women who possessed minimal family history or risk factors. It is important to understand the factors driving the uptake of risk reduction activities, particularly if engagement with a genetics service is considered part of that pathway. Continued education about cancer risk due to family history, individual features and awareness surrounding genetic testing criteria, costs and availability is required for both the public and health professionals.

Factors Affecting Utilization of Voluntary HIV Counseling and Testing Services among Teachers in Awi Zone, Northwest Ethiopia

PubMed Central

Bizuneh, Kelemu Dessie

2017-01-01

HIV/AIDS affects the basic educational sector which is the most productive segment of the population and vital to the creation of human capital. The loss of skilled and experienced teachers due to the problem is increasingly compromising the provision of quality education in most African countries. The study was proposed to determine the magnitude of VCT utilization and assess contributing factors that affect VCT service utilization among secondary school teachers in Awi Zone. A cross-sectional study design was conducted among 588 participants in 2014. Self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 16, presented as frequencies and summary statistics, and tested for presence of significant association with odds ratio at 95% CI. More than half (53.6%) of study participants were tested for HIV. Those who had sexual intercourse, had good knowledge about VCT, were divorced/widowed, were in the age group of 20–29 years, and were married utilized VCT services two, three, four, three, and two times better than their counterparts, respectively. Actions targeting unmarried status, increase of educational level, and teachers with age groups above 30 years are necessary to follow their counterparts to utilize VCT service in order to save loss of teachers. PMID:28512582

Using fee-for-service testing to generate revenue for the 21st century public health laboratory.

PubMed

Loring, Carol; Neil, R Brock; Gillim-Ross, Laura; Bashore, Matthew; Shah, Sandip

2013-01-01

The decrease in appropriations for state public health laboratories (SPHLs) has become a major concern as tax revenues and, subsequently, state and federal funding, have decreased. These reductions have forced SPHLs to pursue revenue-generating opportunities to support their work. We describe the current state of funding in a sampling of SPHLs and the challenges these laboratories face as they implement or expand fee-for-service testing. We conducted surveys of SPHLs to collect data concerning laboratory funding sources, test menus, fee-for-service testing, and challenges to implementing fee-for-service testing. Most SPHLS receive funding through three revenue sources: state appropriation, federal funding, and fee-for-service testing (cash funds). Among SPHLs, state appropriations ranged from $0 to more than $6 per capita, federal funding ranged from $0.10 to $5 per capita, and revenue from fee-for-service testing ranged from $0 to $4 per capita. The tests commonly performed on a fee-for-service basis included assays for sexually transmitted diseases, mycobacterial cultures, newborn screening, and water testing. We found that restrictive legislation, staffing shortages, inadequate software for billing fee-for-service testing, and regulations on how SPHLs use their generated revenue are impediments to implementing fee-for-service testing. Some SPHLs are considering implementing or expanding fee-for-service testing as a way to recapture funds lost as a result of state and federal budget cuts. This analysis revealed many of the obstacles to implementing fee-for-service testing in SPHLs and the potential impact on SPHLs of continued decreases in funding.

Normative data and the influence of age and gender on power, balance, flexibility, and functional movement in healthy service members.

PubMed

Teyhen, Deydre S; Riebel, Mark A; McArthur, Derrick R; Savini, Matthew; Jones, Mackenzie J; Goffar, Stephen L; Kiesel, Kyle B; Plisky, Phillip J

2014-04-01

Determine the influence of age and sex and describe normative data on field expedient tests associated with power, balance, trunk stability, mobility, and functional movement in a military population. Participants (n = 247) completed a series of clinical and functional tests, including closed-chain ankle dorsiflexion (DF), Functional Movement Screen (FMS), Y-Balance Test Lower Quarter (YBT-LQ), Y-Balance Test Upper Quarter (YBT-UQ), single leg vertical jump (SLVJ), 6-m timed hop (6-m timed), and triple hop. Descriptive statistics were calculated. Analysis of variance tests were performed to compare the results based on sex and age (<30 years, >30 years). Service members demonstrated DF of 34.2 ± 6.1°, FMS composite score of 16.2 ± 2.2, YBT-LQ normalized composite score of 96.9 ± 8.6%, YBT-UQ normalized composite score of 87.6 ± 9.6%, SLVJ of 26.9 ± 8.6 cm, 6-m hop of 2.4 ± 0.5 seconds, and a triple hop of 390.9 ± 110.8 cm. Men performed greater than women (p < 0.05) on the YBT-LQ, YBT-UQ, SLVJ, 6-m timed, and triple hop. Those <30 years of age performed better than older participants (p < 0.05) on the DF, FMS, YBT-LQ, SLVJ, 6-m hop, and triple hop. Findings provide normative data on military members. Men performed better on power, balance, and trunk stability tests, whereas younger individuals performed better on power, balance, mobility, and functional movement. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Consumer participation in quality improvements for chronic disease care: development and evaluation of an interactive patient-centered survey to identify preferred service initiatives.

PubMed

Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Roos, Ian A; Henskens, Frans A; Paul, David J

2014-12-19

With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives. The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score. In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time. A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen's kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care.

A collaborative approach to cancer risk assessment services using genetic counselor extenders in a multi-system community hospital.

PubMed

Cohen, Stephanie A; Nixon, Dawn M

2016-10-01

This study aimed to evaluate a unique approach to cancer risk assessment for improved access by smaller rural communities. Local, on-site nurse navigators were trained and utilized as genetic counselor extenders (GCEs) to provide basic risk assessment and offer BRCA1/2 genetic testing to select patients based on a triaging process in collaboration with board-certified genetic counselors (CGCs). From August 2012 to July 2014, 12,477 family history questionnaires representing 8937 unique patients presenting for a screening mammogram or new oncology appointment were triaged. Of these, 8.2 % patients were identified at increased risk for hereditary breast cancer, and 4.2 % were identified at increased risk for other hereditary causes of cancer. A total of 75 of 1130 at-risk patients identified (6.6 %) completed a genetic risk assessment appointment; 23 with a GCE and 52 with a CGC. A review of the completed genetic test requisition forms from a 9-year pre-collaboration time period found that 16 % (20/125) did not appear to meet genetic testing criteria. Overall, there was a fourfold increase in patients accessing genetic services in this study period compared to the pre-collaboration time period. Efficiency of this model was assessed by determining time spent by the CGC in all activities related to the collaboration, which amounted to approximately 16 h/month. Adjustments have been made and the program continues to be monitored for opportunities to improve efficiency. This study demonstrates the feasibility of CGCs and GCEs collaborating to improve access to quality services in an efficient manner.

A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service.

PubMed

Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard

2014-09-01

To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.

Analysis of Operation TEAPOT nuclear test BEE radiological and meteorological data

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

Quinn, V.E.

This report describes the Weather Service Nuclear Support Office (WSNSO) analyses of the radiological and meteorological data collected for the BEE nuclear test of Operation TEAPOT. Inconsistencies in the radiological data and their resolution are discussed. The methods of normalizing the radiological data to a standard time and estimating fallout-arrival times are presented. The meteorological situations on event day and the following day are described. A comparison of the WSNSO fallout analysis with an analysis performed in the 1950's is presented. The radiological data used to derive the WSNSO fallout pattern are tabulated in an appendix.

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 3 2014-01-01 2014-01-01 false Service test. 228.24 Section 228.24 Banks and...) COMMUNITY REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its...

12 CFR 563e.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Service test. 563e.24 Section 563e.24 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT Standards for Assessing Performance § 563e.24 Service test. (a) Scope of test. The service test evaluates a savings...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 3 2012-01-01 2012-01-01 false Service test. 228.24 Section 228.24 Banks and... REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its assessment area(s) by...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Service test. 228.24 Section 228.24 Banks and... REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its assessment area(s) by...

12 CFR 25.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Service test. 25.24 Section 25.24 Banks and... DEPOSIT PRODUCTION REGULATIONS Regulations Standards for Assessing Performance § 25.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its...

12 CFR 563e.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Service test. 563e.24 Section 563e.24 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT Standards for Assessing Performance § 563e.24 Service test. (a) Scope of test. The service test evaluates a savings...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false Service test. 228.24 Section 228.24 Banks and... REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its assessment area(s) by...

12 CFR 25.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Service test. 25.24 Section 25.24 Banks and... DEPOSIT PRODUCTION REGULATIONS Regulations Standards for Assessing Performance § 25.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its...

PowerPack Developments

NASA Technical Reports Server (NTRS)

2007-01-01

A vintage 1960 J-2 thrust chamber is fitted with brackets and pumps recently at the Pratt & Whitney Rocketdyne assembly facility in Stennis Space Center's Building 9101. Together, the parts comprise the J-2X Powerpack 1A test article. Mississippi Space Services machined the new bracket (the V-shaped arm on the right), making this the first time parts for an engine test article were machined, welded and assembled on site at SSC.

PowerPack Developments

NASA Image and Video Library

2007-04-11

A vintage 1960 J-2 thrust chamber is fitted with brackets and pumps recently at the Pratt & Whitney Rocketdyne assembly facility in Stennis Space Center's Building 9101. Together, the parts comprise the J-2X Powerpack 1A test article. Mississippi Space Services machined the new bracket (the V-shaped arm on the right), making this the first time parts for an engine test article were machined, welded and assembled on site at SSC.

The SUCCESS model for laboratory performance and execution of rapid molecular diagnostics in patients with sepsis.

PubMed

Dekmezian, Mhair; Beal, Stacy G; Damashek, Mary Jane; Benavides, Raul; Dhiman, Neelam

2015-04-01

Successful performance and execution of rapid diagnostics in a clinical laboratory hinges heavily on careful validation, accurate and timely communication of results, and real-time quality monitoring. Laboratories must develop strategies to integrate diagnostics with stewardship and evidence-based clinical practice guidelines. We present a collaborative SUCCESS model for execution and monitoring of rapid sepsis diagnostics to facilitate timely treatment. Six months after execution of the Verigene Gram-Positive Blood Culture (BC-GP) and the AdvanDx PNA-FISH assays, data were collected on 579 and 28 episodes of bacteremia and fungemia, respectively. Clinical testing was executed using a SUCCESS model comprising the following components: stewardship, utilization of resources, core strategies, concierge services, education, support, and surveillance. Stewardship needs were identified by evaluating the specialty services benefiting from new testing. Utilization of resources was optimized by reviewing current treatment strategies and antibiogram and formulary options. Core strategies consisted of input from infectious disease leadership, pharmacy, and laboratory staff. Concierge services included automated Micro-eUpdate and physician-friendly actionable reports. Education modules were user-specific, and support was provided through a dedicated 24/7 microbiology hotline. Surveillance was performed by daily audit by the director. Using the SUCCESS model, the turnaround time for the detailed report with actionable guidelines to the physician was ∼3 hours from the time of culture positivity. The overall correlation between rapid methods and culture was 94% (546/579). Discrepant results were predominantly contaminants such as a coagulase-negative staphylococci or viridans streptococci in mixed cultures. SUCCESS is a cost-effective and easily adaptable model for clinical laboratories with limited stewardship resources.

Subjective Quality Assessment of Underwater Video for Scientific Applications

PubMed Central

Moreno-Roldán, José-Miguel; Luque-Nieto, Miguel-Ángel; Poncela, Javier; Díaz-del-Río, Víctor; Otero, Pablo

2015-01-01

Underwater video services could be a key application in the better scientific knowledge of the vast oceanic resources in our planet. However, limitations in the capacity of current available technology for underwater networks (UWSNs) raise the question of the feasibility of these services. When transmitting video, the main constraints are the limited bandwidth and the high propagation delays. At the same time the service performance depends on the needs of the target group. This paper considers the problems of estimations for the Mean Opinion Score (a standard quality measure) in UWSNs based on objective methods and addresses the topic of quality assessment in potential underwater video services from a subjective point of view. The experimental design and the results of a test planned according standardized psychometric methods are presented. The subjects used in the quality assessment test were ocean scientists. Video sequences were recorded in actual exploration expeditions and were processed to simulate conditions similar to those that might be found in UWSNs. Our experimental results show how videos are considered to be useful for scientific purposes even in very low bitrate conditions. PMID:26694400

Subjective Quality Assessment of Underwater Video for Scientific Applications.

PubMed

Moreno-Roldán, José-Miguel; Luque-Nieto, Miguel-Ángel; Poncela, Javier; Díaz-del-Río, Víctor; Otero, Pablo

2015-12-15

Underwater video services could be a key application in the better scientific knowledge of the vast oceanic resources in our planet. However, limitations in the capacity of current available technology for underwater networks (UWSNs) raise the question of the feasibility of these services. When transmitting video, the main constraints are the limited bandwidth and the high propagation delays. At the same time the service performance depends on the needs of the target group. This paper considers the problems of estimations for the Mean Opinion Score (a standard quality measure) in UWSNs based on objective methods and addresses the topic of quality assessment in potential underwater video services from a subjective point of view. The experimental design and the results of a test planned according standardized psychometric methods are presented. The subjects used in the quality assessment test were ocean scientists. Video sequences were recorded in actual exploration expeditions and were processed to simulate conditions similar to those that might be found in UWSNs. Our experimental results show how videos are considered to be useful for scientific purposes even in very low bitrate conditions.

Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

PubMed Central

Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y.; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

2017-01-01

This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios. PMID:28117724

Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation.

PubMed

Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

2017-01-21

This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

Testing the US Integrated Ocean Observing System Data Discovery and Distribution Infrastructure with Real-World Problems

NASA Astrophysics Data System (ADS)

Snowden, D. P.; Signell, R.; Knee, K.; Kupiec, J.; Bird, A.; Fratantonio, B.; Koeppen, W.; Wilcox, K.

2014-12-01

The distributed, service-oriented architecture of the US Integrated Ocean Observing System (US IOOS) has been implemented mostly independently by US IOOS partners, using different software approaches and different levels of compliance to standards. Some uniformity has been imparted by documenting the intended output data formats and content and service interface behavior. But to date, a rigorous testing of the distributed system of systems has not been done. To assess the functionality of this system, US IOOS is conducting a system integration test (http://github.com/ioos/system-test) that evaluates whether the services (i.e. SOS, OPeNDAP, WMS, CS/W) deployed to the 17 Federal partners and 11 Regional Associations can solve real-world problems. Scenarios were selected that both address IOOS societal goals and test different functionality of the data architecture. For example, one scenario performs an assessment of water level forecast skill by prompting the user for a bounding box and a temporal extent, searching metadata catalogs via a Catalog Services for the Web (CS/W) interface to discover available sea level observations and model results, extracting data from the identified service endpoints (either OPeNDAP or SOS), interpolating both modeled and observed data onto a common time base, and then comparing the skill of the various models. Other scenarios explore issues such as hypoxia and wading bird habitats. For each scenario, the entire workflow (user input, search, access, analysis and visualization) is captured in an IPython Notebook on GitHub. This allows the scenarios to be self-documenting as well as reproducible by anyone, using free software. The Python packages required to run the scenarios are all available on GitHub and Conda packages are available on binstar.org so that users can easily run the scenarios using the free Anaconda Python distribution. With the advent of hosted services such as Wakari, it is possible for anyone to reproduce these workflows for free, without installing any software locally, using just their web browser. Thus in addition to performing as a system integration test, this project serves to provide examples that anyone in the geoscience community can adapt to solve other real-world problems.

Acceptability of HIV self-testing: a systematic literature review.

PubMed

Krause, Janne; Subklew-Sehume, Friederike; Kenyon, Chris; Colebunders, Robert

2013-08-08

The uptake of HIV testing and counselling services remains low in risk groups around the world. Fear of stigmatisation, discrimination and breach of confidentiality results in low service usage among risk groups. HIV self-testing (HST) is a confidential HIV testing option that enables people to find out their status in the privacy of their homes. We evaluated the acceptability of HST and the benefits and challenges linked to the introduction of HST. A literature review was conducted on the acceptability of HST in projects in which HST was offered to study participants. Besides acceptability rates of HST, accuracy rates of self-testing, referral rates of HIV-positive individuals into medical care, disclosure rates and rates of first-time testers were assessed. In addition, the utilisation rate of a telephone hotline for counselling issues and clients` attitudes towards HST were extracted. Eleven studies met the inclusion criteria (HST had been offered effectively to study participants and had been administered by participants themselves) and demonstrated universally high acceptability of HST among study populations. Studies included populations from resource poor settings (Kenya and Malawi) and from high-income countries (USA, Spain and Singapore). The majority of study participants were able to perform HST accurately with no or little support from trained staff. Participants appreciated the confidentiality and privacy but felt that the provision of adequate counselling services was inadequate. The review demonstrates that HST is an acceptable testing alternative for risk groups and can be performed accurately by the majority of self-testers. Clients especially value the privacy and confidentiality of HST. Linkage to counselling as well as to treatment and care services remain major challenges.

Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement.

PubMed

Mpunga, Dieudonné; Lumbayi, J P; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

2017-06-27

To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as "high" if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or "low" if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services ( P <.001). Public facilities were less likely than private facilities to have high-quality services ( P =.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives. Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives. © Mpunga et al.

GEMSS: grid-infrastructure for medical service provision.

PubMed

Benkner, S; Berti, G; Engelbrecht, G; Fingberg, J; Kohring, G; Middleton, S E; Schmidt, R

2005-01-01

The European GEMSS Project is concerned with the creation of medical Grid service prototypes and their evaluation in a secure service-oriented infrastructure for distributed on demand/supercomputing. Key aspects of the GEMSS Grid middleware include negotiable QoS support for time-critical service provision, flexible support for business models, and security at all levels in order to ensure privacy of patient data as well as compliance to EU law. The GEMSS Grid infrastructure is based on a service-oriented architecture and is being built on top of existing standard Grid and Web technologies. The GEMSS infrastructure offers a generic Grid service provision framework that hides the complexity of transforming existing applications into Grid services. For the development of client-side applications or portals, a pluggable component framework has been developed, providing developers with full control over business processes, service discovery, QoS negotiation, and workflow, while keeping their underlying implementation hidden from view. A first version of the GEMSS Grid infrastructure is operational and has been used for the set-up of a Grid test-bed deploying six medical Grid service prototypes including maxillo-facial surgery simulation, neuro-surgery support, radio-surgery planning, inhaled drug-delivery simulation, cardiovascular simulation and advanced image reconstruction. The GEMSS Grid infrastructure is based on standard Web Services technology with an anticipated future transition path towards the OGSA standard proposed by the Global Grid Forum. GEMSS demonstrates that the Grid can be used to provide medical practitioners and researchers with access to advanced simulation and image processing services for improved preoperative planning and near real-time surgical support.

On-time reliability impacts of advanced traveler information services (ATIS) : Washington, DC case study, executive summary

DOT National Transportation Integrated Search

1999-05-01

This report documents the development and testing of a Surveillance and Delay Advisory System (SDAS) for application in congested rural areas. SDAS included several techniques that could be used on rural highways to give travelers advance information...

Restructuring Schools on a Service-Industry Model.

ERIC Educational Resources Information Center

Holden, Daniel

1994-01-01

Proposes reform in education from an "assembly line" to a "provider-client" approach. Swanton High School (Ohio), winner of GTE's Pioneering Partners program, which used Learning Management Systems to track student progress and testing, satellite courses, videodiscs, Hypercard, QuickTime video, and Internet connections, is…

Evaluation of wearing surface materials for FRP bridge decks : final report.

DOT National Transportation Integrated Search

2005-07-01

The wearing surface on many fiber reinforced polymer (FRP) composite bridge decks have cracked or delaminated after only a short time in service. Consequently, a set of tests were conducted on four wearing surface products in order to select the mate...

Scalable Integrated Multi-Mission Support System (SIMSS) Simulator Release 2.0 for GMSEC

NASA Technical Reports Server (NTRS)

Kim, John; Velamuri, Sarma; Casey, Taylor; Bemann, Travis

2012-01-01

Scalable Integrated Multi-Mission Support System (SIMSS) Simulator Release 2.0 software is designed to perform a variety of test activities related to spacecraft simulations and ground segment checks. This innovation uses the existing SIMSS framework, which interfaces with the GMSEC (Goddard Mission Services Evolution Center) Application Programming Interface (API) Version 3.0 message middleware, and allows SIMSS to accept GMSEC standard messages via the GMSEC message bus service. SIMSS is a distributed, component-based, plug-and-play client-server system that is useful for performing real-time monitoring and communications testing. SIMSS runs on one or more workstations, and is designed to be user-configurable, or to use predefined configurations for routine operations. SIMSS consists of more than 100 modules that can be configured to create, receive, process, and/or transmit data. The SIMSS/GMSEC innovation is intended to provide missions with a low-cost solution for implementing their ground systems, as well as to significantly reduce a mission s integration time and risk.

eTEST: Developing a Smart Home HIV Testing Kit that Enables Active, Real-Time Follow-Up and Referral After Testing.

PubMed

Wray, Tyler; Chan, Philip A; Simpanen, Erik; Operario, Don

2017-05-08

Men who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV. The aim of our study was to use qualitative research methods with high-risk MSM to inform development of a "smart" HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone. In phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST. Phase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful. Using BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time. ©Tyler Wray, Philip A Chan, Erik Simpanen, Don Operario. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 08.05.2017.

eTEST: Developing a Smart Home HIV Testing Kit that Enables Active, Real-Time Follow-Up and Referral After Testing

PubMed Central

Chan, Philip A; Simpanen, Erik; Operario, Don

2017-01-01

Background Men who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV. Objective The aim of our study was to use qualitative research methods with high-risk MSM to inform development of a “smart” HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone. Methods In phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST. Results Phase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful. Conclusions Using BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time. PMID:28483744

Reducing Cancelations on the Day of Scheduled Surgery at a Children's Hospital.

PubMed

Pratap, Jayant Nick; Varughese, Anna M; Mercurio, Patti; Lynch, Terri; Lonnemann, Teresa; Ellis, Andrea; Rugg, John; Stone, W Ray; Bedinghaus, Cindi

2015-05-01

Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation. Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and text-message reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods. Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites. By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization. Copyright © 2015 by the American Academy of Pediatrics.

Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda.

PubMed

Abongomera, G; Kiwuwa-Muyingo, S; Revill, P; Chiwaula, L; Mabugu, T; Phillips, A; Katabira, E; Musiime, V; Gilks, C; Chan, A; Hakim, J; Colebunders, R; Kityo, C; Gibb, D M; Seeley, J; Ford, D

2015-11-28

Decentralization of ART services scaled up significantly with the country wide roll out of option B plus in Uganda. Little work has been undertaken to examine population level access to HIV care particularly in hard to reach areas in rural Africa. Most work on ART scale up has been done at health facility level which omits people not accessing healthcare in the community. This study describes health service usage, particularly HIV testing and care in 2/6 parishes of Lapono sub-county of northern Uganda, prior to introduction of ART services in Lira Kato Health Centre (a local lower-level health centre III), as part of ART decentralization. Household and individual questionnaires were administered to household members (aged 15-59 years). Logit random effects models were used to test for differences in proportions (allowing for clustering within villages). 2124 adults from 1351 households were interviewed (755 [36%] males, 1369 [64 %] females). 2051 (97%) participants reported seeking care locally for fever, most on foot and over half at Lira Kato Health Centre. 574 (76%) men and 1156 (84%) women reported ever-testing for HIV (P < 0.001 for difference); 34/574 (6%) men and 102/1156 (9%) women reported testing positive (P = 0.04). 818/850 (96%) women who had given birth in the last 5 years had attended antenatal care in their last pregnancy: 7 women were already diagnosed with HIV (3 on ART) and 790 (97%) reported being tested for HIV (34 tested newly positive). 124/136 (91%) HIV-positive adults were in HIV-care, 123/136 (90 %) were taking cotrimoxazole and 74/136 (54%) were on ART. Of adults in HIV-care, most were seen at Kalongo hospital (n = 87), Patongo Health Centre (n = 7) or Lira Kato Health Centre (n = 23; no ART services). 58/87, 5/7 and 20/23 individuals walked to Kalongo hospital (56 km round-trip, District Health Office information), Patongo Health Centre (76 km round-trip, District Health Office information) and Lira Kato Health Centre (local) respectively. 8 HIV-infected children were reported; only 2 were diagnosed aged <24 months: 7/8 were in HIV-care including 3 on ART. Higher proportions of women compared to men reported ever-testing for HIV and testing HIV-positive, similar to other surveys. HIV-infected men and women travelled considerable distances for ART services. Children appeared to be under-accessing testing and referral for treatment. Decentralization of ART services to a local health facility would decrease travel time and transport costs, making care and treatment more easily accessible.

Education, Technology, and Media: A Peak into My Summer Internship at NASA Glenn Research Center in Cleveland, Ohio

NASA Technical Reports Server (NTRS)

Moon, James

2004-01-01

My name is James Moon and I am a senor at Tennessee State University where my major is Aeronautical and Industrial Technology with a concentration in industrial electronics. I am currently serving my internship in the Engineering and Technical Services Directorate at the Glenn Research Center (GRC). The Engineering and Technical Service Directorate provides the services and infrastructure for the Glenn Research Center to take research concepts to reality. They provide a full range of integrated services including engineering, advanced prototyping and testing, facility management, and information technology for NASA, industry, and academia. Engineering and Technical Services contains the core knowledge in Information Technology (IT). This includes data systems and analysis, inter and intranet based systems design and data security. Including the design and development of embedded real-time sohare applications for flight and supporting ground systems, Engineering and Technical Services provide a wide range of IT services and products specific to the Glenn Research Center research and engineering community.

Digital time stamping system based on open source technologies.

PubMed

Miskinis, Rimantas; Smirnov, Dmitrij; Urba, Emilis; Burokas, Andrius; Malysko, Bogdan; Laud, Peeter; Zuliani, Francesco

2010-03-01

A digital time stamping system based on open source technologies (LINUX-UBUNTU, OpenTSA, OpenSSL, MySQL) is described in detail, including all important testing results. The system, called BALTICTIME, was developed under a project sponsored by the European Commission under the Program FP 6. It was designed to meet the requirements posed to the systems of legal and accountable time stamping and to be applicable to the hardware commonly used by the national time metrology laboratories. The BALTICTIME system is intended for the use of governmental and other institutions as well as personal bodies. Testing results demonstrate that the time stamps issued to the user by BALTICTIME and saved in BALTICTIME's archives (which implies that the time stamps are accountable) meet all the regulatory requirements. Moreover, the BALTICTIME in its present implementation is able to issue more than 10 digital time stamps per second. The system can be enhanced if needed. The test version of the BALTICTIME service is free and available at http://baltictime. pfi.lt:8080/btws/ and http://baltictime.lnmc.lv:8080/btws/.

Respite service use among caregivers of older people: comparative analysis of family dementia caregivers with musculoskeletal and circulatory system disorder caregivers.

PubMed

Vecchio, Nerina; Fitzgerald, Janna A; Radford, Katrina; Kurrle, Susan

2018-01-01

To identify the main drivers of the use of respite services and the need for respite services among caregivers of people experiencing dementia relative to family caregivers of people with other health conditions. Based on nationally representative secondary data regression analysis was used to test the association between selected health conditions and the utilisation of and need for respite services. For a person living with dementia the odds of using respite care are higher than for a person with either a musculoskeletal or circulatory condition. Family caregivers of people living with dementia report the odds of the need for more respite as 5.3 times higher than for family caregivers of people with musculoskeletal conditions and 7.7 times higher than for family caregivers of people with circulatory conditions. The main reason for never using respite services is largely driven by the type of health condition, age of care recipient, existence of a spouse, and level of disability. Respite services that cater to the specific needs of families experiencing dementia at home should become a higher priority within the aged care sector. Alternative models of respite care that focus on prevention and early intervention would be cost effective.

A web service framework for astronomical remote observation in Antarctica by using satellite link

NASA Astrophysics Data System (ADS)

Jia, M.-h.; Chen, Y.-q.; Zhang, G.-y.; Jiang, P.; Zhang, H.; Wang, J.

2018-07-01

Many telescopes are deployed in Antarctica as it offers excellent astronomical observation conditions. However, because Antarctica's environment is harsh to humans, remote operation of telescope is necessary for observation. Furthermore, communication to devices in Antarctica through satellite link with low bandwidth and high latency limits the effectiveness of remote observation. This paper introduces a web service framework for remote astronomical observation in Antarctica. The framework is based on Python Tornado. RTS2-HTTPD and REDIS are used as the access interface to the telescope control system in Antarctica. The web service provides real-time updates through WebSocket. To improve user experience and control effectiveness under the poor satellite link condition, an agent server is deployed in the mainland to synchronize the Antarctic server's data and send it to domestic users in China. The agent server will forward the request of domestic users to the Antarctic master server. The web service was deployed and tested on Bright Star Survey Telescope (BSST) in Antarctica. Results show that the service meets the demands of real-time, multiuser remote observation and domestic users have a better experience of remote operation.

Influence of race/ethnicity on genetic counseling and testing for hereditary breast and ovarian cancer.

PubMed

Forman, Andrea D; Hall, Michael J

2009-01-01

Risk assessment coupled with genetic counseling and testing for the cancer predisposition genes BRCA1 and BRCA2 (BRCA1/2) has become an integral element of comprehensive patient evaluation and cancer risk management in the United States for individuals meeting high-risk criteria for hereditary breast and ovarian cancer (HBOC). For mutation carriers, several options for risk modification have achieved substantial reductions in future cancer risk. However, several recent studies have shown lower rates of BRCA1/2 counseling and testing among minority populations. Here, we explore the role of race/ethnicity in cancer risk assessment, genetic counseling and genetic testing for HBOC and the BRCA1/2 cancer predisposition genes. Barriers to genetic services related to race/ethnicity and underserved populations, including socioeconomic barriers (e.g., time, access, geographic, language/cultural, awareness, cost) and psychosocial barriers (e.g., medical mistrust, perceived disadvantages to genetic services), as well as additional barriers to care once mutation carriers are identified, will be reviewed.

Thin film strain gage development program

NASA Technical Reports Server (NTRS)

Grant, H. P.; Przybyszewski, J. S.; Anderson, W. L.; Claing, R. G.

1983-01-01

Sputtered thin-film dynamic strain gages of 2 millimeter (0.08 in) gage length and 10 micrometer (0.0004 in) thickness were fabricated on turbojet engine blades and tested in a simulated compressor environment. Four designs were developed, two for service to 600 K (600 F) and two for service to 900 K (1200 F). The program included a detailed study of guidelines for formulating strain-gage alloys to achieve superior dynamic and static gage performance. The tests included gage factor, fatigue, temperature cycling, spin to 100,000 G, and erosion. Since the installations are 30 times thinner than conventional wire strain gage installations, and any alteration of the aerodynamic, thermal, or structural performance of the blade is correspondingly reduced, dynamic strain measurement accuracy higher than that attained with conventional gages is expected. The low profile and good adherence of the thin film elements is expected to result in improved durability over conventional gage elements in engine tests.

Drug testing for newborn exposure to illicit substances in pregnancy: pitfalls and pearls.

PubMed

Farst, Karen J; Valentine, Jimmie L; Hall, R Whit

2011-01-01

Estimates of the prevalence of drug usage during pregnancy vary by region and survey tool used. Clinicians providing care to newborns should be equipped to recognize a newborn who has been exposed to illicit drugs during pregnancy by the effects the exposure might cause at the time of delivery and/or by drug testing of the newborn. The purpose of this paper is to provide an overview of the literature and assess the clinical role of drug testing in the newborn. Accurate recognition of a newborn whose mother has used illicit drugs in pregnancy cannot only impact decisions for healthcare in the nursery around the time of delivery, but can also provide a key opportunity to assess the mother for needed services. While drug use in pregnancy is not an independent predictor of the mother's ability to provide a safe and nurturing environment for her newborn, other issues that often cooccur in the life of a mother with a substance abuse disorder raise concerns for the safety of the discharge environment and should be assessed. Healthcare providers in these roles should advocate for unbiased and effective treatment services for affected families.

49 CFR 232.505 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Pre-revenue service acceptance testing plan. 232... § 232.505 Pre-revenue service acceptance testing plan. (a) General; submission of plan. Except as... its system the operating railroad or railroads shall submit a pre-revenue service acceptance testing...

Sustained load performance of adhesive anchor systems in concrete

NASA Astrophysics Data System (ADS)

Davis, Todd Marshall

Stemming from a tragic failure of an adhesive anchor system, this research project investigated the sustained load performance of adhesive anchors in concrete under different installation and in-service conditions. The literature review investigated the current state of art of adhesive anchors. Extensive discussion was devoted to the behavior of adhesive anchors in concrete as well as the many factors that can affect their short-term and sustained load strength. Existing standards and specifications for the testing, design, construction, and inspection of adhesive anchors were covered. Based on the results of the literature review and the experience of the research group, a triage was conducted on many parameters identified as possibly affecting the sustained load performance of adhesive anchors and the highest priority parameters were investigated in this project. A stress versus time-to-failure approach was used to evaluate sensitivity of three ICC-ES AC 308 approved adhesive anchor systems. Of the various parameters investigated, only elevated in-service temperature and manufacturer's cure time was shown to exhibit adverse effects on sustained loads more than that predicted by short-term tests of fully cured adhesive over a reasonable structure lifetime of 75 years. In a related study, various tests were conducted on the adhesive alone (time-temperature superposition, time-stress superposition, and dogbone tensile tests). The results of that study were used to investigate the existence of a correlation with long-term anchor pullout testing in concrete. No consistent correlations were detected for the adhesives in the study. Tests were also conducted on the effect of early-age concrete on adhesive anchor bond strength. On the basis of confined test bond-strength alone, adhesive A (vinyl ester) did not show any significant increase after 14 days (102% of 28 day strength at 14 days), and adhesive B and C (epoxies) did not show any significant increase after 7 days (104% and 93% of 28 days strength at 7 days respectively). The results of this research were used to draft recommended standards and specifications for AASHTO pertaining to testing, design, construction, and inspection of adhesive anchors in concrete for transportation structures. These draft standards were not included in this dissertation.

Calgary Laboratory Services

PubMed Central

2015-01-01

Calgary Laboratory Services provides global hospital and community laboratory services for Calgary and surrounding areas (population 1.4 million) and global academic support for the University of Calgary Cumming School of Medicine. It developed rapidly after the Alberta Provincial Government implemented an austerity program to address rising health care costs and to address Alberta’s debt and deficit in 1994. Over roughly the next year, all hospital and community laboratory test funding within the province was put into a single budget, fee codes for fee-for-service test billing were closed, roughly 40% of the provincial laboratory budget was cut, and roughly 40% of the pathologists left the province of Alberta. In Calgary, in the face of these abrupt changes in the laboratory environment, private laboratories, publicly funded hospital laboratories and the medical school department precipitously and reluctantly merged in 1996. The origin of Calgary Laboratory Services was likened to an “unhappy shotgun marriage” by all parties. Although such a structure could save money by eliminating duplicated services and excess capacity and could provide excellent city-wide clinical service by increasing standardization, it was less clear whether it could provide strong academic support for a medical school. Over the past decade, iterations of the Calgary Laboratory Services model have been implemented or are being considered in other Canadian jurisdictions. This case study analyzes the evolution of Calgary Laboratory Services, provides a metric-based review of academic performance over time, and demonstrates that this model, essentially arising as an unplanned experiment, has merit within a Canadian health care context. PMID:28725754

Developing a discrete choice experiment in Malawi: eliciting preferences for breast cancer early detection services.

PubMed

Kohler, Racquel E; Lee, Clara N; Gopal, Satish; Reeve, Bryce B; Weiner, Bryan J; Wheeler, Stephanie B

2015-01-01

In Malawi, routine breast cancer screening is not available and little is known about women's preferences regarding early detection services. Discrete choice experiments are increasingly used to reveal preferences about new health services; however, selecting appropriate attributes that describe a new health service is imperative to ensure validity of the choice experiment. To identify important factors that are relevant to Malawian women's preferences for breast cancer detection services and to select attributes and levels for a discrete choice experiment in a setting where both breast cancer early detection and choice experiments are rare. We reviewed the literature to establish an initial list of potential attributes and levels for a discrete choice experiment and conducted qualitative interviews with health workers and community women to explore relevant local factors affecting decisions to use cancer detection services. We tested the design through cognitive interviews and refined the levels, descriptions, and designs. Themes that emerged from interviews provided critical information about breast cancer detection services, specifically, that breast cancer interventions should be integrated into other health services because asymptomatic screening may not be practical as an individual service. Based on participants' responses, the final attributes of the choice experiment included travel time, health encounter, health worker type and sex, and breast cancer early detection strategy. Cognitive testing confirmed the acceptability of the final attributes, comprehension of choice tasks, and women's abilities to make trade-offs. Applying a discrete choice experiment for breast cancer early detection was feasible with appropriate tailoring for a low-income, low-literacy African setting.

a Web Api and Web Application Development for Dissemination of Air Quality Information

NASA Astrophysics Data System (ADS)

Şahin, K.; Işıkdağ, U.

2017-11-01

Various studies have been carried out since 2005 under the leadership of Ministry of Environment and Urbanism of Turkey, in order to observe the quality of air in Turkey, to develop new policies and to develop a sustainable air quality management strategy. For this reason, a national air quality monitoring network has been developed providing air quality indices. By this network, the quality of the air has been continuously monitored and an important information system has been constructed in order to take precautions for preventing a dangerous situation. The biggest handicap in the network is the data access problem for instant and time series data acquisition and processing because of its proprietary structure. Currently, there is no service offered by the current air quality monitoring system for exchanging information with third party applications. Within the context of this work, a web service has been developed to enable location based querying of the current/past air quality data in Turkey. This web service is equipped with up-todate and widely preferred technologies. In other words, an architecture is chosen in which applications can easily integrate. In the second phase of the study, a web-based application was developed to test the developed web service and this testing application can perform location based acquisition of air-quality data. This makes it possible to easily carry out operations such as screening and examination of the area in the given time-frame which cannot be done with the national monitoring network.

Acoustic emission testing of composite vessels under sustained loading

NASA Technical Reports Server (NTRS)

Lark, R. F.; Moorhead, P. E.

1978-01-01

Acoustic emission (AE) tests have been conducted on small-diameter Kevlar 49/epoxy pressure vessels subjected to long-term sustained load-to-failure tests. Single-cycle burst tests were used as a basis for determining the test pressure in the sustained-loading tests. AE data from two vessel locations were compared. The data suggest that AE from vessel wall-mounted transducers is quite different for identical vessels subjected to the same pressure loading. AE from boss-mounted transducers yielded relatively consistent values. These values were not a function of time for vessel failure. The development of an AE test procedure for predicting the residual service life or integrity of composite vessels is discussed.

Field Testing Of An Expert Model: Can The Model Predict Habitat Potential For Saltmarsh Birds?

EPA Science Inventory

Salt marshes are valuable resources, which provide numerous ecosystem services, including flood protection, fish nursery habitat, and nesting habitat for a number of threatened and endangered species. At the present time, due primarily to coastal development and sea level rise,...

75 FR 67227 - Relocation Cost Sharing in the Broadcast Auxiliary Service

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-02

... relocating parties. In the process, the Commission balances the responsibilities for and benefits of... well as to balance the responsibilities for and benefits of relocating incumbent BAS operations among... adhere closely to these time-tested principles to balance the interest of incumbent licensees, new...

Iridium Short Burst Data: Two-Way, Robust, Reliable, Low Power Communications for Oceanographic Data Transmission Applications

NASA Astrophysics Data System (ADS)

Roggenstein, E. B.; Hensley, W.

2011-12-01

Over the past two hundred years, water level observations in coastal areas have been used to help mariners navigate oceans and estuaries, cartographers develop nautical charts, government agencies regulate boundaries, and scientists gain a better understanding of various physical processes in the ocean. As technology has progressed the latency in providing these data to the user has been reduced. The National Oceanic and Atmospheric Administration's (NOAA) Center for Operational Oceanographic Products and Services (CO-OPS) provides near real-time oceanographic and meteorological data to support navigation, coastal managers, and storm surge and tsunami warning programs. CO-OPS maintains the National Water Level Observation Network (NWLON), a system of over 200 stations for the coastal United States, Great Lakes, Caribbean islands, and Pacific island territories. CO-OPS also supports the NOAA Physical Oceanographic Real Time Systems° (PORTS), which are currently operating in 21 US ports. With an expanding role in Arctic and Alaska support, CO-OPS has identified a need for a robust and reliable data communications pathway to supplement the existing Geostationary Operational Environmental Systems (GOES) network, which has limitations at high latitudes. Iridium satellite Short Burst Data (SBD) services offer a global coverage, including remote Arctic regions outside of GOES coverage. Previous testing conducted by CO-OPS has shown a great potential for the SBD service including continuous near-real-time 6 minute data transmissions from two CO-OPS test water level stations located in Guam, with >99.9% data return. Also, successful transmissions of hourly wave statistics were demonstrated with a with a test system that employed a Nortek Acoustic Wave and Current (AWAC) instrument in Chesapeake Bay were accomplished. Data transmissions involved a buoy-mounted SIM-less SBD modem. Independent of location, data can be transmitted from a remote instrument platform to Iridium satellites with a latency of just 15 seconds. Successful test demonstrations have led to discussions regarding prospective work to integrate these small modems into CO-OPS current meters that are mounted on United States Coast Guard (USCG) Aid to Navigation (ATON) buoys, improving the reliability of the real-time transmission pathway between data collection and data reporting via PORTS °. Overall, this work has shown that with careful evaluation of data needs, commercial Iridium service can be economically used to accomplish telemetry requirements. It also shows potential for event-driven high frequency data transmission options, for applications such as marine warning systems. CO-OPS efforts to test and evaluate Iridium communications oceanographic observatories reported on here has been a collaborative endeavor with the United States Army Corp Engineers (USACE) Field Research Facility (FRF) in Duck, NC, the USACE Cold Regions Research Engineering Laboratory (CRREL) in Hanover, NH, NAL Research Inc, Sutron Corporation,and Nortek USA.

Fingerstroke time estimates for touchscreen-based mobile gaming interaction.

PubMed

Lee, Ahreum; Song, Kiburm; Ryu, Hokyoung Blake; Kim, Jieun; Kwon, Gyuhyun

2015-12-01

The growing popularity of gaming applications and ever-faster mobile carrier networks have called attention to an intriguing issue that is closely related to command input performance. A challenging mirroring game service, which simultaneously provides game service to both PC and mobile phone users, allows them to play games against each other with very different control interfaces. Thus, for efficient mobile game design, it is essential to apply a new predictive model for measuring how potential touch input compares to the PC interfaces. The present study empirically tests the keystroke-level model (KLM) for predicting the time performance of basic interaction controls on the touch-sensitive smartphone interface (i.e., tapping, pointing, dragging, and flicking). A modified KLM, tentatively called the fingerstroke-level model (FLM), is proposed using time estimates on regression models. Copyright © 2015 Elsevier B.V. All rights reserved.

An Empirical Study of the Impact of Service Quality on Patient Satisfaction in Private Hospitals, Iran

PubMed Central

Zarei, Ehsan; Daneshkohan, Abbas; Pouragha, Behrouz; Marzban, Sima; Arab, Mohammad

2015-01-01

Objective: Perceived service quality is the most important predictor of patient satisfaction. The purpose of this study was to investigate the impact of the service quality on the overall satisfaction of patients in private hospitals of Tehran, Iran. Method: This cross-sectional study was conducted in the year 2010. The study’s sample consisted of 969 patients who were recruited from eight private general hospitals in Tehran, Iran using consecutive sampling. A questionnaire was used for data collection; contacting 21 items (17 items about service quality and 4 items about overall satisfaction) and its validity and reliability were confirmed. Data analysis was performed using t-test, ANOVA and multivariate regression. Result: this study found a strong relationship between service quality and patient satisfaction. About 45% of the variance in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction. Conclusions: Constructs related to costs, delivery of service and interpersonal aspect of care had the most positive impact on overall satisfaction of patients. Managers and owners of private hospitals should set reasonable prices compared to the quality of service. In terms of process quality, waiting time for visits, admissions, and surgeries must be declined and services provided at the fastest possible time. It should be emphasized to strengthen of interpersonal aspects of care and communication skills of care providers. PMID:25560338

An empirical study of the impact of service quality on patient satisfaction in private hospitals, Iran.

PubMed

Zarei, Ehsan; Daneshkohan, Abbas; Pouragha, Behrouz; Marzban, Sima; Arab, Mohammad

2014-07-29

Perceived service quality is the most important predictor of patient satisfaction. The purpose of this study was to investigate the impact of the service quality on the overall satisfaction of patients in private hospitals of Tehran, Iran. This cross-sectional study was conducted in the year 2010. The study's sample consisted of 969 patients who were recruited from eight private general hospitals in Tehran, Iran using consecutive sampling. A questionnaire was used for data collection; contacting 21 items (17 items about service quality and 4 items about overall satisfaction) and its validity and reliability were confirmed. Data analysis was performed using t-test, ANOVA and multivariate regression. this study found a strong relationship between service quality and patient satisfaction. About 45% of the variance in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction. Constructs related to costs, delivery of service and interpersonal aspect of care had the most positive impact on overall satisfaction of patients. Managers and owners of private hospitals should set reasonable prices compared to the quality of service. In terms of process quality, waiting time for visits, admissions, and surgeries must be declined and services provided at the fastest possible time. It should be emphasized to strengthen of interpersonal aspects of care and communication skills of care providers.

Demand management and test request rationalization.

PubMed

Smellie, W S A

2012-07-01

Demand for laboratory testing is increasing disproportionately to medical activity, and the tests involved are becoming increasingly complex. When this phenomenon is seen in parallel with declining teaching of laboratory medicine in the medical curriculum, a need emerges to manage demand to avoid unnecessary expenditure and improve the use of laboratory services: 'the right test in the right patient at the right time.' Various methods have been tried to manage demand, with success depending on the medical context, type of health service and preintervention situation. Because many factors contribute to demand, and the different settings in which these exist, it is not realistic to meta-analyse the studies and we are limited to trying to identify trends in results in particular situations. The studies suggest that education combined with facilitating interventions, such as feedback, prompts and changes to laboratory request forms are the most successful. From the perspective of a whole health service, it is important that results are not exaggerated by assessing benefits in terms of total rather than marginal cost. It would be desirable, although difficult, to include the impact on downstream clinical activity caused or avoided by the interventions. Advances in information and web technology may make the elusive goal of achieving substantial demand control more achievable.

Just-in-time information improved decision-making in primary care: a randomized controlled trial.

PubMed

McGowan, Jessie; Hogg, William; Campbell, Craig; Rowan, Margo

2008-01-01

The "Just-in-time Information" (JIT) librarian consultation service was designed to provide rapid information to answer primary care clinical questions during patient hours. This study evaluated whether information provided by librarians to answer clinical questions positively impacted time, decision-making, cost savings and satisfaction. A randomized controlled trial (RCT) was conducted between October 2005 and April 2006. A total of 1,889 questions were sent to the service by 88 participants. The object of the randomization was a clinical question. Each participant had clinical questions randomly allocated to both intervention (librarian information) and control (no librarian information) groups. Participants were trained to send clinical questions via a hand-held device. The impact of the information provided by the service (or not provided by the service), additional resources and time required for both groups was assessed using a survey sent 24 hours after a question was submitted. The average time for JIT librarians to respond to all questions was 13.68 minutes/question (95% CI, 13.38 to 13.98). The average time for participants to respond their control questions was 20.29 minutes/question (95% CI, 18.72 to 21.86). Using an impact assessment scale rating cognitive impact, participants rated 62.9% of information provided to intervention group questions as having a highly positive cognitive impact. They rated 14.8% of their own answers to control question as having a highly positive cognitive impact, 44.9% has having a negative cognitive impact, and 24.8% with no cognitive impact at all. In an exit survey measuring satisfaction, 86% (62/72 responses) of participants scored the service as having a positive impact on care and 72% (52/72) indicated that they would use the service frequently if it were continued. In this study, providing timely information to clinical questions had a highly positive impact on decision-making and a high approval rating from participants. Using a librarian to respond to clinical questions may allow primary care professionals to have more time in their day, thus potentially increasing patient access to care. Such services may reduce costs through decreasing the need for referrals, further tests, and other courses of action. Controlled-Trials.com ISRCTN96823810.

Just-in-Time Information Improved Decision-Making in Primary Care: A Randomized Controlled Trial

PubMed Central

McGowan, Jessie; Hogg, William; Campbell, Craig; Rowan, Margo

2008-01-01

Background The “Just-in-time Information” (JIT) librarian consultation service was designed to provide rapid information to answer primary care clinical questions during patient hours. This study evaluated whether information provided by librarians to answer clinical questions positively impacted time, decision-making, cost savings and satisfaction. Methods and Finding A randomized controlled trial (RCT) was conducted between October 2005 and April 2006. A total of 1,889 questions were sent to the service by 88 participants. The object of the randomization was a clinical question. Each participant had clinical questions randomly allocated to both intervention (librarian information) and control (no librarian information) groups. Participants were trained to send clinical questions via a hand-held device. The impact of the information provided by the service (or not provided by the service), additional resources and time required for both groups was assessed using a survey sent 24 hours after a question was submitted. The average time for JIT librarians to respond to all questions was 13.68 minutes/question (95% CI, 13.38 to 13.98). The average time for participants to respond their control questions was 20.29 minutes/question (95% CI, 18.72 to 21.86). Using an impact assessment scale rating cognitive impact, participants rated 62.9% of information provided to intervention group questions as having a highly positive cognitive impact. They rated 14.8% of their own answers to control question as having a highly positive cognitive impact, 44.9% has having a negative cognitive impact, and 24.8% with no cognitive impact at all. In an exit survey measuring satisfaction, 86% (62/72 responses) of participants scored the service as having a positive impact on care and 72% (52/72) indicated that they would use the service frequently if it were continued. Conclusions In this study, providing timely information to clinical questions had a highly positive impact on decision-making and a high approval rating from participants. Using a librarian to respond to clinical questions may allow primary care professionals to have more time in their day, thus potentially increasing patient access to care. Such services may reduce costs through decreasing the need for referrals, further tests, and other courses of action. Trial Registration Controlled-Trials.com ISRCTN96823810 PMID:19023446

A Strategy for Reforming Avionics Acquisition and Support

DTIC Science & Technology

1988-07-01

are observable: " Some problems manifest symptoms in one operating mode but not in another. The pilot directly controls some radar operating modes by...for each flight. Their removals occurred in the flight controls , inertial navigation, head-up display, radar, and instru- ments. Although removals...accrue a comparable amount of service time. 6Automatic stations can test 50 LRU types although the Air Force has chosen to test only 37 of them at the

Joint Services Electronics Program.

DTIC Science & Technology

1983-04-01

shape of the photon-assisted tunneling features and of their dependence on laser power. The cleanest test of the theory was made at 4.2 K, above T...Properties of Small-area Tunnel Junctions by research unit 2; Nonequilibrium Switching Phenomena on Picosecond Time Scales by research unit 2; Liquid...ocean, with the lower ends grounded or joined by a third conductor in a tunnel through the mountain has been suc-Tested. A theoretical and experimental

Direct-to-consumer sales of genetic services on the Internet.

PubMed

Gollust, Sarah E; Wilfond, Benjamin S; Hull, Sara Chandros

2003-01-01

PURPOSE The increasing use of the Internet to obtain genetics information and to order medical services without a prescription, combined with a rise in direct-to-consumer marketing for genetic testing, suggests the potential for the Internet to be used to sell genetic services. METHODS A systematic World Wide Web search was conducted in May 2002 to assess the availability of genetic services sold directly to consumers on the Internet. RESULTS Out of 105 sites that offered genetic services directly, most offered non-health-related services, including parentage confirmation testing (83%), identity testing (56%), and DNA banking (24%); however, health-related genetic tests were offered through 14 sites (13%). The health-related genetic tests available ranged from standard tests, such as hemochromatosis and cystic fibrosis, to more unconventional tests related to nutrition, behavior, and aging. Of these 14 sites, 5 described risks associated with the genetic services and 6 described the availability of counseling. CONCLUSIONS The availability of direct sales of health-related genetic tests creates the potential for inadequate pretest decision making, misunderstanding test results, and access to tests of questionable clinical value.

Direct-to-consumer sales of genetic services on the Internet

PubMed Central

Gollust, Sarah E.; Wilfond, Benjamin S.; Hull, Sara Chandros

2016-01-01

Purpose The increasing use of the Internet to obtain genetics information and to order medical services without a prescription, combined with a rise in direct-to-consumer marketing for genetic testing, suggests the potential for the Internet to be used to sell genetic services. Methods A systematic World Wide Web search was conducted in May 2002 to assess the availability of genetic services sold directly to consumers on the Internet. Results Out of 105 sites that offered genetic services directly, most offered non–health-related services, including parentage confirmation testing (83%), identity testing (56%), and DNA banking (24%); however, health-related genetic tests were offered through 14 sites (13%). The health-related genetic tests available ranged from standard tests, such as hemochromatosis and cystic fibrosis, to more unconventional tests related to nutrition, behavior, and aging. Of these 14 sites, 5 described risks associated with the genetic services and 6 described the availability of counseling. Conclusions The availability of direct sales of health-related genetic tests creates the potential for inadequate pretest decision making, misunderstanding test results, and access to tests of questionable clinical value. PMID:12865763

Laboratory Test Utilization Management: General Principles and Applications in Hematopathology.

PubMed

Reichard, Kaaren K; Wood, Adam J

2016-03-01

As the cost of health care continues to rise and reimbursement rates decrease, there is a growing demand and need to cut overall costs, enhance quality of services, and maintain as a top priority the needs and safety of the patient. In this article, we provide an introduction to test utilization and outline a general approach to creating an efficient, cost-effective test utilization strategy. We also present and discuss 2 test utilization algorithms that are evidence-based and may be of clinical utility as we move toward the future of doing the necessary tests at the right time. Copyright © 2016 Elsevier Inc. All rights reserved.

Advanced Protection & Service Restoration for FREEDM Systems

NASA Astrophysics Data System (ADS)

Singh, Urvir

A smart electric power distribution system (FREEDM system) that incorporates DERs (Distributed Energy Resources), SSTs (Solid State Transformers - that can limit the fault current to two times of the rated current) & RSC (Reliable & Secure Communication) capabilities has been studied in this work in order to develop its appropriate protection & service restoration techniques. First, a solution is proposed that can make conventional protective devices be able to provide effective protection for FREEDM systems. Results show that although this scheme can provide required protection but it can be quite slow. Using the FREEDM system's communication capabilities, a communication assisted Overcurrent (O/C) protection scheme is proposed & results show that by using communication (blocking signals) very fast operating times are achieved thereby, mitigating the problem of conventional O/C scheme. Using the FREEDM System's DGI (Distributed Grid Intelligence) capability, an automated FLISR (Fault Location, Isolation & Service Restoration) scheme is proposed that is based on the concept of 'software agents' & uses lesser data (than conventional centralized approaches). Test results illustrated that this scheme is able to provide a global optimal system reconfiguration for service restoration.

77 FR 64366 - Market Test of Experimental Product-Metro Post

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-19

... POSTAL SERVICE Market Test of Experimental Product--Metro Post AGENCY: Postal Service TM . ACTION: Notice. SUMMARY: The Postal Service gives notice of a market test of an experimental product in... Service[supreg] hereby gives notice that, pursuant to 39 U.S.C. 3641(c)(1), it will begin a market test of...

A Strategy toward Collaborative Filter Recommended Location Service for Privacy Protection

PubMed Central

Wang, Peng; Yang, Jing; Zhang, Jianpei

2018-01-01

A new collaborative filtered recommendation strategy was proposed for existing privacy and security issues in location services. In this strategy, every user establishes his/her own position profiles according to their daily position data, which is preprocessed using a density clustering method. Then, density prioritization was used to choose similar user groups as service request responders and the neighboring users in the chosen groups recommended appropriate location services using a collaborative filter recommendation algorithm. The two filter algorithms based on position profile similarity and position point similarity measures were designed in the recommendation, respectively. At the same time, the homomorphic encryption method was used to transfer location data for effective protection of privacy and security. A real location dataset was applied to test the proposed strategy and the results showed that the strategy provides better location service and protects users’ privacy. PMID:29751670

A Strategy toward Collaborative Filter Recommended Location Service for Privacy Protection.

PubMed

Wang, Peng; Yang, Jing; Zhang, Jianpei

2018-05-11

A new collaborative filtered recommendation strategy was proposed for existing privacy and security issues in location services. In this strategy, every user establishes his/her own position profiles according to their daily position data, which is preprocessed using a density clustering method. Then, density prioritization was used to choose similar user groups as service request responders and the neighboring users in the chosen groups recommended appropriate location services using a collaborative filter recommendation algorithm. The two filter algorithms based on position profile similarity and position point similarity measures were designed in the recommendation, respectively. At the same time, the homomorphic encryption method was used to transfer location data for effective protection of privacy and security. A real location dataset was applied to test the proposed strategy and the results showed that the strategy provides better location service and protects users' privacy.

Changes in abortion service provision in Bihar and Jharkhand states, India between 2004 and 2013

PubMed Central

Singh, Kaushalendra K.; Li, Qingfeng; Fruhauf, Timothee; Tsui, Amy O.

2018-01-01

Background The Medical Termination of Pregnancy (MTP) Act of 1971 liberalized abortion laws in India. This study examines changes in abortion service provision and characteristics of abortion providers in Bihar and Jharkhand states, India between 2004 and 2013. Methods We used state-representative data from cross-sectional surveys of reproductive health service providers we conducted in 2004 (N = 1,323) and 2012/2013 (N = 1,020). We employed chi-squared tests to examine and compare abortion providers’ characteristics, and fitted separate multivariate logistic regression models for provision of surgical, medical, and any abortion services, respectively, adjusting for potential confounders to identify factors associated with abortion service provision at the two survey time points. Results Of providers interviewed in 2004 and 2012/2013, 63.7% and 84.5%, respectively, offered abortion services. Among abortion providers, 21.1% offered surgical and 10.7% offered medical abortions in 2004; 15.8% and 94.1% did so, respectively, in 2012/2013. Private providers were more likely than public providers to offer abortion services at both time points. Compared to female providers, male providers were significantly less likely to provide both surgical and medical abortions in 2004, and significantly less likely to provide surgical abortions in 2012/2013. Pharmacists and community health workers played increasingly important roles in abortion service provision, especially medical abortion, during the period. Conclusion This study documents important changes in abortion provision in the two Indian states during 2004–2013. PMID:29879132

Designing testing service at baristand industri Medan’s liquid waste laboratory

NASA Astrophysics Data System (ADS)

Kusumawaty, Dewi; Napitupulu, Humala L.; Sembiring, Meilita T.

2018-03-01

Baristand Industri Medan is a technical implementation unit under the Industrial and Research and Development Agency, the Ministry of Industry. One of the services often used in Baristand Industri Medan is liquid waste testing service. The company set the standard of service is nine working days for testing services. At 2015, 89.66% on testing services liquid waste does not meet the specified standard of services company because of many samples accumulated. The purpose of this research is designing online services to schedule the coming the liquid waste sample. The method used is designing an information system that consists of model design, output design, input design, database design and technology design. The results of designing information system of testing liquid waste online consist of three pages are pages to the customer, the recipient samples and laboratory. From the simulation results with scheduled samples, then the standard services a minimum of nine working days can be reached.

The two-sample problem with induced dependent censorship.

PubMed

Huang, Y

1999-12-01

Induced dependent censorship is a general phenomenon in health service evaluation studies in which a measure such as quality-adjusted survival time or lifetime medical cost is of interest. We investigate the two-sample problem and propose two classes of nonparametric tests. Based on consistent estimation of the survival function for each sample, the two classes of test statistics examine the cumulative weighted difference in hazard functions and in survival functions. We derive a unified asymptotic null distribution theory and inference procedure. The tests are applied to trial V of the International Breast Cancer Study Group and show that long duration chemotherapy significantly improves time without symptoms of disease and toxicity of treatment as compared with the short duration treatment. Simulation studies demonstrate that the proposed tests, with a wide range of weight choices, perform well under moderate sample sizes.

Service-learning's impact on dental students' attitude towards community service.

PubMed

Coe, J M; Best, A M; Warren, J J; McQuistan, M R; Kolker, J L; Isringhausen, K T

2015-08-01

This study evaluated service-learning programme's impact on senior dental students' attitude towards community service at Virginia Commonwealth University (VCU) School of Dentistry. Experience gained through service-learning in dental school may positively impact dental students' attitude towards community service that will eventually lead into providing care to the underserved. Two surveys (pre- and post-test) were administered to 105 senior dental students. For the first survey (post-test), seventy-six students of 105 responded and reported their attitude towards community service immediately after the service-learning programme completion. Three weeks later, 56 students of the 76 responded to the second survey (retrospective pre-test) and reported their recalled attitude prior to the programme retrospectively. A repeated-measure mixed-model analysis indicated that overall there was improvement between pre-test and post-test. Scales of connectedness, normative helping behaviour, benefits, career benefits and intention showed a significant pre-test and post-test difference. An association between attitude towards community service and student characteristics such as age, gender, ethnicity and volunteer activity was also examined. Only ethnicity showed an overall significant difference. White dental students appear to have a differing perception of the costs of community service. The service-learning programme at VCU School of Dentistry has positively impacted senior dental students' attitude towards community service. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Service-learning’s Impact on Dental Students’ Attitude toward Community Service

PubMed Central

Coe, J. M.; Best, A. M.; Warren, J. J.; McQuistan, M. R.; Kolker, J. L.; Isringhausen, K. T.

2014-01-01

Introduction This study evaluated service-learning program’s impact on senior dental students’ attitude toward community service at Virginia Commonwealth University (VCU) School of Dentistry. Experience gained through service-learning in dental school may positively impact dental students’ attitude toward community service that will eventually lead into providing care to the underserved. Materials and methods Two surveys (pre and post-test) were administered to 105 senior dental students. For the first survey (post-test), seventy six students out of 105 responded and reported their attitude toward community service immediately after the service-learning program completion. Three weeks later, fifty six students out of the 76 responded to the second survey (retrospective pre-test) and reported their recalled attitude prior to the program retrospectively. Results A repeated-measure mixed-model analysis indicated that overall there was improvement between pre-test and post-test. Scales of connectedness, normative helping behavior, benefits1, career benefits, and intention showed a significant pre-test and post-test difference. An association between attitude toward community service and student characteristics such as age, gender, ethnicity, and volunteer activity was also examined. Only ethnicity showed an overall significant difference. White dental students appear to have a differing perception of the costs of community service. Conclusions The service-learning program at VCU School of Dentistry has positively impacted senior dental students’ attitude toward community service. PMID:25142286

Are there any differences between different testing sites? A cross-sectional study of a Norwegian low-threshold HIV testing service for men who have sex with men.

PubMed

Moseng, Bera Ulstein; Bjørnshagen, Vegar

2017-10-06

To describe a Norwegian low-threshold HIV testing service targeting men who have sex with men (MSM). After the HIV testing consultation, all users of the HIV testing service were invited to answer the study questionnaire. The study setting included the sites where testing was performed, that is, the testing service's office in Oslo, cruising areas, bars/clubs and in hotels in other Norwegian cities. MSM users of the testing service. Data were collected on demographics, HIV testing and sexual behaviour as well as the participant's motivations for choosing to take an HIV test at this low-threshold HIV testing service. The data are stratified by testing site. 1577 HIV testing consultations were performed, the study sample consisted of 732 MSM users. 11 tested positive for HIV. 21.7% had a non-western background, 27.1% reported having a non-gay sexual orientation. 21.9% had 10 or more male sexual partners during the last year, 27.9% reported also having had a female sexual partner. 56.4% reported having practised unprotected anal intercourse during the last 6 months. 20.1% had never tested for HIV before. Most of these user characteristics varied by testing sites. The Norwegian low-threshold testing service recruits target groups that are otherwise hard to reach with HIV testing. This may indicate that the testing service contributes to increase HIV testing rates among MSM in Norway. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

HMO penetration and quality of care: the case of breast cancer.

PubMed

Decker, S L; Hempstead, K

1999-01-01

In theory, health maintenance organizations (HMOs) receiving a fixed payment rate per enrolled member have an incentive to coordinate services and emphasize prevention and early detection of disease in order to minimize costs of care. This article tests whether higher HMO penetration rates across counties in the United States and across time improve the use of mammography services, the chance of early rather than late detection of breast cancer, and ultimately improve breast cancer survival. We use two data sets to test the effect of HMO penetration on use of breast cancer services and on breast cancer health outcomes for women aged 55 to 64 years. These data sources are matched with county-level data on HMO penetration and other market variables from the Bureau of Health Profession's Area Resource File. Results of logit regression show evidence that HMO penetration positively affects the probability of recent mammography receipt. However, we do not find a statistically significant relationship between HMO penetration and either stage of diagnosis or breast cancer survival.

Flight service evaluation of composite helicopter components

NASA Technical Reports Server (NTRS)

Mardoian, George H.; Ezzo, Maureen B.

1994-01-01

This paper presents the results of a NASA funded contract and Sikorsky research and development programs to evaluate structural composite components in flight service on Sikorsky Model S-76 helicopters. Selected components were removed and tested at prescribed intervals over a nine year time frame. Four horizontal stabilizers and thirteen tail rotor spars were returned from commercial service in West Palm Beach, Florida and in the Gulf Coast region of Louisiana to determine the long term effects of operations in hot and humid climates on component performance. Concurrent with the flight component evaluation, panels of materials used in their fabrication were exposed to the environment in ground racks. Selected panels were tested annually to determine the effects of exposure on physical and mechanical properties. The results of 55,741 component flight hours and 911 months of field exposure are reported and compared with initial Federal Aviation Administration (FAA) certification data. The findings of this program have provided increased confidence in the long term durability of advanced composite materials used in helicopter structural applications.

Utilizing Remote Real-Time Videoconferencing to Expand Access to Cancer Genetic Services in Community Practices: A Multicenter Feasibility Study.

PubMed

Bradbury, Angela; Patrick-Miller, Linda; Harris, Diana; Stevens, Evelyn; Egleston, Brian; Smith, Kyle; Mueller, Rebecca; Brandt, Amanda; Stopfer, Jill; Rauch, Shea; Forman, Andrea; Kim, Rebecca; Fetzer, Dominique; Fleisher, Linda; Daly, Mary; Domchek, Susan

2016-02-01

Videoconferencing has been used to expand medical services to low-access populations and could increase access to genetic services at community sites where in-person visits with genetic providers are not available. To evaluate the feasibility of, patient feedback of, and cognitive and affective responses to remote two-way videoconferencing (RVC) telegenetic services at multiple sociodemographically diverse community practices without access to genetic providers. Patients at 3 community sites in 2 US states outside the host center completed RVC pretest (visit 1, V1) and post-test (visit 2, V2) genetic counseling for cancer susceptibility. Surveys evaluated patient experiences, knowledge, satisfaction with telegenetic and cancer genetics services, anxiety, depression, and cancer worry. A total of 82 out of 100 (82.0%) approached patients consented to RVC services. A total of 61 out of 82 patients (74%) completed pretest counseling and 41 out of 61 (67%) proceeded with testing and post-test counseling. A total of 4 out of 41 (10%) mutation carriers were identified: BRCA2, MSH2, and PMS2. Patients reported many advantages (eg, lower travel burden and convenience) and few disadvantages to RVC telegenetic services. Most patients reported feeling comfortable with the video camera--post-V1: 52/57 (91%); post-V2: 39/41 (95%)--and that their privacy was respected--post-V1: 56/57 (98%); post-V2: 40/41 (98%); however, some reported concerns that RVC might increase the risk of a confidentiality breach of their health information--post-V1: 14/57 (25%); post-V2: 12/41 (29%). While the majority of patients reported having no trouble seeing or hearing the genetic counselor--post-V1: 47/57 (82%); post-V2: 39/41 (95%)--51 out of 98 (52%) patients reported technical difficulties. Nonetheless, all patients reported being satisfied with genetic services. Compared to baseline, knowledge increased significantly after pretest counseling (+1.11 mean score, P=.005); satisfaction with telegenetic (+1.74 mean score, P=.02) and genetic services (+2.22 mean score, P=.001) increased after post-test counseling. General anxiety and depression decreased after pretest (-0.97 mean anxiety score, P=.003; -0.37 mean depression score, P=.046) and post-test counseling (-1.13 mean anxiety score, P=.003; -0.75 mean depression score, P=.01); state anxiety and cancer-specific worry did not significantly increase. Remote videoconferencing telegenetic services are feasible, identify genetic carriers in community practices, and are associated with high patient satisfaction and favorable cognitive and affective outcomes, suggesting an innovative delivery model for further study to improve access to genetic providers and services. Potential barriers to dissemination include technology costs, unclear billing and reimbursement, and state requirements for provider licensure.

An Accelerated Method for Soldering Testing

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

Han, Qingyou; Xu, Hanbing; Ried, Paul

2007-01-01

An accelerated method for testing die soldering has been developed. High intensity ultrasonic vibrations have been applied to simulate the die casting conditions such as high pressure and high molten metal velocity on the pin. The soldering tendency of steels and coated pins has been examined. The results suggest that in the low carbon steel/Al system, the onset of soldering is 60 times faster with ultrasonic vibration than that without ultrasonic vibration. In the H13/A380 system, the onset of soldering reaction is accelerated to between 30-60 times. Coatings significantly reduce the soldering tendency. For purposes of this study, several commercialmore » coatings from Balzers demonstrated the potential for increasing the service life of core pins between 15 and 180 times.« less

Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing.

PubMed

Wenzel, Suzanne L; Rhoades, Harmony; Harris, Taylor; Winetrobe, Hailey; Rice, Eric; Henwood, Ben

2017-05-01

Homeless persons suffer disproportionately high rates of HIV infection, and moving into permanent supportive housing (PSH) can provide a stable base from which to access needed prevention services. However, little is known about HIV risk or prevention behavior during this critical time of transition. The current study investigated STI and HIV risk and prevention behavior and recent use of prevention and treatment services (i.e., education, testing, medication) among homeless persons preparing to move into PSH. Data come from interviews with 421 homeless adults before they moved into PSH. Thirty-seven percent of the respondents were sexually active; of those, 75.7% reported unprotected sex. Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing for another STI. Fewer than one-third (31%) of respondents reported receiving posttest counseling at their last HIV test. HIV seropositivity was self-reported by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100% antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the sample reported any HIV prevention education in the past year. This population of homeless adults about to move into PSH report high rates of HIV risk behavior, but low rates of HIV prevention education and very little PrEP utilization. Further, low rates of ARV adherence among HIV-positive respondents indicate significant risk for HIV transmission and acquisition. Entering PSH is a period of transition for homeless persons when integrated care is critically important to ensure positive health outcomes, but these data suggest that PrEP and other HIV prevention services are poorly accessed among this population. As such, multipronged services that integrate PrEP and other HIV prevention services are needed to prevent transmission and acquisition of HIV in this high-risk, vulnerable population and ensure the health and wellbeing of PSH residents.

46 CFR 61.05-10 - Boilers in service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... question, shall be subjected to a hydrostatic test of 11/2 times the maximum allowable working pressure... pressure. (d) In applying hydrostatic pressure to boilers, arrangements shall be made to prevent main and auxiliary stop valves from being simultaneously subjected to the hydrostatic pressure on one side and steam...

Through the Looking Glass: One School's Reflection on Differentiation

ERIC Educational Resources Information Center

Tieso, Carol

2004-01-01

Teachers must deal with a diversity of students' abilities, strengths, and interests in their classrooms while at the same time covering the material, prepping students for standardized tests, and preparing themselves to be "highly qualified." Legislation requiring services for gifted and talented students and the paucity of quality programs for…

46 CFR 4.06-1 - Responsibilities of the marine employer.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Responsibilities of the marine employer. 4.06-1 Section... MARINE CASUALTIES AND INVESTIGATIONS Mandatory Chemical Testing Following Serious Marine Incidents Involving Vessels in Commercial Service § 4.06-1 Responsibilities of the marine employer. (a) At the time of...

46 CFR 4.06-1 - Responsibilities of the marine employer.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Responsibilities of the marine employer. 4.06-1 Section... MARINE CASUALTIES AND INVESTIGATIONS Mandatory Chemical Testing Following Serious Marine Incidents Involving Vessels in Commercial Service § 4.06-1 Responsibilities of the marine employer. (a) At the time of...

46 CFR 4.06-1 - Responsibilities of the marine employer.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Responsibilities of the marine employer. 4.06-1 Section... MARINE CASUALTIES AND INVESTIGATIONS Mandatory Chemical Testing Following Serious Marine Incidents Involving Vessels in Commercial Service § 4.06-1 Responsibilities of the marine employer. (a) At the time of...

46 CFR 4.06-1 - Responsibilities of the marine employer.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Responsibilities of the marine employer. 4.06-1 Section... MARINE CASUALTIES AND INVESTIGATIONS Mandatory Chemical Testing Following Serious Marine Incidents Involving Vessels in Commercial Service § 4.06-1 Responsibilities of the marine employer. (a) At the time of...

46 CFR 4.06-1 - Responsibilities of the marine employer.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Responsibilities of the marine employer. 4.06-1 Section... MARINE CASUALTIES AND INVESTIGATIONS Mandatory Chemical Testing Following Serious Marine Incidents Involving Vessels in Commercial Service § 4.06-1 Responsibilities of the marine employer. (a) At the time of...

Exploring the Potential of In-Service Training through Distance Education.

ERIC Educational Resources Information Center

Kelsey, Timothy W.; Mincemoyer, Claudia C.

2001-01-01

Survey responses from 228 Pennsylvania extension staff revealed time- or travel-related reasons inhibited inservice participation. They preferred regional locations over any other, though they were receptive to having some inservice programs delivered using distance education technologies. A pilot test of quarterly satellite inservice programs was…

Program for establishing long-time flight service performance of composite materials in the center wing structure of C-130 aircraft. Phase 1: Advanced development

NASA Technical Reports Server (NTRS)

Harvill, W. E.; Kays, A. O.; Young, E. C.; Mcgee, W. M.

1972-01-01

Areas where selective reinforcement of conventional metallic structure can improve static strength/fatigue endurance at lower weight than would be possible if metal reinforcement were used are discussed. These advantages are now being demonstrated by design, fabrication, and tests of three boron-epoxy reinforced C-130E center wing boxes. This structural component was previously redesigned using an aluminum build-up to meet increased severity of fatigue loadings. Direct comparisons of relative structural weights, manufacturing costs, and producibility can therefore be obtained, and the long-time flight service performance of the composite reinforced structure can be evaluated against the wide background of metal reinforced structure.

Data federation strategies for ATLAS using XRootD

NASA Astrophysics Data System (ADS)

Gardner, Robert; Campana, Simone; Duckeck, Guenter; Elmsheuser, Johannes; Hanushevsky, Andrew; Hönig, Friedrich G.; Iven, Jan; Legger, Federica; Vukotic, Ilija; Yang, Wei; Atlas Collaboration

2014-06-01

In the past year the ATLAS Collaboration accelerated its program to federate data storage resources using an architecture based on XRootD with its attendant redirection and storage integration services. The main goal of the federation is an improvement in the data access experience for the end user while allowing more efficient and intelligent use of computing resources. Along with these advances come integration with existing ATLAS production services (PanDA and its pilot services) and data management services (DQ2, and in the next generation, Rucio). Functional testing of the federation has been integrated into the standard ATLAS and WLCG monitoring frameworks and a dedicated set of tools provides high granularity information on its current and historical usage. We use a federation topology designed to search from the site's local storage outward to its region and to globally distributed storage resources. We describe programmatic testing of various federation access modes including direct access over the wide area network and staging of remote data files to local disk. To support job-brokering decisions, a time-dependent cost-of-data-access matrix is made taking into account network performance and key site performance factors. The system's response to production-scale physics analysis workloads, either from individual end-users or ATLAS analysis services, is discussed.

Preventative services offered by veterinarians on sheep farms in England and Wales: Opinions and drivers for proactive flock health planning.

PubMed

Bellet, Camille; Woodnutt, Joanna; Green, Laura E; Kaler, Jasmeet

2015-12-01

Recent independent UK government reports and studies have highlighted the importance, but lack, of flock health services provided by veterinarians. Qualitative interviews were analysed by thematic analysis to construct belief statements to understand veterinarians' opinions on preventative advice and drivers for current services to sheep farmers. A postal questionnaire was sent to 515 sheep practices registered with the Royal College of Veterinary Surgeon (RCVS) in England and Wales in 2012 to gather quantitative data on these belief statements and to gather demographic information and current services provided by the veterinarian. Exploratory factor analysis with heuristic approaches was conducted on the respondents' belief statements to identify common factors of veterinarian beliefs. Three main factors were identified: motivation for proactiveness, perceived capability to offer preventative services and perceived opportunity to deliver these services. A beta regression model was built to identify the factors significantly associated with the time veterinarians spent in an advisory role. The relative proportion of time increased by 10% (1.01-1.19), 16% (1.03-1.30) and 29% (CI: 1.09-1.53) for each unit increase in score for factor 1 motivation, factor 2 capability and factor 3 opportunity respectively, indicating that these latent factors explained time veterinarians spent in an advisory role with sheep clients. There was a significant correlation between these factors suggesting influence of the associated beliefs between factors. This study provides insight into the nature and drivers of veterinarians' current behaviour and beliefs. These results could be further tested in behaviour intervention studies and help in designing efficient strategies aiming at promoting proactive health services offered by veterinarians on sheep farms in England and Wales. Copyright © 2015 Elsevier B.V. All rights reserved.

Integrating Windblown Dust Forecasts with Public Safety and Health Systems

NASA Astrophysics Data System (ADS)

Sprigg, W. A.

2014-12-01

Experiments in real-time prediction of desert dust emissions and downstream plume concentrations (~ 3.5 km near-surface spatial resolution) succeed to the point of challenging public safety and public health services to beta test a dust storm warning and advisory system in lowering risks of highway and airline accidents and illnesses such as asthma and valley fever. Key beta test components are: high-resolution models of dust emission, entrainment and diffusion, integrated with synoptic weather observations and forecasts; satellite-based detection and monitoring of soil properties on the ground and elevated above; high space and time resolution for health surveillance and transportation advisories.

Preventing Mother-to-Child Transmission of HIV in Resource-Limited Settings: The Elizabeth Glaser Pediatric AIDS Foundation Experience

PubMed Central

Sripipatana, Tabitha; Turner, Abigail Norris; Hoblitzelle, Chuck; Robinson, Joanna; Wilfert, Catherine

2009-01-01

Objectives. In September 1999, the Elizabeth Glaser Pediatric AIDS Foundation initiated a multicountry, service-based programmatic effort in the developing world to reduce perinatally acquired HIV infection. We review 6½ years of one of the world's largest programs for the prevention of mother-to-child transmission (PMTCT) of HIV. Methods. Each PMTCT facility records patient data in antenatal clinics and labor and delivery settings about counseling, testing, HIV status, and antiretroviral prophylaxis and submits the data to foundation staff. Results. More than 2.6 million women have accessed foundation-affiliated services through June 2006. Overall, 92.9% of women who received antenatal care or were eligible for PMTCT services in labor and delivery have been counseled, and 82.8% of those counseled accepted testing. Among women identified as HIV positive, 75.0% received antiretroviral prophylaxis (most a single dose of nevirapine), as did 45.6% of their infants. Conclusions. The foundation's experience has demonstrated that opt-out testing, supplying mothers with medication at time of diagnosis, and providing the infant dose early have measurably improved program efficiency. PMTCT should be viewed as an achievable paradigm and an essential part of the continuum of care. PMID:18703458

HIV prevalence, attitudes and behaviour in clients of a confidential HIV testing and counselling centre in Uganda.

PubMed

Müller, O; Barugahare, L; Schwartländer, B; Byaruhanga, E; Kataaha, P; Kyeyune, D; Heckmann, W; Ankrah, M

1992-08-01

To describe clients, operation and impact of an African public HIV testing and counselling centre. Analysis of samples from clients attending the AIDS Information Centre (AIC) in Kampala, Uganda in early 1991. HIV-1-positive and HIV-negative consecutive clients (250 of each), 86 consecutive couples, and 200 consecutive clients who were HIV-negative in 1990 and were attending for their repeat test. HIV seroprevalence rates, attitudes, behaviour and behaviour change. HIV-1 prevalence was 28% overall, 24% in men and 35% in women. Reasons for taking the HIV test were a planned marriage or a new relationship (27%; 84% in couples), to plan for the future (35%), distrust of sexual partner (14%) and illness or disease/death (not HIV-specific) of partner (20%). The majority of the reported intentions in response to a positive or a negative HIV test result were positive, demonstrating the ability to cope with this information. Of repeat clients, two (1%) had become HIV-1-positive. The majority of repeat clients reported one sexual partner only (67%) or sexual abstinence (25%). Compared with pre-test information from AIC clients attending for the first time, repeat clients reported casual sexual contacts less often (6 versus 25%) and, of those, the majority used condoms. Our study demonstrates the demand for and the feasibility of confidential HIV testing and counseling services in Uganda, and illustrates the value of these services in achieving behaviour changes. Such services should be considered an additional approach for the reduction of HIV transmission in Africa, especially in areas with high HIV seroprevalence rates.

Key messages for communicating information about BRCA1 and BRCA2 to women with breast or ovarian cancer: Consensus across health professionals and service users.

PubMed

Jacobs, Chris; Pichert, Gabriella; Harris, Jackie; Tucker, Kathy; Michie, Susan

2017-11-01

Genetic testing of cancer predisposing genes will increasingly be needed in oncology clinics to target cancer treatment. This Delphi study aimed to identify areas of agreement and disagreement between genetics and oncology health professionals and service users about the key messages required by women with breast/ovarian cancer who undergo BRCA1/BRCA2 genetic testing and the optimal timing of communicating key messages. Participants were 16 expert health professionals specialising in oncology/genetics and 16 service users with breast/ovarian cancer and a pathogenic BRCA1/BRCA2 variant. Online questionnaires containing 53 inductively developed information messages were circulated to the groups separately. Participants rated each message as key/not key on a Likert scale and suggested additional messages. Questionnaires were modified according to the feedback and up to 3 rounds were circulated. Consensus was reached when there was ≥75% agreement. Thirty key messages were agreed by both groups with 7 of the key messages agreed by ≥95% of participants: dominant inheritance, the availability of predictive testing, the importance of pretest discussion, increased risk of breast and ovarian cancer, and the option of risk-reducing mastectomy and bilateral salpingo-oophorectomy. Both groups agreed that key messages should be communicated before genetic testing and once a pathogenic variant has been identified. There was a high level of agreement within and between the groups about the information requirements of women with breast/ovarian cancer about BRCA1/BRCA2. These key messages will be helpful in developing new approaches to the delivery of information as genetic testing becomes further integrated into mainstream oncology services. Copyright © 2017 John Wiley & Sons, Ltd.

Dissatisfaction with cardiovascular health and primary health care services: Southern Mani, isolated area in Europe. A case study.

PubMed

Mariolis, Anargiros; Mihas, Constantinos; Alevizos, Alevizos; Mariolis-Sapsakos, Theodoros; Sergentanis, Theodoros N; Kalogerakos, Nikolaos; Virvilis, Christos; Fourkas, Constantinos; Skandalakis, Panayiotis; Stefanadis, Christodoulos

2008-01-01

Access to local providers of primary health care (PHC) services and their utilisation is a challenge faced by the authorities of developed as well as developing countries. The aim of our study was to assess and evaluate the level of satisfaction with the currently provided cardiovascular and PHC services in the southernmost region of continental Greece (and of the European Union), Southern Mani. The sample (422 individuals, 375 of whom finally participated: 187 men and 188 women, response ratio: 88.86%), was selected between January-December 2006, using stratified randomisation by sex and age. Participants were asked to fill in a validated questionnaire containing socio-demographic data and items about the health needs/level of satisfaction with cardiovascular health and PHC services, as well as two indices for cardiovascular health: i) frequency of international normalised ratio (INR) measurement in case of atrial fibrillation, and ii) history of timely thrombolysis in case of acute myocardial infarction. The majority of the responders stated that their level of satisfaction with PHC services was "low" or "very low" (total: 52.80%), while the percentage of dissatisfaction with cardiovascular health services was 56.0%. In addition, most of the participants expressed a strong wish for improvement of PHC services (71.33%). The level of satisfaction with PHC services was higher than with cardiovascular health services (2.49 +/- 1.26 vs. 2.38 +/- 1.24; p < 0.001). Satisfaction scores for both cardiovascular health and PHC services were negatively associated with the distance from the nearest PHC Unit. Only 11.1% of patients (95% CI: 0.3%-48.2%) reported annual testing of prothrombin time more than once, while among those with a history of acute myocardial infarction, none reported timely thrombolysis (0%, one-sided 97.5% CI: 0%-41.0%). It is evident that a large portion of the Southern Mani population perceives the provided cardiovascular health and PHC services as problematic, while the distance from the nearest PHC unit seems to be one of the most important factors and predictors of dissatisfaction. The provision of efficient PHC services in isolated areas is a matter that should be re-evaluated.

AWSCS-A System to Evaluate Different Approaches for the Automatic Composition and Execution of Web Services Flows

PubMed Central

Tardiole Kuehne, Bruno; Estrella, Julio Cezar; Nunes, Luiz Henrique; Martins de Oliveira, Edvard; Hideo Nakamura, Luis; Gomes Ferreira, Carlos Henrique; Carlucci Santana, Regina Helena; Reiff-Marganiec, Stephan; Santana, Marcos José

2015-01-01

This paper proposes a system named AWSCS (Automatic Web Service Composition System) to evaluate different approaches for automatic composition of Web services, based on QoS parameters that are measured at execution time. The AWSCS is a system to implement different approaches for automatic composition of Web services and also to execute the resulting flows from these approaches. Aiming at demonstrating the results of this paper, a scenario was developed, where empirical flows were built to demonstrate the operation of AWSCS, since algorithms for automatic composition are not readily available to test. The results allow us to study the behaviour of running composite Web services, when flows with the same functionality but different problem-solving strategies were compared. Furthermore, we observed that the influence of the load applied on the running system as the type of load submitted to the system is an important factor to define which approach for the Web service composition can achieve the best performance in production. PMID:26068216

AWSCS-A System to Evaluate Different Approaches for the Automatic Composition and Execution of Web Services Flows.

PubMed

Tardiole Kuehne, Bruno; Estrella, Julio Cezar; Nunes, Luiz Henrique; Martins de Oliveira, Edvard; Hideo Nakamura, Luis; Gomes Ferreira, Carlos Henrique; Carlucci Santana, Regina Helena; Reiff-Marganiec, Stephan; Santana, Marcos José

2015-01-01

This paper proposes a system named AWSCS (Automatic Web Service Composition System) to evaluate different approaches for automatic composition of Web services, based on QoS parameters that are measured at execution time. The AWSCS is a system to implement different approaches for automatic composition of Web services and also to execute the resulting flows from these approaches. Aiming at demonstrating the results of this paper, a scenario was developed, where empirical flows were built to demonstrate the operation of AWSCS, since algorithms for automatic composition are not readily available to test. The results allow us to study the behaviour of running composite Web services, when flows with the same functionality but different problem-solving strategies were compared. Furthermore, we observed that the influence of the load applied on the running system as the type of load submitted to the system is an important factor to define which approach for the Web service composition can achieve the best performance in production.

Long-term environmental effects and flight service evaluation of composite materials

NASA Technical Reports Server (NTRS)

Dexter, H. Benson

1987-01-01

Results of a NASA-Langley sponsored research program to establish the long term effects of realistic flight environments and ground based exposure on advanced composite materials are presented. The effects of moisture, ultraviolet radiation, aircraft fuels and fluids, sustained stress, and fatigue loading are reported. Residual strength and stiffness as a function of exposure time and exposure location are reported for seven different material systems after 10 years of worldwide outdoor exposure. Flight service results of over 300 composite components installed on rotorcraft and transport aircraft are included. Over 4 million total component flight hours were accumulated on various aircraft since initiation of flight service in 1973. Service performance, maintenance characteristics, and residual strength of numerous composite components installed on commercial and military aircraft are reported as a function of flight hours and years in service. Residual strength test results of graphite/epoxy spoilers with 10 years of worldwide service and over 28,000 flight hours are reported.

Hazard perception in emergency medical service responders.

PubMed

Johnston, K A; Scialfa, C T

2016-10-01

The perception of on-road hazards is critically important to emergency medical services (EMS) professionals, the patients they transport and the general public. This study compared hazard perception in EMS and civilian drivers of similar age and personal driving experience. Twenty-nine EMS professionals and 24 non-professional drivers were given a dynamic hazard perception test (HPT). The EMS group demonstrated an advantage in HPT that was independent of simple reaction time, another indication of the validity of the test. These results are also consistent with the view that professional driving experience results in changes in the ability to identify and respond to on-road hazards. Directions for future research include the development of a profession-specific hazard perception tool for both assessment and training purposes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reasons for compliance or noncompliance with advice to test for hepatitis C via an internet-mediated blood screening service: a qualitative study.

PubMed

Zuure, Freke R; Heijman, Titia; Urbanus, Anouk T; Prins, Maria; Kok, Gerjo; Davidovich, Udi

2011-05-10

Hepatitis C virus (HCV) is mainly transmitted by exposure to infected blood, and can lead to liver cirrhosis and liver cancer. Since the onset of HCV and the development of liver cirrhosis usually are asymptomatic, many HCV-infected individuals are still undiagnosed. To identify individuals infected with HCV in the general population, a low threshold, internet-mediated blood testing service was set up. We performed a qualitative study examining reasons for compliance and noncompliance with advice to test for HCV via the online blood testing service. Semistructured telephone interviews were conducted with 33 website visitors who had been advised to test for HCV (18 testers, 15 non-testers). Transcribed interviews were analyzed qualitatively and interpreted using psychosocial theories of health behavior. Reasons for testing pertaining to the online service were: the testing procedure is autonomous, personalized test advice is provided online, reminder emails are sent, and there is an online planning tool. Reasons for testing not specific to the online service were: knowing one's status can prevent liver disease and further transmission of HCV, HCV is curable, testing can provide reassurance, physical complaints are present, and there is liver disease in one's social environment. Service-related reasons for not testing pertained to inconvenient testing facilities, a lack of commitment due to the low threshold character of the service, computer/printing problems, and incorrectly interpreting an online planning tool. The reasons for not testing that are not specific to the online service were: the belief that personal risk is low, the absence of symptoms, low perceived urgency for testing and treatment, fear of the consequences of a positive test result, avoiding threatening information, and a discouraging social environment. Features specific to the online service played a significant role in motivation to test for HCV above and beyond the more conventional perceived health benefits of HCV testing. However, some online specific features were considered problematic and need to be adapted. Methods and strategies for dealing with these impeding factors and for improving compliance with testing via the online service are outlined.

Reasons for compliance or noncompliance with advice to test for hepatitis C via an internet-mediated blood screening service: a qualitative study

PubMed Central

2011-01-01

Background Hepatitis C virus (HCV) is mainly transmitted by exposure to infected blood, and can lead to liver cirrhosis and liver cancer. Since the onset of HCV and the development of liver cirrhosis usually are asymptomatic, many HCV-infected individuals are still undiagnosed. To identify individuals infected with HCV in the general population, a low threshold, internet-mediated blood testing service was set up. We performed a qualitative study examining reasons for compliance and noncompliance with advice to test for HCV via the online blood testing service. Methods Semistructured telephone interviews were conducted with 33 website visitors who had been advised to test for HCV (18 testers, 15 non-testers). Transcribed interviews were analyzed qualitatively and interpreted using psychosocial theories of health behavior. Results Reasons for testing pertaining to the online service were: the testing procedure is autonomous, personalized test advice is provided online, reminder emails are sent, and there is an online planning tool. Reasons for testing not specific to the online service were: knowing one's status can prevent liver disease and further transmission of HCV, HCV is curable, testing can provide reassurance, physical complaints are present, and there is liver disease in one's social environment. Service-related reasons for not testing pertained to inconvenient testing facilities, a lack of commitment due to the low threshold character of the service, computer/printing problems, and incorrectly interpreting an online planning tool. The reasons for not testing that are not specific to the online service were: the belief that personal risk is low, the absence of symptoms, low perceived urgency for testing and treatment, fear of the consequences of a positive test result, avoiding threatening information, and a discouraging social environment. Conclusions Features specific to the online service played a significant role in motivation to test for HCV above and beyond the more conventional perceived health benefits of HCV testing. However, some online specific features were considered problematic and need to be adapted. Methods and strategies for dealing with these impeding factors and for improving compliance with testing via the online service are outlined. PMID:21569224

42 CFR 410.32 - Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Procedural Terminology published by the American Medical Association. (vii) Diagnostic tests performed by a... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.32 Diagnostic x-ray tests, diagnostic laboratory...

42 CFR 410.32 - Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Procedural Terminology published by the American Medical Association. (vii) Diagnostic tests performed by a... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.32 Diagnostic x-ray tests, diagnostic laboratory...

Integrated Information Support System (IISS). Volume 8. User Interface Subsystem. Part 3. User Interface Services Product Specification.

DTIC Science & Technology

1985-11-01

User Interface that consists of a set of callable execution time routines available to an application program for form processing . IISS Function Screen...provisions for test consists of the normal testing techniques that are accomplished during the construction process . They consist of design and code...application presents a form * to the user which must be filled in with information for processing by that application. The application then

A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings

PubMed Central

Blank, Michael B.; Himelhoch, Seth S.; Balaji, Alexandra B.; Metzger, David S.; Dixon, Lisa B.; Rose, Charles E.; Oraka, Emeka; Davis-Vogel, Annet; Thompson, William W.; Heffelfinger, James D.

2014-01-01

Objectives. We estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia, Pennsylvania, and Baltimore, Maryland, January 2009 to August 2011. Methods. We used a multisite, cross-sectional design stratified by clinical setting. We tested 1061 individuals for HIV in university-based inpatient psychiatric units (n = 287), intensive case-management programs (n = 273), and community mental health centers (n = 501). Results. Fifty-one individuals (4.8%) were HIV-infected. Confirmed positive HIV tests were 5.9% (95% confidence interval [CI] = 3.7%, 9.4%) for inpatient units, 5.1% (95% CI = 3.1%, 8.5%) for intensive case-management programs, and 4.0% (95% CI = 2.6%, 6.1%) for community mental health centers. Characteristics associated with HIV included Black race, homosexual or bisexual identity, and HCV infection. Conclusions. HIV prevalence for individuals receiving mental health services was about 4 times as high as in the general population. We found a positive association between psychiatric symptom severity and HIV infection, indicating that engaging persons with mental illness in appropriate mental health treatment may be important to HIV prevention. These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care. PMID:24524493

Do multimedia based information services increase knowledge and satisfaction in head and neck cancer patients?

PubMed

D'Souza, V; Blouin, E; Zeitouni, A; Muller, K; Allison, P J

2013-09-01

To investigate the impact of a Multimode Comprehensive Tailored Information Package (MCTIP) on Head and Neck (H&N) cancer patients' knowledge and satisfaction. A non-randomized controlled trial was conducted at two participating hospitals. One hospital delivered the MCTIP and the second hospital provided normal care. The study was approved by local ethical committees. Patients with Stage III and IV cancer in the H&N region were recruited between their diagnosis and treatment. All participants were evaluated at baseline, 3 and 6months later using the Satisfaction with Cancer Information Profile (SCIP) and a Cancer Knowledge questionnaire. Data were analyzed using descriptive statistics, T tests, chi square tests and finally linear mixed model analyses to test the potential impact of the intervention. A total of 103 participants participated in this study and complete data at all time points were collected for 96. The Test group reported higher levels of Cancer Knowledge and Satisfaction at all time points (p<0.001 with all comparisons) compared to the Control group. Our study demonstrated an association between receiving the multimedia based tailored information and higher levels of satisfaction and cancer knowledge compared to those who receive information in ad hoc manner. Exploring patients' informational needs is necessary before planning information services to them. Copyright © 2013 Elsevier Ltd. All rights reserved.

Consumer Participation in Quality Improvements for Chronic Disease Care: Development and Evaluation of an Interactive Patient-Centered Survey to Identify Preferred Service Initiatives

PubMed Central

Paul, Christine L; Bryant, Jamie; Roos, Ian A; Henskens, Frans A; Paul, David J

2014-01-01

Background With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives. Objective The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score. Methods In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time. Results A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen’s kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. Conclusions The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care. PMID:25532217

Assessing the feasibility of harm reduction services for MSM: the late night breakfast buffet study

PubMed Central

Rose, Valerie J; Raymond, H Fisher; Kellogg, Timothy A; McFarland, Willi

2006-01-01

Background Despite the leveling off in new HIV infections among men who have sex with men (MSM) in San Francisco, new evidence suggests that many recent HIV infections are linked with the use of Methamphetamine (MA). Among anonymous HIV testers in San Francisco, HIV incidence among MA users was 6.3% compared to 2.1% among non-MA users. Of particular concern for prevention programs are frequent users and HIV positive men who use MA. These MSM pose a particular challenge to HIV prevention efforts due to the need to reach them during very late night hours. Methods The purpose of the Late Night Breakfast Buffet (LNBB) was to determine the feasibility and uptake of harm reduction services by a late night population of MSM. The "buffet" of services included: needle exchange, harm reduction information, oral HIV testing, and urine based sexually transmitted infection (STI) testing accompanied by counseling and consent procedures. The study had two components: harm reduction outreach and a behavioral survey. For 4 months during 2004, we provided van-based harm reduction services in three neighborhoods in San Francisco from 1 – 5 a.m. for anyone out late at night. We also administered a behavioral risk and service utilization survey among MSM. Results We exchanged 2000 needles in 233 needle exchange visits, distributed 4500 condoms/lubricants and provided 21 HIV tests and 12 STI tests. Fifty-five MSM enrolled in the study component. The study population of MSM was characterized by low levels of income and education whose ages ranged from 18 – 55. Seventy-eight percent used MA in the last 3 months; almost 25% used MA every day in the same time frame. Of the 65% who ever injected, 97% injected MA and 13% injected it several times a day. MA and alcohol were strong influences in the majority of unprotected sexual encounters among both HIV negative and HIV positive MSM. Conclusion We reached a disenfranchised population of MA-using MSM who are at risk for acquiring or transmitting HIV infection through multiple high risk behaviors, and we established the feasibility and acceptability of late night harm reduction for MSM and MSM who inject drugs. PMID:17018154

HIV counseling and testing practices among clients presenting at a market HIV clinic in Kampala, Uganda: a cross-sectional study.

PubMed

Matovu, Joseph Kb; Bukuluki, Paul W; Mafigiri, David K; Mudondo, Harriet

2017-09-01

Uptake of HIV counseling and testing (HCT) among informal sector workers is not well documented. To assess HCT practices among clients presenting for HIV services at a market HIV clinic in Kampala, Uganda. Between August 1 and September 15, 2009, clients presenting for HIV services at a market HIV clinic were invited to participate in the study. Socio-demographic and HCT data were collected from consenting adults aged 16+ years. Descriptive statistics were performed using STATA version 14.1. Of 224 individuals who consented to the interview, n=139 62 % were market vendors while n=85 38 % were engaged in other market-related activities. Majority of the respondents, n=165, 73.7 %, had ever tested for HIV; of these, n=148,89.7 % had ever tested for 2+ times. The main reasons for repeat testing were the need to confirm previous HIV test results, n=126, 85.1% and the belief that the previous HIV test results were false, n=35, 23.6 %. Uptake of couples' HCT was low, n=63, 38.2 %, despite the fact that n=200, 89 % had ever heard of couples' HCT. These findings indicate high rates of repeat testing but low rates of couples' HCT uptake in this population.

Communication latencies of Apple push notification messages relevant for delivery of time-critical information to anesthesia providers.

PubMed

Rothman, Brian S; Dexter, Franklin; Epstein, Richard H

2013-08-01

Tablet computers and smart phones have gained popularity in anesthesia departments for educational and patient care purposes. VigiVU(™) is an iOS application developed at Vanderbilt University for remote viewing of perioperative information, including text message notifications delivered via the Apple Push Notification (APN) service. In this study, we assessed the reliability of the APN service. Custom software was written to send a message every minute to iOS devices (iPad(®), iPod Touch(®), and iPhone(®)) via wireless local area network (WLAN) and cellular pathways 24 hours a day over a 4-month period. Transmission and receipt times were recorded and batched by days, with latencies calculated as their differences. The mean, SEM, and the exact 95% upper confidence limits for the percent of days with ≥1 prolonged (>100 seconds) latency were calculated. Acceptable performance was defined as mean latency <30 seconds and ≤0.5% of latencies >100 seconds. Testing conditions included fixed locations of devices in high signal strength locations. Mean latencies were <1 second for iPad and iPod devices (WLAN), and <4 seconds for iPhone (cellular). Among >173,000 iPad and iPod latencies, none were >100 seconds. For iPhone latencies, 0.03% ± 0.01% were >100 seconds. The 95% upper confidence limits of days with ≥1 prolonged latency were 42% (iPhone) and 5% to 8% (iPad, iPod). The APN service was reliable for all studied devices over WLAN and cellular pathways, and performance was better than third party paging systems using Internet connections previously investigated using the same criteria. However, since our study was a best-case assessment, testing is required at individual sites considering use of this technology for critical messaging. Furthermore, since the APN service may fail due to Internet or service provider disruptions, a backup paging system is recommended if the APN service were to be used for critical messaging.

Comparing performance of multinomial logistic regression and discriminant analysis for monitoring access to care for acute myocardial infarction.

PubMed

Hossain, Monir; Wright, Steven; Petersen, Laura A

2002-04-01

One way to monitor patient access to emergent health care services is to use patient characteristics to predict arrival time at the hospital after onset of symptoms. This predicted arrival time can then be compared with actual arrival time to allow monitoring of access to services. Predicted arrival time could also be used to estimate potential effects of changes in health care service availability, such as closure of an emergency department or an acute care hospital. Our goal was to determine the best statistical method for prediction of arrival intervals for patients with acute myocardial infarction (AMI) symptoms. We compared the performance of multinomial logistic regression (MLR) and discriminant analysis (DA) models. Models for MLR and DA were developed using a dataset of 3,566 male veterans hospitalized with AMI in 81 VA Medical Centers in 1994-1995 throughout the United States. The dataset was randomly divided into a training set (n = 1,846) and a test set (n = 1,720). Arrival times were grouped into three intervals on the basis of treatment considerations: <6 hours, 6-12 hours, and >12 hours. One model for MLR and two models for DA were developed using the training dataset. One DA model had equal prior probabilities, and one DA model had proportional prior probabilities. Predictive performance of the models was compared using the test (n = 1,720) dataset. Using the test dataset, the proportions of patients in the three arrival time groups were 60.9% for <6 hours, 10.3% for 6-12 hours, and 28.8% for >12 hours after symptom onset. Whereas the overall predictive performance by MLR and DA with proportional priors was higher, the DA models with equal priors performed much better in the smaller groups. Correct classifications were 62.6% by MLR, 62.4% by DA using proportional prior probabilities, and 48.1% using equal prior probabilities of the groups. The misclassifications by MLR for the three groups were 9.5%, 100.0%, 74.2% for each time interval, respectively. Misclassifications by DA models were 9.8%, 100.0%, and 74.4% for the model with proportional priors and 47.6%, 79.5%, and 51.0% for the model with equal priors. The choice of MLR or DA with proportional priors, or DA with equal priors for monitoring time intervals of predicted hospital arrival time for a population should depend on the consequences of misclassification errors.

MACHINING TEST SPECIMENS FROM HARVESTED ZION RPV SEGMENTS

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

Nanstad, Randy K; Rosseel, Thomas M; Sokolov, Mikhail A

2015-01-01

The decommissioning of the Zion Nuclear Generating Station (NGS) in Zion, Illinois, presents a special and timely opportunity for developing a better understanding of materials degradation and other issues associated with extending the lifetime of existing nuclear power plants (NPPs) beyond 60 years of service. In support of extended service and current operations of the US nuclear reactor fleet, the Oak Ridge National Laboratory (ORNL), through the Department of Energy (DOE), Light Water Reactor Sustainability (LWRS) Program, is coordinating and contracting with Zion Solutions, LLC, a subsidiary of Energy Solutions, an international nuclear services company, the selective procurement of materials,more » structures, components, and other items of interest from the decommissioned reactors. In this paper, we will discuss the acquisition of segments of the Zion Unit 2 Reactor Pressure Vessel (RPV), cutting these segments into blocks from the beltline and upper vertical welds and plate material and machining those blocks into mechanical (Charpy, compact tension, and tensile) test specimens and coupons for microstructural (TEM, SEM, APT, SANS and nano indention) characterization. Access to service-irradiated RPV welds and plate sections will allow through wall attenuation studies to be performed, which will be used to assess current radiation damage models [1].« less

Methods developed to elucidate nursing related adverse events in Japan.

PubMed

Yamagishi, Manaho; Kanda, Katsuya; Takemura, Yukie

2003-05-01

Financial resources for quality assurance in Japanese hospitals are limited and few hospitals have quality monitoring systems of nursing service systems. However, recently its necessity has been recognized. This study has cost effectively used adverse event occurrence rates as indicators of the quality of nursing service, and audited methods of collecting data on adverse events to elucidate their approximate true numbers. Data collection was conducted in July, August and November 2000 at a hospital in Tokyo that administered both primary and secondary health care services (281 beds, six wards, average length of stay 23 days). We collected adverse events through incident reports, logs, check-lists, nurse interviews, medication error questionnaires, urine leucocyte tests, patient interviews and medical records. Adverse events included the unplanned removals of invasive lines, medication errors, falls, pressure sores, skin deficiencies, physical restraints, and nosocomial infections. After evaluating the time and useful outcomes of each source, it soon became clear that we could elucidate adverse events most consistently and cost-effectively through incident reports, check lists, nurse interviews, urine leucocyte tests and medication error questionnaires. This study suggests that many hospitals in Japan could monitor the quality of the nursing service using these sources.

Effects of antenatal care and HIV treatment integration on elements of the PMTCT cascade: Results from the SHAIP cluster-randomized controlled trial in Kenya

PubMed Central

Turan, Janet M.; Onono, Maricianah; Steinfeld, Rachel L.; Shade, Starley B.; Owuor, Kevin; Washington, Sierra; Bukusi, Elizabeth A.; Ackers, Marta L.; Kioko, Jackson; Interis, Evelyn C.; Cohen, Craig R.

2015-01-01

Background Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. The current study aimed to determine if integration of HIV services into ANC settings improves PMTCT service utilization outcomes. Methods ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or non-integrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), while control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. Results HIV care enrollment was higher in intervention compared to control clinics (69% versus 36%, Odds Ratio (OR)=3.94, 95% Confidence Interval (CI): 1.14–13.63). Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, Hazard Ratio (HR)=2.20, 95% CI: 1.62–3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%, OR=3.22, 95% CI: 1.81–5.72). Infant testing was more common in the intervention arm (25% versus 18%), however not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Conclusions Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions. PMID:25967269

Application of teledentistry in oral medicine in a community dental service, N. Ireland.

PubMed

Bradley, M; Black, P; Noble, S; Thompson, R; Lamey, P J

2010-10-23

Currently, patients with oral medicine conditions from all areas of Northern Ireland are referred by dentists and doctors to a small number of specialist services: predominantly, the Regional Oral Medicine Consultant at the School of Dentistry, Belfast. On receipt of the referral the consultant makes an assessment of the urgency of the case and the patient is placed on a waiting list. Until the recent implementation of waiting list initiatives (Elective Access Protocol, Department of Health, N. Ireland, 2006), patients remained on the waiting list for long periods of time. Analysis of these patient profiles highlights that many need both multiple treatment and review appointments of their chronic conditions, and consequently remain in the hospital system for significant periods of time. This increases the waiting time for these services. The idea of using teledentistry to triage referrals, and its potential as a tool to support locally based treatment, poses an alternative approach to the management of oral medicine referrals. It may be of particular interest to practitioners in rural locations where distance from the regional centre is significant. In 2005, to test this theory, a prototype teledentistry system was set up as part of a service improvement scheme by the Community Dental Service of the Homefirst Legacy Trust (now Northern Trust) in partnership with the Oral Medicine Department at the School of Dentistry, Royal Group of Hospitals Legacy Trust (now Belfast Trust). This paper describes the feasibility study.

Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study

PubMed Central

2010-01-01

Introduction In 2004, Mozambique, supported by large increases in international disease-specific funding, initiated a national rapid scale-up of antiretroviral treatment (ART) and HIV care through a vertical "Day Hospital" approach. Though this model showed substantial increases in people receiving treatment, it diverted scarce resources away from the primary health care (PHC) system. In 2005, the Ministry of Health (MOH) began an effort to use HIV/AIDS treatment and care resources as a means to strengthen their PHC system. The MOH worked closely with a number of NGOs to integrate HIV programs more effectively into existing public-sector PHC services. Case Description In 2005, the Ministry of Health and Health Alliance International initiated an effort in two provinces to integrate ART into the existing primary health care system through health units distributed across 23 districts. Integration included: a) placing ART services in existing units; b) retraining existing workers; c) strengthening laboratories, testing, and referral linkages; e) expanding testing in TB wards; f) integrating HIV and antenatal services; and g) improving district-level management. Discussion: By 2008, treatment was available in nearly 67 health facilities in 23 districts. Nearly 30,000 adults were on ART. Over 80,000 enrolled in the HIV/AIDS program. Loss to follow-up from antenatal and TB testing to ART services has declined from 70% to less than 10% in many integrated sites. Average time from HIV testing to ART initiation is significantly faster and adherence to ART is better in smaller peripheral clinics than in vertical day hospitals. Integration has also improved other non-HIV aspects of primary health care. Conclusion The integration approach enables the public sector PHC system to test more patients for HIV, place more patients on ART more quickly and efficiently, reduce loss-to-follow-up, and achieve greater geographic HIV care coverage compared to the vertical model. Through the integration process, HIV resources have been used to rehabilitate PHC infrastructure (including laboratories and pharmacies), strengthen supervision, fill workforce gaps, and improve patient flow between services and facilities in ways that can benefit all programs. Using aid resources to integrate and better link HIV care with existing services can strengthen wider PHC systems. PMID:20180975

Joint Ordnance Test Procedure (JOTP)-010 Safety and Suitability for Service Assessment Testing for Shoulder Launched Munitions

DTIC Science & Technology

2016-05-09

electromagnetic environment for which they are designed to be used. These tests are performed on a powered weapon during simulated normal operation and are...010B SAFETY AND SUITABILITY FOR SERVICE ASSESSMENT TESTING FOR SHOULDER LAUNCHED MUNITIONS Joint Services Munition Safety Test Working Group JOTP...12 6.8 Test Sample Quantities .......................................................... 13 7. PRE- AND POST - TEST INSPECTIONS